Abstract

The lower labial bar is rarely indicated as a major connector for a removable partial denture. It can be used satisfactorily when large mandibular tori interfere with conventional lingual bar placement or when the lower teeth are severely lingually tipped and placement of a lingual bar is not possible.

THE MANDIBULAR LABIAL BAR MAJORCONNECTORCLINICALEDITOR'S NOTE: Drs Wood and Winkler and Mr Lanza are to be congratulated for developing this fascinatinginnovation. Although the case described involved the presence of mandibular natural teeth, the conditions indicatingthe utilization of the labial bar can apply to mandibles that have been restored with implants (eg, large tori, linguallyinclined implants). Therefore, the authors were asked to submit this interesting paper to the Journal of OralImplantology.Robert Wood, DMDSheldon Winkler, DDSJohn Lanza, BAKEY WORDSLabial barRemovable partial dentureFrameworkMajor connectorRobert Wood, DMD, is assistant professor ofRestorative Dentistry and assistant director ofthe Removable Prosthodontic Clinic at TempleUniversity School of Dentistry, Philadelphia,PA.Sheldon Winkler, DDS, is professor ofRestorative Dentistry at Temple UniversitySchool of Dentistry, 3223 North Broad Street,Philadelphia, PA 19140-5096. He formerlyserved as professor and chairman of theDepartment of Prosthodontics at TempleUniversity. Correspondence should be addressedto Dr Winkler at swinkdent@aol.com.John Lanza, BA, is a dental laboratorytechnician, Department of RestorativeDentistry, Temple University School ofDentistry, Philadelphia, PA.284 Vol. XXIX/No. Six/2003The lower labial bar is rarely indicated as a major connector for a removablepartial denture. It can be used satisfactorily when large mandibular tori interferewith conventional lingual bar placement or when the lower teeth are severelylingually tipped and placement of a lingual bar is not possible.eTver, in certain situations, the lower la- tory choice.tisf t i y rall e n ge bar ial la o H . r ecto n c r majo thisinclude anyoinfnormationw oninbthe case of severeslingualhe onltippingy saoweve H . d r i co be e tm trea o ks te nture dmeany remoxtboovabledpartialnotcontourednt canor restonsredde .eOrthodontiare- be can e . red d nsi co be can tha y ntl u req inf so usedIhNTRODUCTIONe mandibular laebial bar istand/or premeolars,Thothteether alternativ,escr,ac-bial bar is the major connector ofchoice.There are two situations when theuse of a labial bar should be considered.Mandibular lingual tori can beextremely large and interfere with thesatisfactory placement of a conventionallingual bar. The lower anterior teethand/or premolars can be lingually inclinedto such an extent that satisfactoryplacement of a lingual bar is notpossible.Unless surgery is contraindicatedor refused by the patient, surgical removalof mandibular tori is the treatmentof choice.In the case of extreme lingual inclinationof the lower anterior teethTHE LOWER LABIAL BARThe labial bar connects the saddles onthe left and right sides of a partial dentureand can also include an anteriorsaddle (Figure 1). Like a conventionalFIGURE 1. Labial bar mandibular removablepartial denture with anterior saddle.FIGURES 2-7. FIGURE 2. A 69-year-old female patient with large bilateral mandibular tori. FIGURE 3. Occlusal view of lower partial dentureframework with labial bar. FIGURE 4. Facial view of chromium alloy mandibular labial bar on master cast. FIGURE 5. Lateral view of labialbar. Note relief provided for the bar. FIGURE 6. Intraoral view of completed labial bar mandibular removable partial denture. Note largemandibular tori. FIGURE 7. Lower facial view of patient with upper and lower removable partial dentures in place. Note absence of lowerlip distortion.lingual bar, it is pear shaped and requiresrelief. It proceeds across the mucosalabial to the anterior mandibularteeth and often buccally to the premolars,preferably as low as possible belowthe gingival margins of the teeth.It can be difficult for a patient toadjust to a labial bar as a result of itslocation between the inner surface ofthe lower lip and the labial gingiva. Insome cases, the labial bar can distortthe lower lip and annoy the patient.The lower the bar is placed, the less thepossibility of distortion of the lower lipand the better the esthetic result.During the laboratory wax-up, thedental technician must ascertain thatthe path of insertion permits easy insertionand removal of the prosthesisby the patient.CASE REPORTA 69-year-old Caucasian woman presentedat the Removable ProsthodonticClinic of Temple University School ofDentistry. Examination revealed thatthe patient was missing several posteriorteeth. Because the patient had nointerest in implants, upper and lowerremovable partial dentures were treatmentplanned to replace the missingteeth.Robert Wood et alExtremely large mandibular toriwere present (Figure 2). The patient refusedsurgical removal of the bony exostoses.Because of the size and locationof the tori, a labial bar was designedfor the lower prosthesis. Upperand lower removable partial dentureswere fabricated, with a lower labial barserving as the major connector for thelower partial denture cast framework(Figures 3 through 7).After 1 year of use, the patient waspleased with the esthetics, comfort, andfunction of the upper and lower removableprostheses. She did not experienceany discomfort from the labial bar.Journal of Oral Implantology 285