Journal

of Oral Science,

Case

Vol. 40, No. 1, 43-47,

Report

A case

report

of removable
bar

Morio

Department
University

1998

of

Iijima

Removable

Research

Noriyuki

Partial

Center,

telescopic

Narita,

Denture

Nihon

partial

Tokyo

Nihon

using

the

dimple-

system

Toshihiko

Prosthodontics,

University,

denture

Matsurnoto

University

School

and

of Dentistry

Sunao

at Matsudo,

Ikeda

Chiba

271-8587,

102-0074

(Received 16 July 1997 and accepted 22 January 1998)

Abstract:
The authors
have devised
a new
attachment
for a removable
partial denture with a
dimple-bar
clasp, guiding channels, and a shoulder,
named the dimple-bar
telescopic system. This system
has advantages over the clasp-type retention device in
that it not only satisfies esthetic requirements,
but also
improves
the handling
and adjustability
of the
attachment
denture.
Furthermore,
it was shown
clinically that the dimple-bar
telescopic system was
free from
food impaction
when used
as an
intracoronal
attachment, and maintained a feeling of
comfort during tongue movement and speech. We

dimple-bar clasp (1), guiding channels (2) and a shoulder

present
a typical
case in which the dimple-bar
telescopic system was used. (J. Oral Sci. 40, 43-47,
1998)

prostheses, 2) secondary caries of the upper teeth, and 3)

incompatibility of the one-sided Conus denture mounted
across the lower right edentulous space. She required
improvement
of esthetic quality and desired a fixed

Key words: removable

prosthesis in the maxilla and removable partial denture in

the mandible. The occlusal plane was not smooth and
early centric occlusal interference was evident. However
she had no notable clinical history, such as evidence of
temporomandibular disorders.

partial

denture;

esthetic

prostheses; telescopic system; attachment.

Introduction
Retention devices for removable partial dentures can
be classified into two types: the general clasp type, and an
attachment system combining male and female portions.
Both are required to be not only functional and easy to
clean, but also esthetically acceptable. The clasp type is
commonly applied to removable partial dentures because
of its simple structure. However, many problems exist
from the viewpoint of esthetics, one of which is exposure
of the metallic color, and in addition, due to crown
contours the clasp type tends to be difficult to keep clean.
In contrast, from both esthetic and hygienic viewpoints,
the attachment system is applicable to many cases of
tooth loss, even if located anteriorly to the dental arch.
The authors have treated 6 patients who required
removable partial prostheses using a new system called
the dimple-bar telescopic system (DBT). All the patients
have retained clinically good conditions for more than
five years.
We report a typical case in which the DBT system was
used as a retention device. The system comprises a
Correspondence to Dr. Morio Iijima, Department of Removable Partial
Denture Prosthodontics, Nihon University School of Dentistry at
Matsudo, 2-870-1 Sakaecho-Nishi, Matsudo-shi, Chiba 271-8587,
Japan

(2), is capable of withstanding functional pressure, and is

applicable in situations demanding high esthetic quality.
Case Report
The patient was a 45-year-old woman. Tooth loss
comprised the upper right second premolar, upper left
lateral incisor, lower right first and second molars and
lower left second molar. In the mandible, tooth loss was
divisible
into class I according
to the Kennedy
classification.
The patient complained of the following:
1) discomfort
due to incompatibility
of the crown

a) channel
b) shoulder
c) dimple

Fig. 1

Inner cap component of the dimple-bar telescopic

system. Inner cap component comprises channel (a),
shoulder (b), and dimple (c).

44

Fig. 2a

Fig. 2b

Occlusal

view.

View from defective

Figs.

Photographs

Lingual

of inner

caps

Views

of outer caps and metal

frame.

Fig. 3b

Views

of outer caps and metal

frame.

side.

Fig. 3c

Fig. 2c

Fig. 3a

Porcelain

fused-to-metal

assembled

on the master

crowns

and

metal

frame

model.

view.

mounted

on the

master

model.

