Home | About us | Editorial board | Search | Ahead of print | Current issue | Archives | Submit article | Instructions| Reviewers

Login 
  Home Print this page Email this page Small font sizeDefault font sizeIncrease font size Users Online: 1093    
     


 
Table of Contents   
CASE REPORT
Year : 2019  |  Volume : 9  |  Issue : 1  |  Page : 94-98
Esthetic clasp cast partial denture


1 Department of Prosthodontics, Faculty of Dentistry, AIMST University, Semeling, 08100 Bedong, Malaysia
2 Department of Periodontics, Faculty of Dentistry, AIMST University, Semeling, 08100 Bedong, Malaysia
3 Department of Dental Materials, Faculty of Dentistry, AIMST University, Semeling, 08100 Bedong, Malaysia
4 Department of Endodontics, Faculty of Dentistry, AIMST University, Semeling, 08100 Bedong, Malaysia
5 Department of Public Health Dentistry, Faculty of Dentistry, AIMST University, Semeling, 08100 Bedong, Malaysia

Date of Submission17-Jun-2018
Date of Acceptance21-Aug-2018
Date of Web Publication14-Feb-2019

Correspondence Address:
Dr. Neeraja Turagam
Faculty of Dentistry, AIMST University, Semeling, 08100 Bedong
Malaysia
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jispcd.JISPCD_220_18

Rights and Permissions

   Abstract 

Denture esthetics as defined by Glossary of prosthodontics terms the effect produced by a dental prosthesis that affects the beauty and attractiveness of the person.[1] Removable partial dentures (RPDs) are the widely accepted and treatment of choice for most cases as it is both effective and affordable. Partially edentulous treatment planning includes both esthetics and masticatory function. A prosthesis that is highly esthetic will improve patient's motivation and acceptance. It is a very wrong notion to expect that patients will tolerate unesthetic partial dentures because good masticatory capability has been achieved. Esthetics plays a vital role in the success of partial dentures, and the length and mobility of the patient's lips play a significant role in achieving it.[2] Patients with short lips or highly mobile lips pose problems as esthetics are compromised because most clasp arms, denture borders, and other components will show when the patient smiles or speaks.[3] RPDs can easily look artificial; hence, special emphasis should aim toward restoring function, phonetics, esthetics with a long-term benefits which requires meticulous attention during fabrication. This case reports is an esthetic clasp designed for a cast partial denture for a young girl for esthetic and function.


Keywords: Esthetic clasp, cast partial denture, clasp, high lip line, low lip line, tooth colored


How to cite this article:
Turagam N, Mudrakola DP, Yelamanchi RS, Deepthi M, Natarajan M. Esthetic clasp cast partial denture. J Int Soc Prevent Communit Dent 2019;9:94-8

How to cite this URL:
Turagam N, Mudrakola DP, Yelamanchi RS, Deepthi M, Natarajan M. Esthetic clasp cast partial denture. J Int Soc Prevent Communit Dent [serial online] 2019 [cited 2019 Mar 24];9:94-8. Available from: http://www.jispcd.org/text.asp?2019/9/1/94/252258



   Introduction Top


It is very unfortunate for patients to lose their teeth at a very young age. The reasons and factors for tooth loss may vary, but the emotional turmoil they go through is very similar. In partially edentulous conditions, implants have become a treatment of choice for the doctors for their patients over removable prosthesis but the various other factors such as anatomic, physiological, psychological, medical, and financial considerations of the patients being the reasons for deciding on the type of removable prosthesis. Removable partial dentures (RPDs) are the most cost-effective and best treatment option for partial edentulism[3] but patients are concerned about the metal exposure in cast partial dentures and hence worried about the esthetic appearance.[4],[5]

Removable cast partial dentures are considered as definitive removable prostheses, but the location of clasps may affect esthetics. Hence, when the patient is more concerned about esthetics and appearance, flexible partial dentures which are esthetically superior to flipper and cast partial dentures may be considered as a treatment of choice. However, for the success of flexible RPD, proper diagnosis, treatment planning, and insertion technique of this prosthesis is very important which may not be accepted by the patients because of the cost of the material. Hence, this case report clears all the concerns of the patients with esthetic clasps located in various esthetically concerned areas which achieve excellent esthetic outcomes on appearance.[6] Dissatisfaction of dentures was related mainly to age, health, prior experience with a prosthesis, and the type of opposing dentition and esthetics[7],[8] Failure to recognize patient expectations can lead to noncompliance and failure of treatment.

