Clasp dental prosthetics and its varieties

Although in its present form, the clasp prosthesis was first made in Germany in the early twentieth century, however, this kind of prosthetics, in fact, was known from the time of the Egyptian pharaohs, in whose tombs primitive prostheses with artificial teeth were found in the mouth of the mummy (they were attached with wire ) The simple idea underlying the clasp prosthesis today has been further developed, which allows you to create high-tech prostheses that are functionally and externally practically indistinguishable from natural human teeth.

Simply put, the clasp prosthesis is a kind of removable denture that transfers the load to both the remaining teeth and the mucous tissues (to the gum, and in the case of a prosthesis for the upper jaw - to the sky). The basis of any type of arch prosthesis is the power frame in the form of an arc - actually the arch (“bugel” from German translates as “arch”). For this reason, the prosthesis itself is often called the arc.

The photo below shows examples of clasp prostheses:

On a note

Clasp prosthetics allows you to eliminate partial defects of the dentition, while maintaining a high level of aesthetics and at the same time not hitting your pocket - the cost of such a prosthesis is usually much lower than an implant prosthesis would cost.

At the same time, arch prosthetics should not be confused with the very “grandmother's” prostheses (“false jaws”), which are put into glasses every night and for which many patients are categorically opposed. The clasp does not have a massive plastic base - the base covering the sky, and its absence provides many advantages over the so-called "suction cup prostheses." In addition, the clasp prosthesis can be worn around the clock, removing only once every few months for additional hygiene.

The advantages of clasp prosthetics make it possible today to use this technology, including as a replacement for fixed prosthetics, especially when the teeth in the mouth may not withstand the chewing load from the "bridge". And despite a number of shortcomings (we will talk about them a little later), the realities today are such that in Russia arch prostheses are used not only by older people, but also by young people.

 

Features of clasp prosthetics and its varieties

The most important characteristic of a denture is the reliability of its fastening in the oral cavity. You must admit that few would have liked the idea that the prosthesis could one day fall out of the mouth during a conversation or during a meal. Meanwhile, with removable laminar dentures, this is also possible.

Unlike clasp prostheses, lamellar ones are fixed in the oral cavity largely due to suction to the mucosa. Actually, that's why such removable dentures are popularly called "suction cups".

With clasp prosthetics, a much more reliable and durable fastening is realized. - for example, on special hooks or locks. All this ensures the immobility of the prosthesis during chewing food and, especially, conversation.

On a note

Many, probably, heard that removable dentures during sneezing can even fly towards the interlocutor. In this case, we are talking about acrylic plate dentures. And this certainly does not apply to clasp prostheses that are adjusted so that they can be removed from the oral cavity only along a certain path, excluding the option of an unexpected prosthesis falling out.

How are “clasps” fastened in the mouth without a plastic base?

Clasp prostheses are fixed using the patient’s teeth.The following types of arch prosthetics are distinguished:

• On the clasps (the prosthesis covers the supporting teeth with special hooks - clasps);
• On attachments (elements of small locks are installed in the abutment teeth and prosthesis, which then snap into place);
• On telescopic crowns (crowns are installed on the supporting teeth and in the prosthesis - then the prosthesis is simply put on the supporting crowns).

We will talk about the advantages and disadvantages of different types of fastening of arch prostheses below.

On a note

Meanwhile, it should be understood that if there are practically no teeth left in the mouth, then clasp prosthetics are unlikely to correct the situation - the prosthesis will simply not be fixed on anything. In this case, an alternative may be, for example, using a plate acrylic or nylon prosthesis (economy option), or implant prosthetics using All-on-4 or All-on-6 technology (more expensive, but also a much more convenient option) .

The main indication for the installation of an arch prosthesis is the absence of several teeth in a row (usually 2-3) on one side of the jaw. However, everything is individual here: in a number of clinical cases, this prosthesis can also be reliably installed with a minimum "margin" of supporting teeth on each jaw.

That is, the possibility of using the clasp prosthetics system is largely determined by the current state of the patient's oral cavity. In particular:

1. The position of the teeth, their number and condition;
2. The presence or absence of gum disease (periodontitis, periodontal disease);
3. The nature of the bite;
4. Maxillofacial abnormalities.

It is interesting

In general, when planning prosthetics, it is important to take into account many nuances, and the dentist must carefully examine the patient before promising something or, especially, starting to do something. Otherwise, it is possible not only to make an inconvenient and useless clasp prosthesis, but to damage even good abutments in the coming months, to form a pathological bite and tooth abrasion, and in severe cases - to provoke serious deformities of the TMJ and create problems with diction.

When choosing one or another variant of arch prosthetics, one should not forget that the use of a dental prosthesis is aimed not only at regaining lost chewing function, but also, very importantly, at restoring the natural beauty of a smile. And arch prostheses really allow you to do this.

