Removable partial dentures:

eliminating retainers in the anterior zone1

Prótesis parcial removible: eliminación de retenedores en la zona anterior1
Christian Rochefort Quiroz2, Constanza González3, Danilo Ocaranza4, Diego Muñoz Rivera5
ORIGINAL ARTICLES

1
This study was sponsored by the Prosthesis Department. School of Dentistry, Universidad de Chile
2
Specialist in Oral Rehabilitation. Universidad de Chile. ORCID: 0000-0001-5285-9982
3
Specialist in Periodontics. Isapre Fundación. ORCID: 0000-0001-7591-9263
4
M. Ed., Universidad de Chile. ORCID: 0000-0002-1222-8964
5
DDS. Assistant in the Prosthesis Department. School of Dentistry, Universidad de Chile. ORCID: 0000-0002-2567-404X
Abstract
Introduction: one of the main factors for discomfort in users of removable partial prosthesis is the presence of
visible retainers in the anterior zone. In Kennedy Class III arches, that is, exclusively dental loading pathways
(in which the functional forces reach their final receptor: the alveolar bone), anterior zone retainers may be
eliminated by selecting an appropriate prosthetic insertion and removal axis, and mainly by carving guiding
planes that should provide retention by mechanical rubbing. This in vitro experimental study aimed to prove
the hypothesis that it is possible to obtain functional retention in a dental-loading pathway removable partial
prosthesis without using retainers in the anterior zone. Methods: 7 maxillary models with different types of
toothless process were used. As a common characteristic, they all were classified as Kennedy Class III with
partial denture arches. A Cr-Co metallic base was built for each model according to their clinical situation.
Keywords: Their design allowed them to be exposed to traction in a universal traction machine (Tinius Olsen H5K-S).
dental esthetics, Results: the proposed hypothesis was confirmed as expected. The traction force needed to displace the
metallic elements, metallic bases with retainers in the anterior zone was 16.93 Newton in average. On the other hand,
retention, prosthetic the metallic bases without retainers in the anterior zone showed an average of 12.84 N. The average values
displacement, obtained for both groups are higher than those reported in the literature (4.903 N). Conclusions: in Class III
visibility removable partial dentures it is possible to use metallic bases with no retainers in the anterior zone.
Resumen
Introducción: un factor que incomoda a los usuarios de prótesis parciales removibles es la presencia de
retenedores visibles en la zona anterior. En clases III de Kennedy, es decir, vías de carga exclusivamente
dentarias, sería posible eliminar los retenedores del sector anterior mediante un adecuado tallado de planos
guías que brinde retención por roce mecánico y la elección de un eje de inserción y remoción protésico. Este
trabajo es un diseño experimental in vitro que tiene por finalidad validar la hipótesis propuesta por nuestro
equipo de investigación, que es posible obtener retención funcional en una prótesis parcial removible de vía
de carga dentaria sin utilizar retenedores en el sector anterior. Métodos: se utilizaron 7 modelos maxilares
en yeso tipo IV, con distinto tipo de desdentamiento, cuya característica común era que correspondían
a clases III de Kennedy de arcos parcialmente desdentados. A cada modelo se le confeccionó una base
metálica de Cr-Co, de acuerdo con sus características clínicas individuales, las cuales presentaron un
Palabras claves: diseño que permitió utilizarlas en una máquina de tracción universal para someterlas a fuerzas de tracción.
estética dental, Resultados: la fuerza de tracción necesaria para desalojar las bases metálicas que contaban con retenedores
elementos en el sector anterior fue del orden de 16,93 N en promedio. En cambio, las bases metálicas sin retenedores en el
metálicos, sector anterior presentaron un valor promedio para su desalojo de 12,84 N. Conclusiones: los valores
retención, desalojo promedio obtenidos para ambos grupos son superiores a los que se señala en la literatura (4,903 N) como
protésico, visibilidad válidos para una retención adecuadamente funcional para una prótesis parcial removible.
Submitted: June 11/2017 – Accepted: April 14/2020

How to quote this article: Rochefort-Quiroz C, González C, Ocaranza D, Muñoz-Rivera D. Removable

partial dentures: eliminating retainers in the anterior zone. Rev Fac Odontol Univ Antioq. 2020; 32(1):
26-35. DOI: http://dx.doi.org/10.17533/udea.rfo.v32n1a3

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 Removable partial dentures: eliminating retainers in the anterior zone

