journal of prosthodontic research 60 (2016) 227228

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Journal of Prosthodontic Research

journal homepage: www.elsevier.com/locate/jpor

Editorial

Non-metal clasp dentures: More evidence is needed for

optimal clinical application
Modern dental practice has seen a rapid increase in the
patients expectation regarding oral appearance; therefore,
esthetic consideration is critical not only in restorative
treatment but also in prosthodontic treatment with removable
partial dentures. However, the metals used in restorative
treatment have a potential risk of causing metal allergy [1].
Thus, the demand for metal-free restoration has been
increasing, and a variety of dental materials that enable
metal-free prosthetic treatment have been developed and
introduced for use in the clinical setting [2].
Recently, non-metal clasp dentures (NMCDs), which are
fabricated using thermoplastic denture base resins and which
do not have visible metal clasps, are increasingly being used by
Japanese general practitioners for the prosthetic restoration of
partially dentate arches [3]. Material characteristics, denture
design, indication, and maintenance of the NMCDs are
different from those of metal clasp-retained dentures (MCDs),
and clinicians have reported various complications with the
short-term use of NMCDs. Therefore, clinical guidelines are
required for ensuring optimal application of NMCDs.
In 2008, the Japan Prosthodontic Society (JPS) proposed that
flexible dentures without metal elements cannot be recommended for clinical application. Later, in 2012, the JPS
organized a meeting of an expert panel comprising clinicians
with experience using NMCDs and published a position paper
in 2013 [35]. The English version of the position paper [4,5] has
been viewed 17,124 times (https://www.myresearchdashboard.
com; accessed August 2, 2016), showing that NMCDs have been
attracting considerable interest from many clinicians and
researchers.
The position paper published in 2013 stated the following:
non-rigid NMCDs cannot be recommended as definitive
dentures in light of current prosthetic principles, with the
exception of patients with metal allergies and some others.
NMCDs that include a metal framework to provide rigidity
may be recommended in cases in which the patient is

uncomfortable with a metal clasp

running through areas that would
affect esthetic appearance [3,4].
Since this statement was based on
the expert opinion of clinicians with
vast experience, the JPS recommendation for rigid NMCDs must be
validated by evidence obtained from
clinical trials.
To my knowledge, only a few retrospective studies on
NMCDs have been reported in recent years, and no welldesigned prospective study has been reported to date. In 2016,
a randomized crossover trial was presented at the 125th
general session of the JPS meeting [6]. In this study, rigid
NMCDs with metal elements and MCDs were delivered in a
crossover pattern to partially dentate patients with missing
molar teeth; subsequently, the clinical performance, patientreported outcomes, influence of wearing dentures on abutment teeth, and denture durability were compared between
the NMCDs and MCDs. The results showed that, compared to
MCDs, NMCDs with a framework provided better oral healthrelated quality of life (OHRQoL), as well as higher patient
satisfaction and chewing ability (Fig. 1). Moreover, no
significant difference was observed in the periodontal
condition of the abutment teeth of both dentures during 3
months of use. These results support the JPS recommendation for the application of rigid NMCDs. However, the followup duration in this study was very short. Thus, studies with
longer follow-up periods are necessary to obtain more
definitive evidence.
Clinical evidence for the application of NMCDs is apparently lacking. To my knowledge, two randomized controlled
trials and a multicenter prospective study on NMCDs are
currently ongoing in Japan. I hope that the JPS position paper
will be reformed as a clinical practical guideline based on
clinical evidence from these ongoing studies.

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journal of prosthodontic research 60 (2016) 227228

OHIP summary score

Overall
Chewing ability
satisfaction

Lower
50
OHRQoL

100

40

80

30

60

20

40

10

20

Higher
OHRQoL

MCD
NMCD

Fig. 1 OHRQoL, satisfaction, and perception of chewing ability in patients with MCDs and NMCDs (n = 21) [6]. Oral health
impact profile (OHIP)-J, a 100-mm visual analog scale, and a 20-item food-intake questionnaire were used for measuring
OHRQoL, satisfaction, and chewing ability, respectively. Comparisons of the outcomes between MCDs and NMCDs were
performed using a linear mixed-effect model. Data are presented as means and standard deviation. *p < 0.05, **p < 0.001.

references

[1] Hosoki M, Nishigawa K, Miyamoto Y, Ohe G, Matsuka Y.

Allergic contact dermatitis caused by titanium screws and
dental implants. J Prosthodont Res 2016. http://dx.doi.org/
10.1016/j.jpor.2015.12.004.
[2] Tanimoto. Dental materials used for metal-free restorations:
recent advances and future challenges. J Prosthodont Res
2015;59:2135.
[3] Fueki K, Ohkubo C, Yatabe M, Arakawa I, Arita M, Ino S, et al.
Clinical application of removable partial dentures using
thermoplastic resin (non-metal clasp dentures). Ann Jpn
Prosthodont Soc 2013;5:387408 (in Japanese).
[4] Fueki K, Ohkubo C, Yatabe M, Arakawa I, Arita M, Ino S,
et al. Clinical application of removable partial dentures
using thermoplastic resin-part I: definition and indication
of non-metal clasp dentures. J Prosthodont Res 2014;
58:310.
[5] Fueki K, Ohkubo C, Yatabe M, Arakawa I, Arita M, Ino S, et al.
Clinical application of removable partial dentures using
thermoplastic resin, Part II: Material properties and clinical

features of non-metal clasp dentures. J Prosthodont Res

2014;58:7184.
[6] Fueki K, Kohno E, Yatabe M, Wakabayashi N. Efficacy of nonmetal clasp dentures with metal framework: a randomized
cross-over trial. Ann Jpn Prosthodont Soc 2016;8(Spec):191.

Kenji Fueki DDS, PhD*

Associate Professor, Removable Partial Denture Prosthodontics,
Graduate School of Medical and Dental Sciences, Tokyo Medical and
Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8549,
Japan
*Fax: +81 3 5803 5514
E-mail address: kunfu.rpro@tmd.ac.jp (K. Fueki)

Available online 17 September 2016

http://dx.doi.org/10.1016/j.jpor.2016.08.003
1883-1958/# 2016 Japan Prosthodontic Society. Published by
Elsevier Ltd. All rights reserved.