By Dr.

Eshan Verma Page 1

Stress Breaker

Introduction
In RPDs, the broad distribution of stresses to the supporting structures of the
arch is generally achieved by using rigid major and minor connectors
1
. However
in distal extension cases (Keneddys class I &II) this might be injurious to the
abutment tooth.
1, 2
This is because of less vertical displaceability of natural
teeth compared to the soft tissues covering the edentulous ridge, transferring
most of the stresses to the abutment tooth.
2
Therefore, use of non rigid
connectors or stress breaker is necessary to protect the abutment tooth.
1, 2

Defining Stress breaker

Stress breaker is defined as a device or system that relieves specific dental
structures of part or all of the occlusal forces and redirects those forces to other
bearing structures or regions.
3
Stress-breakers are those elements of partial
dentures which are interposed in a connector system in order to introduce a
controlled and intentional degree of flexibility into the structure.
4
In simple
words, it is a device, which allows movement between the denture base and the
retainer to reduce lateral and tipping forces on abutment teeth
5
. It is also
known as Stress director
2
, stress equalizer
1
, broken stress partial denture
6
,
articulated prosthesis
6
, and semi rigid connectors
6
.


Principle concerning their application
4


Stress breakers are based on the principle of selective load distribution between
the supporting tissues. When
load is applied to a free-end
saddle which is tooth-and-
mucosa-supported, part of the
load will be applied to the
abutment tooth and part will be
applied to the mucosa
underlying the free-end saddle.
The distribution of the applied
load between these two
supporting tissues can be
altered by varying the rigidity
of the connector used to join
By Dr. Eshan Verma Page 2

the support/retention unit on the abutment tooth to the saddle. If the rigidity of
this connector is high, the proportion of the load applied to the abutment tooth
will be at a maximum. Whereas when a flexible/movable connector is used, the
proportion of load applied to the abutment tooth will decrease and that applied
to the mucous membrane under the saddle will increase. The more
flexible/mobile is the connector which is used, the greater will be the proportion
of the load falling on the mucous membrane. Flexible/ movable connectors used
for the purpose of achieving such selective load distribution are termed stress-
breakers.


Classification

Based on the location, stress
breaker can be classified as
6

Intracoronal
Extracoronal

Based on the type of movement,
stress breaker can be classified
as
4
Type I - Those utilising a hinge
or moveable joint.
Type 2 - Those utilising flexible
connection.

Type 1 Stress-breakers:
This joint may be in the form of
hinges (e.g. D-E hinge type stress
breaker, trummion type stress
breaker), sleeves (e.g. Baca
design), sleeves with springs (e.g.
Dalbo retainer and Crismani retainer) and
cylinders or ball and socket Devices (e.g.
ASC-52 attachment).
1
These are mostly
Dalbo Retainer
By Dr. Eshan Verma Page 3

used in association with precision
attachments (e.g. intracoronal
Crismani combined unit and Dalbo
extracoronal retainer) however can
also be used with clasp units (e.g. the
Wipla Unit).
4
The joint allows vertical
and hinge movement of the base to
prevent direct transmission of tipping
forces to the abutment.
5












Type 2 Stress-breakers

These are normally used in association with clasp units as direct retainers.

Various forms are possible such as-

1. Wrought wire
connector
4,6
- e.g.
torsion bar
Torsion bar may be
used in the design of a
lower partial denture
carrying bi-lateral free-
end saddles. Bars
extend anteriorly from
the clasp units on each
side to join a lingual bar
near the mid line
.Flexibility can be
controlled by varying
the cross-section of the
ASC-52 attachment

By Dr. Eshan Verma Page 4

torsion bars, the method of construction (cast or wrought) and the
material of construction (normally gold alloys or cobalt chromium
alloys).Disadvantages are associated with the use of the torsion bar
structure in that the double bar system is liable to trap food and cause
irritation to the tongue.