INTRODUCTION stability and prosthetic support, patients will

accept poor esthetic appearance.1,3
Rehabilitation with removable partial pros-
thesis facilitates treatment and the subse- This study aims to find a possible solution to
quent resolution of the patients’ complex one of the most used dental treatments in the
clinical problems, such as large toothless Chilean population.16 Certainly, the biggest
spaces and absence of distal parts, or even challenge is how to better deal with the es-
the recovery of occlusal vertical dimension thetic aspect of a removable partial prosthe-
due to tooth loss (collapse) in the posterior sis without affecting its functionality, especial-
occlusal table. This requires performing the ly the retentive capacity. In short, this in vitro
entire treatment in a relatively short time study suggests that by achieving adequate
and at a substantially lower operational cost parallelism of the guiding planes in biome-
compared to other treatment modalities.1 chanical preparation, there will be no loss of
However, dissatisfaction has been observed functional retention when removing anterior
in a considerable number of patients with retainers in Kennedy Clasification type III.
this type of dental prosthesis.
The design and development of removable METHODS
partial prostheses often involves the use
of retainers for direct retention. These can Operational definitions: this is an in vitro
have various disadvantages, favoring the study
appearance of bacterial plaque accumulation
Presence/absence of anterior retainers
sites, the risk of abrasion of tooth surfaces
that are in close contact with each other, and This categorizes the presence or absence
the deformation of the prosthetic structure of anterior retaining clasps of the retaining
over time. In addition, prosthetic appearance systems, dividing them into two classes:
has often been reported as a key element denture bases with anterior retainers and
in patient’s acceptance of removable partial bases with no anterior retainers. It is therefore
prosthetic rehabilitation.4,5,6 The appearance a categorical variable.
of removable partial prostheses is highly
important to patients, and the structures that Type of anterior attachments
are visible when opening the mouth are a
An evaluation was conducted, classifying
common cause of rejection.2
attachments into two groups: attachments
A critical analysis by Santana et al reveals that of the same type if the same type of part
dissatisfaction can be avoided in most cases is found on both sides of the arcade, and
if prostheses are made in such a way that the attachments of different type if they differ
basic functional requirements are addressed from each other on both sides of the arcade.
with minimal exposure during mastication
and phonation, incorporating patient’s Retention
aesthetic demands, which are usually The retention value on each denture base
disregarded.2 It is unrealistic to assume was assessed as the maximum tensile
that by achieving an acceptable chewing strength obtained in each evaluation, which
capacity and therefore adequate retention, is a force value recorded in Newton as an
international unit.

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 Removable partial dentures: eliminating retainers in the anterior zone

Type of edentulism the design and processing of prostheses,

used to determine, create and confirm
Seven edentulism types were determined,
the parallelism of two or more surfaces)
with the most being Kennedy Class III subdi-
in order to identify the guiding planes as
vision 1, with anterior abutments correspon-
well as prosthetic and dental equators. This
ding to first premolars and/or canines, and a
design was also modified in the prosthetic
toothless area delimited at the most by a se-
site area, where two metal washers were
cond molar as a posterior abutment. symmetrically located, one per side, in the
Sample collection center of each void. This was done to make
sure that the traction tests were correctly
To carry out the proposed study, 7 ideal performed.
maxillary models with different levels of
partial tooth loss were obtained in dental Each model was individually analyzed on
plaster type IV, based on a silicone pattern. the surveyor to determine the most suitable
insertion and removal axis, establish the
The abutment pieces were replaced on
location of the model’s elements, and
them with similes of aladdinite (Nissin®),
determine the necessary modifications for the
thus obtaining 7 partially edentulous jaw
abutments, in order to carry out the carving
models, all of whom corresponded to
of guiding planes according to each case.
Class III Kennedy subdivision 1 of partially
toothed arches. Each model included Later, a handpiece (rotating instrument) was
anterior attachments with esthetics affected positioned on the vertical arm of the paralleling
by retainers, canines and first premolars. All surveyor, using a diamond cylindrical drill.
tooth loss possibilities that were part of the The corresponding carvings were made to
classification and that considered aesthetic establish the guiding planes on the position
compromise were previously determined. determined for each model according to the
conclusions from the analysis.13
For each obtained model, the metal base
most suited to its edentulism was designed The biomechanical preparation for each
and drawn, considering all the parts of the model was carried out. This involved the
removable partial prosthesis, determining preparation and carving of each bed to
the position of the retaining complex after support the abutment teeth, following the
further analysis with a paralleling surveyor indications of the proposed model for each
(a high-precision auxiliary equipment for case (Figure 1).