Fig. 3d

DBT

system

inner

and outer caps separated.

with 2 rigidly

anchored

free-end

saddles;

45

Porcelain
designed
system
first

fused-to-metal
as shown

was
molar

prostheses
shoulder

applied
using

and

bridges

4a, b. In the mandible,

to the
porcelain

consisting
was designed

premolar
and left
tooth
loss in the

crowns

in Fig.

right

second

were
the DBT

premolar

fused-to-metal

only
of a guiding
for treatment
of

and

crowns,

the

channel.
right

second
premolar.
For treatment
mandible,
a metal
plate
denture

left
and
A
first

of the
was

designed by combining the DBT system, a metal frame,

and an outer cap. On the basis of the cross-arch
stabilization
theory (3), a denture was designed
bilaterally, and the altered casting technique was applied
to achieve functional
support. Establishment
of the
functional support not only protected the abutment tooth,
but also provided
a retention
effect with a rigid
connecting system.

Fig. 4a

Fig. 4b

Fig. 4c

Fig. 4d

Fig. 4e

Figs. 4a-e

Clinical photographs of entire DBT system used in the present case in Figs. 2a-c and 3a-d.
(Figs. 4a, b, c, d and e : reflected in a mirror)

46

The basic aim of the treatment was to improve esthetic

quality, to correct the occlusal plane, and to make the
movement of the mandible smoother using the mutually
protected occlusion for the anterior guidance of
mandibular movement.
The basic structure of the DBT system is shown in
Figs. 1, 2a-c and 3a-d. The inner cap prosthesis of the
abutment tooth consists of a guiding channel formed
along the distal and mesial axial walls of the abutment
tooth, a shoulder formed on the lingual axial wall, and a
dimple formed on the surface adjacent to the missing
tooth. The outer cap is designed to accept the components
of the inner cap, and the dimple faces a semi-spherical
protrusion designed on the tip of the resilient retention
arm of the dimple-bar.
The friction force generated between the main and
auxiliary structural components, which include a rigid
inner cap and a removable outer cap, enable superb
retention. The auxiliary component consists of a dimple
and dimple-bar.
The guiding channel restricts the direction of the
denture pathway and protects the outer cap from
excessive external force and abrasion during wear and
removal. The guiding channel also produces a clamping
effect that increases the stability of the outer cap to
prevent it from moving to the lateral direction.
The shoulder has a rectangular shape designed to
support the vertical occlusal force, and the width of the
shoulder is adaptable according to the shape of the crown
and the direction of the dental axis. If the width of the
lingual axial wall is insufficient to support functional
force, it can be supported at the bottom of the guiding
channel.
The dimple on the axial wall at the side of the missing
tooth provides the force to retain the outer cap by
insertion of the semi-spherical protrusion on the tip of the
dimple-bar. The dimple is a semi-spherical retraction.
The depth of the dimple is equal to half that of the #5 or
#6 round bar. The diameter of the dimple is the same as
that of the #5 or #6 round bar. The length of the dimplebar is 1.5 cm (4). Therefore, the force from the dimplebar supplements the friction force between the inner and
outer caps, and because it is on the axial wall to the side
of the missing tooth, the dimple-bar is covered by the
mesial surface of the artificial teeth.
Discussion
The retaining appliance for the removable partial
denture was developed in consideration of the increasing
demand for esthetic quality. Many attachments have been
designed, but most have been used without improvements.
Owing to progress in casting techniques and the
development of the parallelometer, the compatibility and
operating properties of the telescopic crown have
improved markedly. For example, the Channel Shoulder
Pin (CSP) introduced by Steiger (2), the Telescopic
system devised by Botteger (5), the removable closure of
the interdental space by Gaerny (6), and the cone
telescope developed by Korber (7) have been widely used
in a clinical setting. However, these are very expensive,