However, from the point of view of aesthetics, there are nuances that are largely determined by the method of fastening the prosthesis in the oral cavity - on clasps, attachments or telescopic crowns.

 

In what cases to prefer clasp prostheses with clasp fixation

Is it possible to talk about aesthetic perfection when it comes to clasp dentures with clasp fixation?

After all, a clasp is a cast metal hook that clings to the neck of the abutment immediately near the gingival margin. Simply put, this hook is clearly visible in the oral cavity.

The photograph below shows a clasp prosthesis with clamming fixation - a metal clasp can be seen even with the naked eye:

Despite the possibilities of the dental technician to partially mask these hooks, all the same, the clasp data cannot argue in the aesthetics with clasp prostheses with other types of fixings.

Clasp fixation with arch prosthetics can be preferred if:

1. There are severe financial restrictions (other options are more expensive);
2. It is also required to obtain a splint effect due to the fact that the clasps are able to distribute the load when chewing in a special way - this makes it possible to save cranked teeth with periodontal diseases (when using a splint arch prosthesis).

To improve the aesthetics of the “hook” clasps, as well as to create maximum comfort during their operation, the Quadrotti and Acre-Fri dentures were invented.

Quadrotti dentures (Quattro Ti) are made of plastic, the properties of which are almost identical to nylon - elastic and yet very durable. The hooks of such a prosthesis are not striking, however, upon close examination, you can still see them.

Acry-Free prostheses are made from acrylic resins - the basis is less elastic than Quadrotti, but also quite durable. The prosthesis also holds in the oral cavity due to clamming fixation, and the hooks are less noticeable than metal ones.

Quadrotti and Acre-Free dentures are quite expensive - on average more expensive than with a metal base based on a titanium alloy.

 

Splinting properties of clasps (about the therapeutic effect of prosthetics)

Before proceeding to the examination of clasp prostheses on attachments, it is useful to say a few words about the splint properties of clasps.

Clasp fixation of clasps, despite some aesthetic imperfections, remains popular, including due to the fact that it allows you to save cranked teeth from loss. Thus, the prosthesis makes it possible not only to restore lost teeth, but also to strengthen existing ones.

The splint clasp prosthesis consists of a metal arch adjacent to the inner side of the teeth, and the clasps have many links, claw-shaped processes or rings that fix each movable tooth. This prosthesis allows you to evenly distribute the masticatory load from moving teeth to healthy, as well as to the alveolar processes (while supporting teeth, it is recommended to close the crowns).

The photo below shows the clasp system of the splint arch prosthesis:

Splinting prosthesis is indicated for:

1. Bare roots;
2. Periodontal disease (with bleeding, pathological gingival pockets and tooth mobility);
3. Incorrect position of the teeth;
4. When teeth are removed (after tooth extraction for a certain time, adjacent teeth gradually begin to lean toward the defect, and antagonist teeth on the opposite jaw extend from the hole, which can lead to their mobility).

Like other varieties of clasp prostheses, splint constructions have their contraindications for installation:

• The period of pregnancy;
• After radiation therapy;
• Oncology;
• Acute inflammatory processes in the oral cavity;
• Mental disorders;
• Serious diseases of the heart (blood vessels) and respiratory system during the period of exacerbation;
• Allergy to prosthetic material;
• Bone disease;
• Alcoholism (drug addiction);
• Lack of a normal level of oral hygiene;
• Severe atrophy of the alveolar processes;
• Lack of necessary supporting teeth or insufficient height;
• Severe occlusion pathology.

These contraindications are relevant for all types of arch prostheses.

 

Clasp dentures on locks (attachments)

"Attachment" in translation from English means "connection". Attachments (attachments) are a system of locks that allow you to securely fasten the clasp prosthesis in the oral cavity with minimal damage in terms of aesthetics.

Special crowns, on which there is a lock (attachment), are usually put on the supporting teeth, and the other fastening is hidden inside the prosthesis itself. With this type of fastening, part of the load during chewing food is transmitted through the lock to the abutment teeth.

Unlike clamper fixation, castle clasp prostheses have a number of significant advantages:

1. Higher aesthetics due to micro-locks hidden in teeth and clasp. From the side it will be almost impossible to understand that a person has a prosthesis installed;
2. Maximum precision fit;
3. Longer service life (7-10 years);
4. Ease of operation;
5. The increased rigidity of fixing;
6. Shorter addictive period.

Cons of clasp prosthetics on attachments:

• Higher cost compared to classic clasps with clasp locks;
• The need to almost always depulpate (remove the "nerve") in the abutment teeth in connection with the preparation for the locks.