Most patients refuse to wear the cast partial dentures due to esthetic reasons, and the treatment is therefore deemed unsuccessful. Unsuccessful treatment rate for clasp retained cast RPDs ranges from 3% to 40% (mean 26%).[8] When so many patients do not comply with treatment, it is instructive to reflect on why and how the treatment is performed.

This case report mainly emphasizes the esthetic considerations during planning and fabrication of cast partial dentures. The dentist must be able to follow all the clinical considerations to achieve superior esthetic outcomes to reach the patient's realistic expectations. Esthetic RPD planning includes proper diagnosis, treatment planning followed by execution of the laboratory steps such as surveying, mouth preparation, framework designing, placement of various components, denture base and teeth.[9]


   Case Report Top


A 22-year-old female patient reported with the chief complaint of replacing missing teeth in the lower jaw [Figure 1]. The patient was very young and was a mixed diet consumer, which demanded a restoration which improves the appearance and masticatory efficiency. Medical history was not significant. Dental history recorded a loss of mandibular right 1st and 2nd molars (46, 47) and left first molar (36) due to caries. However, the space needed for replacing 36 was more than required due to the physiological migration of teeth. The whole set of maxillary teeth were intact. Intraoral examination revealed this dentate situation as Kennedy Class II mod 1 based on Kennedy's classification.
Figure 1: Intraoral preoperative

Click here to view


Social, drug, and history of habits were not significant. Extraoral examination disclosed a high lip line and a broad smile showing up to the molars. A detailed examination revealed oral hygiene was satisfactory and her periodontal condition for all remaining teeth was good. Diagnosis and treatment plan was done after radiographic investigations and a diagnostic mounting on a semi-adjustable articulator. After presenting different treatment options, the patient opted for a cast partial denture in relation to mandibular arch.

Diagnostic models were analyzed, and surveying was done on a dental cast surveyor. The four principal factors were evaluated, namely the path of insertion and removal, esthetics, interferences, and guiding planes.[4],[10],[11] After evaluating the condition Cast partial denture was decided as the treatment plan. The denture design had been planned as Lingual bar as major connector as the lingual sulcus depth was more than 8 mm when measured. Surveying of the cast was done using the surveyor, and according to the favorable undercuts circumferential clasps with mesial rest on 37, 45 and circumferential clasp with distal rest on 35 has been planned. Mockup mouth preparations were done on the diagnostic models and the desired mouth preparations were executed in the patient's mouth and final impressions were made with putty and light body and monophase polyvinyl siloxane impression material (Aquasil Elastomer Impression Material, Dentsply, Germany). The casts were then poured using die stone (Ultrarock). Surveying the master cast was done, the unfavorable undercuts were blocked, and refractory casts was fabricated using phosphate bonded investment material. Wax pattern were contoured using preformed wax patterns. The refractory model with the wax pattern was invested, and casting procedure was carried out. Finishing and polishing were done in the conventional manner. The metal framework was tried in the patients' mouth for accurate adaptation. The occlusal rim was made and teeth setting was done and to check for proper alignment and tried again.

Once curing was done in the conventional way, and the final prosthesis was issued, the patient was extremely satisfied with the fit and esthetics [Figure 2]. The patient was put on a strict follow-up protocol for 1 month during which she adapted well to the prosthesis. The patient was highly satisfied as there was no metal exposure of the clasps and the tooth-colored clasps masked the artificial appearance, and the young patient was happy with the esthetic outcome [Figure 3], [Figure 4], [Figure 5], [Figure 6]. A 3-month and 6-month follow-up was done the esthetics, function and did not show any sign of looseness and the patient was very satisfied.
Figure 2: Intraoral try in of esthetic clasp cast partial denture

Click here to view
Figure 3: Esthetic clasp on cast

Click here to view
Figure 4: Cast partial denture intraoral with bilateral occlusion

Click here to view
Figure 5: Left lateral

Click here to view
Figure 6: Right Lateral

Click here to view


Material used for esthetics

The traditional use of the conventional metal clasps such as cobalt-chromium (Co-Cr), gold, stainless steel, and titanium damages esthetics due to display in the oral cavity which hampers the patient's self-esteem. Acetal resin (polyoxymethylene [POM]), a thermoplastic resin, may be used as an alternative denture clasp material. Acetal was first proposed as an unbreakable thermoplastic resin RPD material in 1971. These injection molded resins were promoted mainly on its ability for superior esthetics, which allowed the clasps to better match the color of abutment tooth.