Figure 1. A, B and C. Preparation of guiding planes and occlusal support

Source: by the authors

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 Removable partial dentures: eliminating retainers in the anterior zone

Once the above procedure was completed, Once the prosthetic bases were obtained,
the depth of each retaining area of the it was verified that they were in proper
anterior abutments was measured, as well condition, evaluating the presence of a
as the length of the guiding planes carved correct adjustment, meaning that both the
on the abutment in each model under study beds and the guiding planes were in close
(Figure 2). contact with their respective prosthetic
elements (occlusal support and minor
connector).

Figure 2. Measuring the convergence angle that determines Figure 3. Evaluation of the prosthetic base, including proper
the retention degree of the abutment tooth adaptation and adjustment to the plaster model
Source: by the authors Source: by the authors

Next, models were sent to the prosthetic To perform the tensile tests, it was neces-
laboratory to manufacture the metal bases sary to adjust the metal bases with a metal
as designed, using Dentaurum® preformed circular washer designed for this purpose
waxes to wax up the structures, and casting and made of the same alloy of the base
in cobalt-chromium alloy. Each base (Cr-Co), measuring 0.8 mm in diameter
corresponds to a conventional removable (Figure 4). These were laterally welded to
partial prosthesis model, including cast posts the base and placed equidistant from the
of the anterior region. abutments of each model under study.

Figure 4. A and B. Metal bases in place with cast washers for tensile testing

Source: by the authors

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 Removable partial dentures: eliminating retainers in the anterior zone

The bases were subjected to tensile analysis equidistant and simultaneous bilateral
on a Tinius Olsen H5K-S14 universal traction traction. Then the unilateral tractions were
machine (Figure 5). This machine works by performed, arbitrarily choosing the left side
vertically loading the metal bases located for all models (Figures 6 and 7). The obtained
on the models from the point established in results indicate the maximum necessary
the prosthetic saddles (washers). First, the force (in Newtons) to traction the metal
bases bilateral tractions were carried out base vertically until surpassing the prosthetic
with a device specially designed to create equator from its final location.

Figure 5. A and B. Device used for tensile testing (Tinius Olsen H5K-S)

Source: by the authors

Figure 6. Traction device installed on Figure 7. A and B. Traction device installed on metal bases to run the test
metal bases to run the test
Source: by the authors
Source: by the authors

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 Removable partial dentures: eliminating retainers in the anterior zone

For each metal base, 10 bilateral and

unilateral measurements were made,
obtaining 20 force values per base. Once
the measurements in the 7 models were
taken, the retaining clasp of each retaining
complex of anterior abutments of the metal
bases was cut, thus eliminating the
unattractive element.
The bases were then set, carrying out the
same previous procedure, i.e., 10 bilateral
and 10 unilateral measurements for each
base, thus completing 40 different force
values for each metal base. In total, 280 Figure 8. Removing retainers from the anterior sector
measurements were obtained, with n = 70
Source: by the authors
for each analysis (Figure 9).

Figure 9. The esthetic change can be seen after removing the retainers from the anterior region with the base attached to
the model

Source: by the authors

Statistical Analysis
deviations between two groups of data,
The obtained data were subjected to
and determining whether the differences
descriptive statistical analysis with the use between groups are statistically significant
of histograms, as well as the Shapiro-Wilkins or just random differences, and whether
and Kolmogorov-Smirnov descriptive tests, they are within the ideal ranges of retention
yielding a normal distribution of data, which force values required in RPD.
allowed to choose the most appropriate
statistical test.
RESULTS
The results were analyzed with Student’s T
statistical test of independent variables and Figure 10 shows the differences in the
different variances with a 0.05 significance, measured force averages for the entire
comparing the mean and standard sample (n = 70) in each.

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 Removable partial dentures: eliminating retainers in the anterior zone

Retention (Newton)

Figure 10. Retention of metal prosthetic bases with and without retainers in the anterior region when subjected to uni- and
bilateral traction

Source: by the authors

The average tensile force value required to Table 3. Bilateral traction without anterior retainers
displace the metal base bilaterally in bases

Maximum
Minimum
Deviation
with anterior retainers was 16.93 N, with a
Standard

Variance
Average

Range
standard deviation of 3.43 N and a range n

of 17.67 N, determined by the difference

between the minimum and maximum values, 70 12.84 2.38 5.663 8.67 19.00 10.33
10 and 27.67 N respectively, as shown in
Table 2. Source: by the authors

Table 2. Bilateral traction with anterior retainers

The average tensile force value required to
displace the metal base unilaterally in bases
Maximum
Minimum
Deviation
Standard

Variance

with anterior retainers was 10.42 N, with a

Average

Range

n
standard deviation of 2.08 N, a range of 9 N,
determined by a minimum force value of 6.5
70 16.93 3.43 11.79 10.00 27.67 17.67 N and a maximum of 15.5 N. These results
can be seen in Table 4.
Source: by the authors
Table 4. Unilateral traction with anterior retainers
The average tensile force value required to
displace the metal base bilaterally in bases
Maximum
Minimum
Deviation
Standard