2. Partial division of the
connectors/ split bar major
connector
4
- e.g. Split lingual
bar, split palatal plate,
Ticonium Hidden lock
design


The principle can be applied in both upper
and lower dentures. The connecter is spitted
by an anterio-posterior slot into upper and
lower portion. Upper portion is attached to
the retainer unit on the abutment while lower
portion is connected to the
saddle, thus creating a degree of
flexibility between the two.

3. Mesial placement of occlusal
rests
4

This offers the simplest
available approach to stress-
breaking. The degree of stress-
breaking achieved is, though,
much less than that available where
more complex devices are employed. It
may be used in the design of either upper
or lower dentures. By positioning the
rest of the clasp unit on the mesial
instead of on the distal fossa of the
By Dr. Eshan Verma Page 5

abutment tooth and by using a minor connector to link the rest to a major
connector (for example, a lingual bar) some flexibility may be introduced
into the clasp unit/saddle link.

4. Clasps having stress breaking action
5


1) Gingivally approaching- resilient I-bar clasp.
2) Occlusally approaching clasp having resilient retentive wrought
gold wire arm (combination clasp).
3) Back-action clasp.
4) Reverse back-action clasp.
5) Extended-arm clasp.
6) Ring clasp.
7) Wrought wire clasp.
8) RPI clasp.
9) RPA clasp.

Indications

The decision as to whether or not a stress breaker is to be used and, where
indicated, the type of stress-breaker to be chosen for use is based on a clinical
assessment of the load-bearing potential of the two supporting tissues. Where it
is judged that the abutment tooth can safely bear the brunt of the applied load,
the use of rigid connection between the saddle and the support & retention unit
on the abutment tooth is indicated. At the opposite end of the scale, where the
periodontal status of the abutment tooth is suspect and the trabecular structure
of the alveolar bone underlying the free-end saddle indicates that a favourable
response to load-bearing by the bone is likely, the use of a flexible type of
stress-breaker would seem to be indicated. Intermediate clinical findings may
indicate the use of a stress-breaker of moderate flexibility. It should, however,
be pointed out that the period for which flexible stress-breakers remain
functionally active in service can be disappointingly short. Doubts have also
been expressed as to whether their theoretical benefits are fully achieved in the
clinical situation.
4
The main indications for the use of stress breaker include
5
1- When internal attachments are used (because of the unyielding nature of
intracoronal retentive elements)
2
2- In distal extension removable partial dentures to distribute the load between
the abutment teeth and the ridge.
3- In cases exhibiting weak abutment teeth and well formed ridges.



By Dr. Eshan Verma Page 6

Advantages and disadvantages
2, 5

Advantages:
Decrease horizontal forces (tipping forces) acting on the abutment teeth
thus it preserves alveolar support of these teeth.
Distribute the stress between the abutment teeth and the residual ridge.
Prevent the quick damage of abutment teeth if relining is needed but not
done.
Providing physiological stimulation of bone which prevent bone
resorption.
Call for minimal direct retention because the denture bases operate more
independently than do those used in conventional removable partial
denture applications.

Disadvantages:
Difficult to construct and expensive.
Less tolerated by the patient.
Flexible connectors may be bent and distorted.
Some split connectors pinch the underlying soft tissue or tongue as they
open and close under function.
The effectiveness of indirect retainers is reduced or eliminated.
Repair and maintenance of any stress breaker is difficult.
All mechanical devices that are free to move in the mouth may collect
debris and become unclean.









By Dr. Eshan Verma Page 7









References

1. McCracken's Removable Partial Prosthodontics 11th Ed

2. Stewart's Clinical Removable Partial Prosthodontics 3
rd
ed

3. The Glossary of Prosthodontic Terms 8
th
ed

4. An Introduction to Removable Denture Prosthodontics 1983 -
Grant,Johnson

5. Partial denture theory and practice 2010- Fayad M

6. Review of Removable partial denture- Lovely M

DOSTAFA FAYAD