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CONTENTS
Introduction History
Contraindication Advantages
Disadvantages Selection of the abutment teeth
Mechanics of retention
Rigid / Resilient attachment
Extracoronal attachment
Role of attachment as stress breaker : Broken stress philosophy Bar attachments Stud attachments
INTRODUCTION
Precision
always
been
A practice builder for the better class of dentistry It helps to elevate the general standard of partial denture
prosthetics.
The
precision attachment is sometimes said to be a connecting link between fixed and removable partial denture as it incorporates features common to both types of construction.
HISTORICAL BACKGROUND
Ash (1912)
Split bar attachment system
T shaped
Precision Attachment
(1906)
H shaped
Precision quality or state of being precise Attachment Mechanical device for the fixation, retention and stabilization of dental prosthesis.
Pin slot
chayes
Mechanical device Direct retainer They are designed to replace occlusal rest, bracing arm, and retaining arm of the conventional clasp retained partial denture.
Parallel attachments Slotted attachments Key and Key way attachments. Male attachments Patrix Flange Insert Key Fitting part
CLASSIFICATION OF ATTACHMENTS
II.
Based on stiffness of the resulting joint Rigid attachments Resilient attachments (Non rigid)
ADVANTAGES
Mechanical advantage - Direct the forces along the long axis of the teeth / more apically - Force application closer to the fulcrum of the tooth
Reduced stress to the abutment Stress free rotational/vertical movements Cross arch load transfer and prosthesis stabilization
Compared to conventional clasp retained partial denture
Less liable to fracture than clasp Less bulky and more esthetics Better retention and stability Less food stagnation
DISADVANTAGES
Complexity of design, procedures for fabrication & clinical treatment
Anatomy of the tooth Limited faciolingual tooth width (incisor and canine areas) Expensive
Complexity of laboratory and clinical procedure
Attachment maintenance (repair or periodic replacement)
Require high technical expertise Dentist and laboratory technician Requires aggressive tooth preparation
INDICATION / APPLICATIONS OF PRECISION ATTACHMENTS Removable Prosthodontics As a retainer in a removable tooth supported partial denture
4 large well rounded abutments are available
For esthetic concern in the anterior part of the mouth
Divergent abutment teeth with high survey lines parallel path of placement. As a retainers in tooth supported over denture
Fixed Prosthodontics As a connector in fixed partial denture construction (long span bridges)
IMPLANT PROSTHODONTICS Implant supported over denture They are used for connection between the tooth and the implant
Poor oral hygiene habits Abnormally high carious rate Inadequate space / room to employ the attachment Compromised endodontic and restorative conditions
Factors : Condition of abutment teeth Number of the abutment teeth Location of the abutment teeth
Periodontal condition Crown root ratio Periodontal support Pulpal status Vitality of the pulp Size of the pulpchamber
Adequate space between the pulp and the normal contour of the tooth
Marginal leakage
Marginal caries
Less life
Black 7-8 mm
105 attachments
30 points of information
INTRACORONAL ATTACHMENTS
Head
Tube Contact plate Adjustment slot Rein forcing plate
MECHANICS OF RETENTION Frictional : Preiskel group I Retention Surface area contact Function of the length Controlled by height of clinical crown
Intermaxillary space available Function of cross sectional dimensions Mechanical : Preiskel group II Auxillary mechanical retentive features Ex. Spring loaded plunger / clips
Passive Attachment :
Omega
Beyeler
ACTIVE ATTACHMENT Active friction grip attachment Active snap grip attachments
McCollum
Crismani
Crismani
Neys attachment :
Conventional H shaped
Latch retained
Bakers attachment
Schatzmann attachment
Frictional retention
Semiprecision attachments
Semiprecision rest intracoronal rest seat and resilient lingual arm. Laboratory fabricated rigid metalic extension (patrix) of a fixed or removable dental prosthesis that fits into a slot type key way (matrix) in a cast restoration allowing some movement between the component. - GPT8
Gillete (1923) : The first semiprecision attachment Rectangular deep rest with buccal and lingual wrought clasps arms
Ira D Zinner (1979)
Circular
Dove tail
Rectangular
Mortice
Resilient Some resiliency (Non-locking type) Proximal form / side walls lateral force control
Parallel outline
Tapering outline
Added reciprocation
Flat
Inclined
Channeled
Advantages : Versatility for clinical situations employing various rest seat outline forms.
