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PRECISION ATTACHMENTS

CONTENTS
Introduction History

Definition and synonyms of attachments


Classification Indications / Applications of precision attachments

Contraindication Advantages
Disadvantages Selection of the abutment teeth

Requirement of the abutment teeth


Selection of the retainer Selection of the attachment

Intracoronal attachment Precision / Semiprecision attachments

Mechanics of retention
Rigid / Resilient attachment

Extracoronal attachment

Extracoronal resilient attachment (ERA) O-ring attachment

Role of attachment as stress breaker : Broken stress philosophy Bar attachments Stud attachments

Magnets as attachment Auxillary attachments


Conclusion

INTRODUCTION

The desire to balance between functional stability


and cosmetic appeal in partial dentures gave rise to the development of Precision Attachments

Precision

Attachments have surrounded by an aura of mystery.

always

been

The use of Precision Attachments for partial denture


retention is

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

Winder Winders design Screw joint retention


Parr (1886)

Extracoronal socket attachment


Stair Telescopic abutment restoration

Ash (1912)
Split bar attachment system

Late 19th century :


Dr.Herman, ES Chayes

T shaped

Precision Attachment
(1906)

H shaped

Chayes Attachment (1912)


First attachment to be available in the general market

Precision quality or state of being precise Attachment Mechanical device for the fixation, retention and stabilization of dental prosthesis.

Pin slot
chayes

Ceka & dallabona

Precision Attachment (GPT-8) :


A retainer consisting of a metal receptacle (matrix)
and a closely fitting part (patrix); the matrix is usually contained within normal or expanded contours of the crown on the abutment tooth and the patrix is attached to a pontic or the removable partial denture framework.

An interlocking device, one component of which is


fixed to an abutment or abutments, and the other is integrated into a removable prosthesis to stabilize and/or retain it.

Mechanical device Direct retainer They are designed to replace occlusal rest, bracing arm, and retaining arm of the conventional clasp retained partial denture.

They function to retain, support and stabilize the removable


partial denture.

SYNONYMS OF ATTACHMENTS Internal attachments Frictional attachments

Parallel attachments Slotted attachments Key and Key way attachments. Male attachments Patrix Flange Insert Key Fitting part

Female attachments Matrix Slot Crypt Keyway Receptacle

CLASSIFICATION OF ATTACHMENTS

Based on method of fabrication and the tolerance of fit


I. Precision attachment (prefabricated types)

II.

Semiprecision attachment (custom made / laboratory made types)

Prefabricated wax / plastic / nylon patterns

According to their relationship to the abutment teeth

Intracoronal (Internal attachment) Extracoronal (External attachment)

Based on stiffness of the resulting joint Rigid attachments Resilient attachments (Non rigid)

Based on geometric configuration and design of the attachment.

Key and Keyway Interlocks


Ball and socket Bar and clip / sleeve Hinge

Telescopic Push button Latch


Screw units

Classification used in literature :

M.C. Mensor (1973)


Classification according to shape, design and primary area of utilization of attachment. Coronal Intracoronal Extracoronal Radicular Telescope studs (pressure buttons) Bar attachment (Bar joints and Bar units) Accessory Auxillary Screw units Bar connectors Bolts Stabilizers Balances Interlocks

Gerardo Beccera and others (1987) Intradental attachments Frictional Magnetic

Extradental attachments Cantilever attachment Bar attachment

ADVANTAGES

Improved esthetics and elevated psychological acceptance

Mechanical advantage - Direct the forces along the long axis of the teeth / more apically - Force application closer to the fulcrum of the tooth

Reduces Non axial loading

Decreases Torquing forces Rotational movement of the abutment

In Distal extension base cases Broken stress philosophy

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

Minimum occlusogingival abutment height (4-6mm)


To incorporate attachment without overcontouring Enough length of parallel contact

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)

Wearing of attachment components

Require high technical expertise Dentist and laboratory technician Requires aggressive tooth preparation

Cooperation and manual dexterity on the part of the patient


Difficult to insert and remove Visually or manually challenged patient

Increase demand on oral hygiene performance

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

Stress Breakers Free end saddles/Distal Extension Base cases (DEB)


When cantilevered pontic is to be used as abutment

For movable joints in sectional dentures Periodontal involvement of the tooth


Contraindicates rigid FPDs Most efficient bilateral bracing and support are essential

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)

To overcome alignment problems where abutments have differing path of withdrawal.

IMPLANT PROSTHODONTICS Implant supported over denture They are used for connection between the tooth and the implant

CONTRAINDICATIONS OF PRECISION ATTACHMENTS

Poor periodontal support.