The general lack of clasp prostheses is preserved - gradual atrophy of bone tissue under the prosthesis, in connection with which it is sometimes necessary to stop voids by applying a layer of plastic to the clasp.

 

Fastening the clasp prosthesis on telescopic crowns

One of the most difficult to manufacture is the so-called telescopic clasp (its fixation is due to telescopic crowns). He is also the most aesthetic in his class.

Before installing the prosthesis, the orthopedist grinds (prepares) the supporting teeth under the crown, covers them with a metal crown, and only then - puts a clasp on which the crowns are also fixed. Simply put, the prosthesis consists of two parts - removable and non-removable, and when installing the prosthesis, crowns on the supporting teeth enter the crowns of the removable part.

The essence of the fastening is shown in the photo below:

The crowns on the supporting teeth are cemented firmly, they can not be removed so easily, but the prosthesis can be removed. For reliable fixation, it is ideal to use at least 6 telescopic crowns.

Despite the simplicity of the idea, this type of clasp prosthesis is notable for its high manufacturing complexity (and, as a result, high price). In Russia, such an option for prosthetics is not as popular today as in some countries of Western Europe and the USA.

 

Advantages and disadvantages of arch prosthetics on implants

All of the above options for arch prosthetics have two major drawbacks:

1. All of them suggest the presence of a removable structure in the oral cavity. In other words, the prosthesis will have to be regularly removed from the mouth - at least in order to carry out its hygiene (brush with toothpaste). In many patients, this is somehow associated with the “false jaw”, even if the prosthesis replaces only a few lost teeth and you have to remove it only once every 2-3 months;
2. Some patients do not even know about the second drawback of clasp prostheses, and this, of course, is unlikely to be mentioned in advertising materials of clinics. But the fact is that even the most beautiful and well-fitted clasp prosthesis does not prevent the gradual atrophy of the bone tissue of the alveolar processes. As a result, over time, the jaw bone will atrophy, as it does not receive a full chewing load previously transmitted through the root of the tooth. A decrease in bone then leads to a change in facial features characteristic of the elderly.

Actually, the fastening of the clasp prosthesis on the implants allows you to get rid of these disadvantages to a certain extent.

In general, there are quite a few advantages:

• The clasp on the implants is a conditionally removable prosthesis (that is, it does not need to be removed regularly on its own, and only a doctor can remove it using special tools);
• Atrophy of the jawbone is prevented directly in the area of ​​installed implants, since the implant serves as an artificial tooth root. However, it is clear that if only 1-2 implants were installed during prosthetics, the effect as a whole will be small;
• In the case of a prosthesis on the upper jaw, reliance on the palate is not required - this greatly facilitates getting used to the prosthesis (there is no discomfort and vomiting reflex, diction is not disturbed);
• When attaching the prosthesis to implants, it becomes unimportant to have several strong teeth in the patient (such teeth in other arch prosthetics would become supportive).

Clasp prosthetics on implants can significantly save in comparison with multiple implants, when an implant plus a crown would have to be replaced with each lost tooth. Often, for fixing the clasp prosthesis, only the end teeth (extreme chewing) are missing - in this case, installing an implant will be almost the only way to solve the problem.

The most popular option for dental prosthetics today with their complete absence is All-on-4 and All-on-6 technologies, which involve the use of clasp prostheses of a beam construction with installation on 4 or 6 implants, respectively.

In fairness, it must be said that this type of prosthetics refers to arch prosthetics only formally - usually arch prosthetics are understood to mean structures that are attached to the oral cavity using the aforementioned clasps, attachments or telescopic crowns.

Feedback:

“I am a lone military pensioner, I am 70 years old. About 8 years ago, all teeth flew. Three times I inserted suction cups in the departmental military clinic for special blat, but they kept on during the conversation, and the devils fell during the meal, and nothing could be done. The dentist explained to me that they say you have fleshy cheeks there, the bands are wrong, your mouth is crooked and everything like that. For the third time after one Armenian, I ran away with the last prosthetic prosthesis and came to my son in St. Petersburg. He advised me of a clasp prosthesis on implants. I got 4 of these bolts in the clinic, and they had a prosthesis on them. It turned out a little expensive, albeit by stock, thanks to the son threw some money. But it's definitely worth it; chewing has become normal. Now I have to get married again ... ".

Sergey, Moscow

 

General principles for the manufacture of clasp prosthesis

Clasp prosthesis, in comparison with a full and partial laminar denture, is much more complicated in its manufacture. In this case, the following stages of manufacturing the structure can be distinguished:

1. Clinical (in the chair of an orthopedic surgeon);
2. Laboratory (in the dental laboratory).

Before starting treatment, the most important point is to collect an anamnesis (questioning) and a comprehensive examination of the patient with a plan for the upcoming treatment. Here, important details are clarified, starting from the patient’s allergic status and bite characteristics, and ending with the definition of prosthetics tactics and the choice of the prosthesis itself.

