Indirect Retainers

Chapter Outline
Role of Indirect Retainers in Control of Prosthesis
Movement
Factors Influencing Effectiveness of Indirect Retainers
Auxiliary Functions of Indirect Retainers
Forms of Indirect Retainers
Auxiliary occlusal rest
Canine rests
Canine extensions from occlusal rests
Cingulum bars (continuous bars) and linguoplates
Modification areas
Rugae support
Role of Indirect Retainers in Control
of Prosthesis Movement

As was described in Chapter 4, partial denture movement

can exist in three planes. Tooth-supported partial dentures
effectively use teeth to control movement away from the
tissues. Tooth-tissue–supported partial dentures do not have
this capability because one end of the prosthesis is free to
move away from the tissue. This may occur because of the
effects of gravity in the maxillary arch or adhesive foods in
either arch. Attention to the details of design and location
of partial denture component parts in control of functional
movement is the strategy used in partial denture design.
When the distal extension denture base is dislodged from
its basal seat, it tends to rotate around the fulcrum lines.
Theoretically, this movement away from the tissues can be
resisted by activation of the direct retainer, the stabilizing
components of the clasp assembly, and the rigid components
of the partial denture framework, which are located on definite
rests on the opposite side of the fulcrum line away from
the distal extension base. These components are referred to
as indirect retainers (Figures 8-1 and 8-2). Indirect retainer
components should be placed as far as possible from the
distal extension base, which provides the best leverage
advantage against dislodgment (Figure 8-3).
For the sake of clarity in discussion of the location and
functions of indirect retainers, fulcrum lines should be considered
the axis about which the denture will rotate when
the bases move away from the residual ridge.
An indirect retainer consists of one or more rests and the
supporting minor connectors (Figures 8-4 and 8-5). The
proximal plates, adjacent to the edentulous areas, also
provide indirect retention. Although it is customary to identify
the entire assembly as the indirect retainer, it should be
remembered that the rest is actually the indirect retainer
united to the major connector by a minor connector. This
is noted to avoid interpretation of any contact with tooth
inclines as part of the indirect retainer. An indirect retainer
should be placed as far from the distal extension base as possible in a prepared rest seat on a
tooth capable of supporting
its function.
Although the most effective location of an indirect
retainer is commonly in the vicinity of an incisor tooth, that
tooth may not be strong enough to support an indirect
retainer and may have steep inclines that cannot be favorably
altered to support a rest. In such a situation, the nearest
canine tooth or the mesio-occlusal surface of the first premolar
may be the best location for the indirect retention,
despite the fact that it is not as far removed from the fulcrum
line. Whenever possible, two indirect retainers closer to the
fulcrum line are used to compensate for the compromise in
distance.

Mandibular distal extension removable partial denture showing the distal extension base being lifted from the ridge
and the clasp assembly being activated and engaged, with the indirect retainer providing stabilization against
dislodgment.
 Fulcrum lines found in various types of partially
edentulous arches, around which the denture may rotate when
bases are subjected to forces directed toward or away from the
residual ridge. Arrows indicate the most advantageous position
of indirect retainer(s). A-B, In a Class I arch, the fulcrum line
passes through the most posterior abutments, provided some
rigid component of the framework is occlusal to the abutment’s
heights of contour. C, In a Class II arch, the fulcrum line is diagonal,
passing through the abutment on the distal extension side
and the most posterior abutment on the opposite side. D, If the
abutment tooth anterior to the modification space lies far enough
removed from the fulcrum line, it may be used effectively for
support of the indirect retainer. E-F, In a Class IV arch, the
fulcrum line passes through two abutments adjacent to the
single edentulous space. G, In a Class III arch with a posterior
tooth on the right side, which has a poor prognosis and eventually
will be lost, the fulcrum line is considered the same as
though posterior tooth were not present. Thus its future loss may
not necessitate altering the original design of the removable
partial denture framework. H, In a Class III arch with nonsupporting
anterior teeth, the adjacent edentulous area is considered
to be the tissue-supported end, with a diagonal fulcrum line
passing through the two principal abutments, as in a Class II
arch.
Part I General Concepts/Treatment Planning

Indirect retainer principle. A, Beams are supported at various points. B, A lifting force will displace the entire beam in
the absence of retainers. C, With direct retainers (dr) at the fulcrum, the lifting force will depress one end of the beam
and elevate the
other end. D, With both direct and indirect retainers (ir) functioning, the lifting force will not displace beam. The farther
the indirect
retainer is from the fulcrum, the more efficiently it should control movement.

Planning the location for an indirect retainer for a

Class II modification 2 removable partial denture. The greatest
distance from the axis of rotation around most distal rests
(fulcrum line) would fall on #22. The decision to use an incisal
rest or cingulum rest will depend on the patient’s concern for the
esthetic impact of an incisal rest versus having a crown (for the
cingulum rest).
Example of indirect retention used in conjunction
with a palatal plate–type major connector. Indirect retainers are
proximal plates on second premolars and occlusal rests located
on first premolars. A secondary function of auxiliary occlusal rest
assemblies is to prevent settling of the anterior portion of the
major connector and to provide stabilization against horizontal
rotation.