Poor crown to root ratio

Poor oral hygiene habits Abnormally high carious rate Inadequate space / room to employ the attachment Compromised endodontic and restorative conditions

SELECTION OF THE ABUTMENT TEETH

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

REQUIREMENTS FOR THE ABUTMENT TEETH Axial space requirement


Sufficient clinical crown length for minimum of 4mm attachment length

Maximum attachment length 6-7 mm

Minimum attachment length 4mm

Inadequate attachment length < 4mm

Buccolingual space requirement

Adequate space between the pulp and the normal contour of the tooth

SELECTION OF THE TYPE OF RETAINER Full crown retainers Intracoronal attachments


More retentive / rigid
Ideal contours Caries protection

Partial coverage retainers Kennedys Cl III partial denture

Splinted abutment teeth


Most vulnerable Inadequate retention

Marginal leakage

Inlays / onlays / pin ledges Not used for intracoronal attachments


Lack of retention

Marginal caries
Less life

Selection of the attachments


Intracoronal vs Extracoronal Resilient vs Non resilient

EM attachment gauge (Matsuo (1970)

75 mm in length Red 3-4 mm Yellow 5-6 mm

Black 7-8 mm

EM attachment selector (Dr. MC Mensor (1973)

105 attachments

30 points of information

Quick reference Communication between the dentist & laboratory technician

INTRACORONAL ATTACHMENTS

Precision attachment (prefabricated type)

Semiprecision attachments (custom made)

Intracoronal precision attachment


(Dr. Herman E.S Chayes)

Conventional attachment T shaped attachments

Modern attachment H shaped 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

DEPENDING ON ARTICULAR RETENTION


Passive attachment Active attachment
Locked precision attachment

Passive Attachment :

Matrix : Simple channels closes at one end to provide stop


Patrix : Solid slide Channels of passive attachment may be round / elliptical slides

Omega

Beyeler

ACTIVE ATTACHMENT Active friction grip attachment Active snap grip attachments

McCollum

Crismani

Crismani

Locked precision attachment


Attachments bolted by means of a sliding bolt or latch

Pinned or screwed together


Latch retained

Mc Collum attachment : H shaped attachment Single adjustment slot

Retention expanding the adjustment slot

Stern attachment Two adjustment slots

Stern Gold latch retained

Crismani attachment : Available as Rigid / Resilient

Rigid crismani attachment Frictional grip


Mechanical Spring clip

Neys attachment :

Conventional H shaped

Ney loc split lingual

Latch retained

Bakers attachment

Schatzmann attachment

Frictional retention

Mechanical retention (spring loaded plunger & coil spring)

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)

Locking semiprecision attachment

Non locking semiprecision attachment

Louis blatter fein (1969) : Four aspects of rest seat preparation


Occlusal form / outline form controls amount of rotation

Circular

Dove tail

Rectangular

Mortice

Resilient Some resiliency (Non-locking type) Proximal form / side walls lateral force control

(Rigid locking type)

Parallel outline

Tapering outline

The angle of the proximal wall with the gingival floor

Gingival floor form : serves the function of reciprocation

Added reciprocation

Flat

Inclined

Channeled

Mortice occlusal form

Rectangular occlusal form

Locking Semiprecision Attachments

Neurohr Williams No. 1 (Mortice rest)

Neys MS Intracoronal attachment (circular rest)

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

Introduced by Henry R. Boos (1900)


Modified by F Ewing Roach (1908)

Application Kennedys class I and class II

Boitel (1978)
Rigid attachments Resilient attachments Bar attachments

EXTRACORONAL ATTACHMENT

Rigid attachments

Hinged attachments (Stress breaking action)

Resilient attachments ERA

O-ring Advantages :
No alteration of contour of the abutment crown Can be used in short abutment teeth Greater freedom in the design

Ease of insertion and removal

Disadvantages (Wolf RE 1980) :

Lack of occlusal satability


Bulky Rebasing problems Improper control of force distribution Encroachment on the gingival papilla use of mini attachment

RIGID EXTRACORONAL ATTACHMENTS

Roach attachment (ball and tube attachment)


Oldest attachment Patrix round ball Matrix - tube

Pin and tube attachment


The simplest Patrix - pin Matrix tube

Stabilex attachment

Two retention pins


Disadvantage is increased length Patrix Matrix

Conex attachment
(Smaller version)

Assembled
Two types pins

Frictional retention Mechanical locking

RESILIENT EXTRA CORONAL ATTACHMENT

Dalbo / Dallabona attachment

a) Patrix
b) Matrix

Assembled

Dalbo stress breaker

Rotational
Matrix and patrix

and Vertical movement

Ceka attachment Developed by karl cluytens (1951)


Two types - Ceka NV attachment - Ceka revax

Matrix metal ring retainer

Patrix Attachment pin (split metal post)

Functional aspect : Mark E, Waltz 1973

A) Support
B) Bracing C) Retention Insertion and removal Reduces frictional wear
Attachment pin / split post

Ceka Revax

ROLE OF ATTACHMENTS AS STRESS BREAKER Broken stress philosophy

Rigid system

Non-rigid system Stress breaker

Mensor stress can only be selected, altered or blocked

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

STRESS BREAKER DESIGNS

ASC-52 attachment

Extracoronal resilient attachment

Patrix and Matrix

Crismani resilient attachment Hinge stress breaker

Neys distal extension stress breaker

Stern stress breaker

Anchorvis attachment

Extracoronal resilient attachment (ERA) :