POM materials formed by polymerizing formaldehyde where the homopolymer is a chain of alternating methyl groups linked to each other by an oxygen molecule. Acetal as a homopolymer has good short-term mechanical properties, but as a copolymer has better long-term stability. This may be used as an alternative denture clasp material.[12] Acetal resin had increased strength, resistance to wear and fracture flexible, high creep resistance and high fatigue endurance, being hydrophobic to water or saliva. All these characteristics make it an ideal material for preformed clasps for partial dentures, single-pressed unilateral partial dentures, partial denture frameworks, provisional bridges, occlusal splints, and even implant abutments.[13]


   Discussion Top


Agerberg and Carlsson reported that cosmetics and esthetics was the primary reason for prosthodontic treatment expressed by patients, with improved mastication being the second-most common reason.[10] The demonstration of clasps by means of photographs and models is done along with the planning of clasp placement after surveying. According to Kapur et al., two principal designs for distal extension partial dentures are Rest, Proximal Plate, I Bar (RPI) concept and circumferential design which did not differ in terms of success rates, maintenance care, and effects on abutment teeth in their randomized clinical trial. Care has to be taken during designing the symmetry of clasp assemblies, in both the maxillary and mandibular arches is crucial for esthetic reasons.[11] Numerous patients fail to wear the partial dentures as they find the display of clasp assemblies esthetically unacceptable.[5],[12] Clasps are used as direct retainers for the RPD. The flexible clasp tip engages the undercut of the abutment to provide retention.[7],[14],[15] Ideally, the clasp assembly must not impact the esthetics adversely, but the location of clasps, clasp type, clasps material, clasp location in the dentition and the number of clasps plays a crucial role. Clasps fabricated with cast chromium covers larger areas of the tooth resulting in more metal to be displayed.[7] Esthetic CPD eliminates the metal display by utilizing desirable undercuts. The engaging action of the framework into these undercuts paves way for a rotational motion to seat the remaining prosthesis. Hence, the dual path of insertion helps eliminating the anterior clasp.[16] A prototype nonmetal clasp denture could be fabricated using CAD/CAM technology.[17] The CAM clasp made by repeated laser sintering and high-speed milling can be used effectively as an RPD component.[18] Technopolymer clasps have been developed for overcoming the esthetic concerns of cast partial dentures[19] They are manufactured from thermoplastic acetal resin (POM) material with a highly crystalline structure which ensures high transverse strength, greater flexibility, and radiolucency. Esthetics constitutes its major advantage as several tooth shades are available for use anteriorly, but long-term studies still need to be conducted.[19]

Acetal resin clasps can be used in larger and deeper undercuts than recommended for chromium-cobalt alloy due to their low modulus of elasticity which also exerts minimal stresses on abutment teeth. In clinical situations, where esthetics and periodontal health are priorities, this may be advantageous.

Acetal resin provides much lesser retention compared to chrome cobalt. Hence, further study has to be carried out for various thicknesses and designs of clasps and framework for its successful dental application.[20]


   Conclusion Top


Currently, RPDs are a treatment of choice for most patients. The aim is not only toward restoring function and phonetics but should also special emphasis should be on restoring esthetics with long-term benefits which require meticulous attention during planning and fabrication. Patient experience and expectations need to be constituted before treatment, as components of the cast partial denture may be visible which may not be acceptable to the patients. In view of the importance of esthetics, creative clasp design offers the possibility of reducing the visibility of clasp assemblies, rendering them more acceptable to the patient. Reports show that acetyl resin has high impact strength and are highly resistant to organic solvents. The modification technique followed in the treatment of this patient to improve esthetics is a simple but yet effective treatment plan for providing an optimum treatment for an individual.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
The glossary of prosthodontic terms: Ninth edition. J Prosthet Dent 2017;117:e1-105.  Back to cited text no. 1
    
2.
De Rossi A, Albuquerque RF Jr., Bezzon OL. Esthetic options for the fabrication of removable partial dentures: A clinical report. J Prosthet Dent 2001;86:465-7.  Back to cited text no. 2
    