If the choice, for objective reasons, tends to clasp prosthetics, then the orthopedic surgeon chooses abutment teeth. If they require treatment (filling or depulping), then the dentist is engaged in preparing the teeth for prosthetics. Further, the orthopedic dentist carries out the preparation of prepared abutments for crowns (this is especially true for castle and telescopic types of attachment).

On a note

The choice of supporting teeth is a very crucial moment, since their future fate may depend on this. If the abutment teeth are incorrectly selected, they can become loose due to stress.

After taking impressions from each jaw (two prints), they are sent to the dental technicians, and the laboratory stage begins: the production of the prosthesis model using the cast.

After that, the prosthesis is tried on in the patient’s oral cavity and corrected. Then, the design is again sent to the laboratory, where the final stages of completion take place, after which the orthopedic surgeon fixes it in the oral cavity and explains to the patient the features of the introduction and removal of the clasp prosthesis, as well as the rules for caring for it.

The deadlines for completing prosthetics are individual, and are largely determined by the type of prosthesis chosen. Dentures on clasps can usually be installed within 2 weeks, and dentures on locks or telescopic crowns - for 3-4 weeks.

How much does a clasp prosthesis cost today?

The cost of clasp prosthetics depends on many factors, but the main ones are two: the complexity of manufacturing the prosthesis and the price of the materials used. For example, clasp prostheses on telescopic crowns, which are a high-precision design, will be relatively expensive. Clasp prosthetics on implants will be even more expensive when, in addition to making the prosthesis, the surgical stage is also planned.

Often in clasp prosthetics, precious metals (gold, platinum) are used, so these products will cost more than prostheses from “classical” titanium-based alloys.

Clasps with clasps, which can be purchased at a price of about 30-40 thousand rubles for a prosthesis, are considered the most "budget" ones. Clasp systems on attachments (with fastening on two micro-locks of the Bredent system, Germany) cost about 80-100 thousand and higher for the finished product. The cost may vary, depending on the region, and in Moscow prices are usually much higher.

As for the cost of clasp prosthetics on implants, it should be borne in mind that the installation of one implant will cost an average of 50-80 thousand rubles. The installation of several implants may be necessary, plus the cost of the prosthesis must be added to this.

On a note

Generally speaking, the cheapness of some dentures in comparison with others is very arbitrary. Of course, removable acrylic plate dentures are almost always much cheaper than any clasp, but compare the cost of clasp prostheses, relying only on the type of fastening - the approach is not entirely correct. Take, for example, at least clasp prostheses on clasps: they can be more expensive than on attachments, due to the use of precious alloys.

Again, clasp prosthetics on implants can become heavier in price when choosing premium implants (Straumann, Nobel), while in the case of using budget implants (Alpha BIO, MIS), the turnkey cost may come closer the cost of installing the prosthesis on telescopic crowns using precious alloys.

 

How to care for your prosthesis in order to use it as long as possible

Unlike the same plate prostheses, the clasp does not need to be removed at night and stored in a “glass”. It is worn around the clock, but at first it is removed 2-3 times a day for hygienic measures using toothpaste and a brush. Do not take toothpaste with a whitening effect (highly abrasive) due to possible damage to the surface of the prosthesis by abrasive particles.

3-4 months after installation, the clasp in the oral cavity adapts so that its plastic edge is immersed in the gum and food does not fall under it. This allows you to remove the prosthesis for hygiene much less often, conducting it on the same principle as with native teeth. However, once every 3 months it is advisable to remove the structure and place it in a special bactericidal solution for processing prostheses (for 2-3 hours - for disinfection from pathogenic microflora).

Comprehensive hygiene of not only supporting, but also all teeth present in the oral cavity, with and without crowns, is also required. It is recommended that you use a dental irrigator.

Every six months to a year (depending on the policy of the clinic), the patient should come to the attending physician in order to:

• Check the dentition for super-contacts, that is, points where the bite on the artificial teeth of the prosthesis (and their own) is clearly overestimated, which means that there will be an overload of the tooth (teeth) and gradual destruction;
• To diagnose the conformity of the base of the clasp and gum, on which it rests;
• For professional dental hygiene.

If the clasp prosthesis for a number of objective reasons must be removed for a long time, then the storage conditions should be as follows: in a dry, clean form in a plastic box at room temperature. Keep the clasp in the refrigerator, or next to the heater is prohibited due to possible deformation of the structure.

 

If you have personal experience of arch prosthetics, be sure to share the information by leaving your review at the bottom of this page (in the comments box).

 

Visual information about different types of arch prostheses

 

Useful video: arch prostheses as an alternative to implants