(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

Use of ERA in DEB cases


Matrix Patrix

Vertical resiliency of 0.4mm


Universal joint hinge action Use in over denture

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

O-ring are made up of Silicone Nitrile Fluorocarbon Ethylene propylene

Advantages of O-ring Ease in changing the attachment

Wide range of movement


Low cost Different degrees of retention

Elimination of the time / cost of the superstructure

STUD ATTACHMENTS (ANCHORS)


Anchor the roots

Simplest of all the attachment


Partrix dowel / post retained restoration Matrix denture base of the prosthesis Classified as :

Rigid stud unit


Resilient stud unit Extraradicular units

Intraradicular units
Extraradicular Intraradicular

Space requirement of these attachment is intermediate between dome shaped coping and thimble shaped coping.

These should be placed parallel to the long axis of the tooth.

DALBO STUD ATTACHMENT

Rigid unit Nylon ring protects the lamella Retention altering the positions of free ends of the lamella

Ball and socket unit

(Vertical and rotational movement)

ROTHERMAN ECCENTRIC ATTACHMENT


Button shaped attachment

Patrix eccentric cylinder with undercut or groove


Matrix Clip or clasp arm

Activation : Bending the clasp arm towards center


Rigid units

Resilient unit

ZEST ANCHOR ATTACHMENT


Polyethylene Nylon stud
Patrix

Funnel shaped tube

Matrix

Advantages :
Reduce vertical space requirement Instrumentation kit

Loads are transferred more apically.

GERBER ATTACHMENT
Largest of the stud unit

Resilient spring controlled vertical plane


Patrix threaded post Matrix retention spring and ring

Resilient gerber

Rigid gerber

Disadvantages : Complex attachment system


Requires more space Permits little rotation

CEKA ATTACHMENT Patrix metal ring

Matrix attachment pin (split metal post)

Ceka revax

Extra radicular

Intra radicular

SPACER RING

Vertical movement of the prosthesis

SCHUBIGER ATTACHMENT

Patrix : threaded post / screw


Matrix : recessed collar, cap nut / lock nut

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

Post coping on endodontically treated teeth


Screwed down into the coping (implant system)

Types of bar attachments :


Customised bar

Dolder bar
Ackermanns bar CM rider bar

Hader bar
Andrews bar

Two groups of bar attachments :

1) Bar units - rigid


2) Bar joints permits rotation

BAR JOINTS

Single sleeve bar joints


Depending on cross section

Multiple sleeve bar joints

Round / circular

Oval / egg shaped

U shaped / parallel sided bars

DOLDER BAR

Egg shaped bar in cross section


Open sided sleeve Two sizes 3.5mm x 1.6mm, 3.0mm x 2.2mm Spacer degree of movement

MOVEMENTS SEEN IN DOLDER BAR

Rest position

Vertical translation

Sagittal rotation

Implant supported over denture

ACKERMANN BAR

Available in different cross section


Circular cross section can be bent in all planes

CM BAR
Made up of precious / semiprecious alloy Retention tags in long axis of the bar

HADERBAR

Helmut Hader in 1960


Available as a prefabricated plastic pattern Notable feature Resin / plastic sleeve

No spacer- more support

English, Donnel & Staubli (1992) Hader EDS system System with 3mm height (8.3mm).

Clips with metal encapsulator

Advantage

Prefabricated plastic pattern no need for soldering.


Precise fit, simplicity, versatility

Advantages of bar attachments :

Rigidly splint the teeth


Provides good retention, stability and support Provides cross arch stabilization

Positioned close to the alveolar bone (exhibit less leverage)


Disadvantages :

Bulk of bar Plaque accumulation


Wearing Soldering procedure

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)

Gillings magnetic attachment


(cobalt somarium alloy magnets)

Split pole paired magnets


Closed field magnetic system

Magnetic retainer with magnets


Magnetic keeper

Jackson magnetic attachment

(cobalt somarium alloy magnets)

Cemented in keeper

Screwed in keeper

SANDWICH DESIGN

Encapsulated magnetic retainer and magnetic keeper

Assembled attachment

Attractive breaking force 4.9 N (500 gm)

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

Screw and tube attachment


Key and keyway / interlocks Presso Matic or Isoclip Bar connectors Attachments for sectional dentures / bolts

Screw and tube attachment

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.

ATTACHMENT USED FOR SECTIONAL DENTURES


Two part dentures : One part - chrome cobalt base Second part - removable acrylic flange with teeth

Advantage of superior esthetics and improved retention Method of union :


Physical interference : Bolt retained prosthesis

Frictional resistance : Split post retained prosthesis

SECTIONAL DESIGNS

Individual sections / separate sections : uses mesial and distal surface of the abutment teeth as guiding planes.

Bolt retain two parts prosthesis

Hinged sections : Buccal and lingual path of insertion

CONCLUSION