custom-made
semi-precision
crowns.
The ability of
dentists to handle such developments must be improved,
as the soldering
and manufacturing
processes
are
complex, and some difficulties exist in postoperative
maintenance due to reduction of retaining ability and
breakage. Recent progress in reproduction techniques for
models in the process of manufacture of metal frames has
made it possible to make more complex casts, resulting in
improvements in compatibility and retaining ability.
The retaining ability of a telescopic crown decreases in
accordance with wearing time. If 1000 denture-wearing
times are repeated, the retaining force of the telescopic
crown decreases
to 50% of its original force (8).
Therefore, an auxiliary retaining appliance is required to
compensate for this decrease in retaining force. In this
case, the dimple-bar designed for the lower left first
molar and lower right second premolar produces a
retaining force through insertion of the semi-spherical
protrusion
part into the dimple, and maintains
the
retaining force for extended periods due to its high
flexibility.
In addition, it is possible to control the
retaining force by simply adjusting the dimple-bar.
Regarding the submergence of the denture base in
accordance
with rotation of the denture around the
abutment teeth during functional loading, the ridge of the
alveolar bone beneath the denture base might be absorbed
and reduced. Therefore, in the present case a newly
altered casting technique was applied to obtain an optimal
functional
supporting effect with the denture base.
Furthermore, in addition to the altered casting technique,
guiding channels were formed at right angles to the
occlusal plane on the left second premolar and the right
first premolar. It is conceivable that guiding channels at
right angles to the occlusal plane might be effective for
preventing submergence of the partial denture. Also,
taking the vertical support of the abutment tooth at
occlusal loading into account, shoulders were formed at
right angles to the direction of occlusal loading on the
lingual wall from the mesial to the distal guiding
channels. From the above, it can be assumed that the
DBT system has a clamping effect which stabilizes and
minimizes functional loading on the remaining tissue; i.e.
the abutment tooth and its surrounding
tissue, and
beneath the denture base. Also, as the DBT system can
be formed within the intracoronal space of the abutment
tooth, it has an advantage in maintaining the comfort of
the tongue during orofacial motor functions, such as in
chewing and speech.
Conclusion
Our clinical evaluation of the DBT system can be
summarized as follows :
1. The system satisfied the esthetic desire of the patient
by showing no exposed metallic surfaces of the
retaining appliance.
2. It is possible to compensate
for the decrease in
retaining force of the telescopic system using the
dimple-bar.
3. A porcelain fused-to-metal crown was applicable to
the DBT system.

47

4. Improvement of handling properties and adjustability

resulted in easy clinical application.
5. The intracoronal attachment with the DBT system is
easy to clean, and the patient is satisfied with the
result.
Through this therapeutic experience, it is considered
that this system is favorable for clinical cases in which
esthetic quality is demanded.
References
1. Matsumoto, T. (1985) Aesthetic prosthesis utilizing
Dowel, Dimple-bar System. Nihon Univ. J. Oral Sci.
11, 35-41(in Japanese)
2. Steiger, A.A. (1949) Planostat und Parallelofor zur
Rillen-Schulter-Stift-Befestigung
von partiellen
Prothesen<<Ste-System>>.
Schweiz.
Mschr.
Zahnheilk. 59, 21-29 (in German)
3. Fauchard, P. (1969) The surgeon dentist or treatise on
the teeth. 2nd ed., Vol.11, Milford House Inc., New

York, 88-92
4. Kuroda, N., Ishii, T., Iijima, M., Shimazaki, R.,
Matsumoto, T. and Ikeda, S. (1988) Utilizing of
tubing method to horizontal bar clasping system.
Nihon Univ. J. Oral Sci. 14, 469-472 (in Japanese)
5. Mager, H. (1973) Das Teleskopsystem in der
zahnarztlichen Prothetik. 4th ed., Johann Ambrosius
Barth, Leipzig, 33-85 (in German)
6. Gaerny, A.A. (1972) Removable closure of the
interdental space (C.I.S.). Buch-und ZeitschriftenVerlag Die Quintessenz, Berlin, 13-34
7. KOrber, K. (1983) Konuskronen. Das rationelle
Teleskopsystem Einfiihrung in klinik und Technik.
5th revised ed., Dr. Alfred Huthig Verlag, Heidelberg,
64-90 (in German)
8. Nagasawa, T., Kubo, M., Maeno, N., Yamashina, T.
and Tsuru, H. (1978) Experimental study on the
decrease of retentive force of several attachments. J.
Hirosima Univ. Dent. Soc. 10, 63-69 (in Japanese)