Variation in tooth size and shapes are easily accommodated. Better crown contour compared to prefabricated type
Disadvantages :
Long term wear is more softness of alloy used. No standardization of sizing : Lack of interchangiability of male and female attachment.
Greater degree of laboratory skill and attention in detail.
EXTRACORONAL ATTACHMENTS
Boitel (1978)
Rigid attachments Resilient attachments Bar attachments
EXTRACORONAL ATTACHMENT
Rigid attachments
O-ring Advantages :
No alteration of contour of the abutment crown Can be used in short abutment teeth Greater freedom in the design
Stabilex attachment
Conex attachment
(Smaller version)
Assembled
Two types pins
a) Patrix
b) Matrix
Assembled
Rotational
Matrix and patrix
A) Support
B) Bracing C) Retention Insertion and removal Reduces frictional wear
Attachment pin / split post
Ceka Revax
Rigid system
Stress director
Shohet (1969) Kratochvil (1981) Low intensity forces on abutment teeth in contrast to rigid attachments.
Rationale of stress breaker movement should be strictly only to displaceable tissue Disadvantages of stress director : More complex, increased wear and breakage Increased bone resorption and trauma Occlusal contacts difficult to maintain Spring like device tendency to fatigue
ASC-52 attachment
Anchorvis attachment
(ERA)
Colour coded retention caps Most flexible White > Orange > Blue > Gray Most rigid
Two types of ERA Standard Reduce vertical (ERA RV) male part is 0.5mm shorter
Yen Chen Ku et al (2000) : ERA provides esthetics, vertical resiliency, easy replacement of worn dentures
O-SO ring / O-ring attachment Patrix - post with the groove or undercut. Matrix O-ring synthetic polymer gaskets + encapsulator
Intraradicular units
Extraradicular Intraradicular
Space requirement of these attachment is intermediate between dome shaped coping and thimble shaped coping.
Rigid unit Nylon ring protects the lamella Retention altering the positions of free ends of the lamella
Resilient unit
Matrix
Advantages :
Reduce vertical space requirement Instrumentation kit
GERBER ATTACHMENT
Largest of the stud unit
Resilient gerber
Rigid gerber
Ceka revax
Extra radicular
Intra radicular
SPACER RING
SCHUBIGER ATTACHMENT
Cut section
BAR ATTACHMENTS
Gilmore clip system (1913) - metal bar with retaining sleeve / clip. Bar can be attached to the :
Coping or crowns over the vital teeth
Dolder bar
Ackermanns bar CM rider bar
Hader bar
Andrews bar
BAR JOINTS
Round / circular
DOLDER BAR
Rest position
Vertical translation
Sagittal rotation
ACKERMANN BAR
CM BAR
Made up of precious / semiprecious alloy Retention tags in long axis of the bar
HADERBAR
English, Donnel & Staubli (1992) Hader EDS system System with 3mm height (8.3mm).
Advantage
Manual dexterity
MAGNETS AS ATTACHMENT
Since 1950 To retain maxillofacial prosthesis Alu, Ni, Iron,Cobalt alloy (alnico)
Limited use larger size
1960 use of rare earth element High field strength Can be used in smaller size. Somarium cobalt (Sm-Co) (Joseph Becker Hoffer 1967) Neodymium iron boron (Nd-Fe-B) 20% stronger Somarium iron nitride High magnetization Used for retention of mandibular overdentures (tooth and implant supported over dentures)
Cemented in keeper
Screwed in keeper
SANDWICH DESIGN
Assembled attachment
Advantages of magnetic attachment : Smaller size and strong attractive force Produce constant force constant retention Easy to incorporate into the prosthesis
Automatic reseating Boon for elderly patients (Parkinsonism, arthritic patient) Less lateral force to the abutment tooth
Disadvantages : Loss of retention due to corrosion or heat instability Requires encapsulation within inert alloys Cant be repaired High cost
Short track records Limited force transmission - Magnets can slide on their keepers.
AUXILLARY ATTACHMENTS
Indications :
To overcome alignment problems Connecting one restoration of fixed partial denture to another Allowing the removal of long span fixed partial denture for repair and examination of abutment.
SECTIONAL DESIGNS
Individual sections / separate sections : uses mesial and distal surface of the abutment teeth as guiding planes.
CONCLUSION