Variance
Average

Range

without anterior retainers was 12.84 N, with n

a standard deviation of 2.379 N, a minimum
value of 8.666 N and a maximum of 19 N,
determining a force range of 10.334 N, as 70 10.42 2.08 4.33 6.50 15.50 9.00

shown in Table 3.
Source: by the authors

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 Removable partial dentures: eliminating retainers in the anterior zone

Table 5 shows that the result of the average 8.07 N in bilateral and unilateral tractions,
tensile force value required to displace the respectively. These values were compared
metal base unilaterally in bases without to the standard value (4.90 N), yielding
anterior retainers was 8.07 N, with a statistically significant differences (p = 0.0000)
standard deviation of 1.92 and minimum for both uni- and bilateral tractions, in the
and maximum force values of 4.67 N and absence of anterior retainers. The retention
12.83 N respectively, determining a range of action offered by carved guiding planes
8.17 N. with controlled parallelism and their close
contact with the minor RPD connectors is
Table 5. Unilateral traction without anterior retainers
likely to provide key assistance in retention
when the biomechanical preparation prior
Maximum
Minimum
Deviation
Standard

Variance
Average

to RPD installation is properly done.6,7,8,9

Range
N
The unilateral tensile tests were carried
out to verify how the prosthetic apparatus
70 8.07 1.92 3.68 4.67 12.83 8.17
would work during the unilateral masticatory
Source: by the authors
process. The force that opposes the unilateral
displacement of a prosthesis is basically
determined by the retention complexes of
the working side (the one that produces
DISCUSSION traction), provoking on the opposite side a
rotation around the retaining clasp contact
This in vitro study aimed to evaluate a new
with the abutment, which undoubtedly
alternative RPD treatment in which retention
generates deleterious forces on it and its
is not affected by removing retainers from
periodontium, which cannot be contained
anterior abutments in Kennedy’s Class III
because rotation disables any function of
dentures, subdivision 1.
the elements that cause reciprocation.6,13,15
The results obtained in this study showed
In addition, the force values obtained
that the tensile force values in the presence
on dental bases bilaterally loaded in the
of anterior retainers were higher in
absence of anterior retainers were higher
the tensile tests with retainers compared
than those in bases that had all the retaining
to the tests with no retainers, as expected.
clasps but unilaterally loaded. This perhaps
These differences are statistically significant
happens because, by generating traction
(p = 0.0000) in both unilateral and bilateral
from both sides, the anti-displacement force
traction. However, the retention values
is provided by both the retaining systems and
yielded by the bases with no retainers appear
the guiding planes, which provide additional
to be sufficient and acceptable to prevent
friction retention. However, this is nullified
the displacement of a prosthetic apparatus
in unilateral traction.3,6,7,12,15
in which—according to the literature—a
conventional RPD apparatus needs a force
of 500 Gf, or 4.90 N, to perform adequately.8
CONCLUSIONS
This value is exceeded, based on the
results obtained in anterior retainer-free This in vitro study aimed to compare the
bases, which were on average 12.84 N and dental loading retention in partial removable

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 Removable partial dentures: eliminating retainers in the anterior zone

prosthesis, both in the presence and standard value reported in the literature,
absence of anterior retainers with parallel also in favor of the results of this study.
guiding planes, analyzing the possibility of
• The obtained strength values do not
eliminating them and thus solve a critical
decrease as the literature states as a
aesthetic problem of RPDs with anterior
sufficient and acceptable value to retain a
abutments. The obtained results lead to
prosthetic device, and it has been shown
conclude that:
that the retaining strength is sufficient to
• There are statistically significant retention retain a prosthesis and to allow a smooth
values differences in denture bases with functioning as shown in this in vitro study.
no anterior retaining clasps compared
to bases with clasps in both bilateral and
unilateral tractions. CONFLICTS OF INTEREST
• There are statistically significant retention
The authors declare that they have no
values differences in denture bases with
conflict of interest.
and without bilateral traction retainers
with respect to the values reported
in the literature as sufficient to retain
a removable prosthetic device, with CORRESPONDING AUTHOR
significantly higher values as the results of
Christian Rochefort Quiroz
this study show.
Professor, Universidad de Chile
• Statistically significant differences were +56 988-060-169
also detected when comparing denture crochefortq@gmail.com
bases with and without retainers in Hernando de Aguirre 128, of. 307
unilateral tractions, compared to the Providencia, Chile

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