3.
Shah R, Aras M. Esthetics in removable partial denture – A review. Kathmandu Univ Med J (KUMJ) 2013;11:344-8.  Back to cited text no. 3
    
4.
Cowan RD, Gilbert JA, Elledge DA, McGlynn FD. Patient use of removable partial dentures: Two- and four-year telephone interviews. J Prosthet Dent 1991;65:668-70.  Back to cited text no. 4
    
5.
Donovan TE, Derbabian K, Kaneko L, Wright R. Esthetic considerations in removable prosthodontics. J Esthet Restor Dent 2001;13:241-53.  Back to cited text no. 5
    
6.
Beaumont AJ Jr. An overview of esthetics with removable partial dentures. Quintessence Int 2002;33:747-55.  Back to cited text no. 6
    
7.
Frank RP, Milgrom P, Leroux BG, Hawkins NR. Treatment outcomes with mandibular removable partial dentures: A population-based study of patient satisfaction. J Prosthet Dent 1998;80:36-45.  Back to cited text no. 7
    
8.
Kokich VO Jr., Kiyak HA, Shapiro PA. Comparing the perception of dentists and lay people to altered dental esthetics. J Esthet Dent 1999;11:311-24.  Back to cited text no. 8
    
9.
McGivney GP, Carr AB. McCracken's Removable Partial Prosthodontics. 10th ed. St. Louis: Mosby Year-Book; 2000. p. 206-7.  Back to cited text no. 9
    
10.
Agerberg G, Carlsson GE. Chewing ability in relation to dental and general health. Analyses of data obtained from a questionnaire. Acta Odontol Scand 1981;39:147-53.  Back to cited text no. 10
    
11.
Kapur KK, Deupree R, Dent RJ, Hasse AL. A randomized clinical trial of two basic removable partial denture designs. Part I: Comparisons of five-year success rates and periodontal health. J Prosthet Dent 1994;72:268-82.  Back to cited text no. 11
    
12.
Fitton JS, Davies EH, Howlett JA, Pearson GJ. The physical properties of a polyacetal denture resin. Clin Mater 1994;17:125-9.  Back to cited text no. 12
    
13.
Phoenix RD, Mansueto MA, Ackerman NA, Jones RE. Evaluation of mechanical and thermal properties of commonly used denture base resins. J Prosthodont 2004;13:17-27.  Back to cited text no. 13
    
14.
Owen CP. Fundamentals of Removable Partial Denture. 2nd ed. Cape Town: UCT Press; 2000. p. 41.  Back to cited text no. 14
    
15.
Sato Y, Hosokawa R. Proximal plate in conventional circumferential cast clasp retention. J Prosthet Dent 2000;83:319-22.  Back to cited text no. 15
    
16.
Sharma D, Bhat BS, Arora H. Restoring anterior aesthetics by a rotational path cast partial denture: An overlooked technique. J Clin Diagn Res 2016;10:ZD11-3.  Back to cited text no. 16
    
17.
Takahashi Y, Hamanaka I, Isshi K. CAD/CAM-fabricated nonmetal clasp denture:In vitro pilot study. Int J Prosthodont 2017;30:277-9.  Back to cited text no. 17
    
18.
Nakata T, Shimpo H, Ohkubo C. Clasp fabrication using one-process molding by repeated laser sintering and high-speed milling. J Prosthodont Res 2017;61:276-82.  Back to cited text no. 18
    
19.
Davenport JC, Basker RM, Heath JR, Ralph JP, Glantz PO. Retention. Br Dent J 2000;189:646-57.  Back to cited text no. 19
    
20.
Takabayashi Y. Characteristics of denture thermoplastic resins for non-metal clasp dentures. Dent Mater J 2010;29:353-61.  Back to cited text no. 20
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]



 

Top
Print this article  Email this article
 
  Search
 
  
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Article in PDF (1,383 KB)
    Citation Manager
    Access Statistics
    Reader Comments
    Email Alert *
    Add to My List *
* Registration required (free)  


    Abstract
   Introduction
   Case Report
   Discussion
   Conclusion
    References
    Article Figures

 Article Access Statistics
    Viewed161    
    Printed3    
    Emailed0    
    PDF Downloaded36    
    Comments [Add]    

Recommend this journal