Attachments in Removable Prosthodontics

Lecture Outline
Why do we use attachments in removable prosthodontics? Retention of removable partial dentures. Definition of attachments. Classification of attachments. Indications for attachments. Contraindications for attachments. Advantages of attachments. Disadvantages of attachments. Other attachments and retention devices. How to choose appropriate attachments for different cases? References.

Attachments
Retention, support and stability. Can be used with: Partial dentures. Overdentures. Implants.

Retention of Removable Partial Dentures

Retention

Neuromuscular control

Mechanical

Inherent physical forces

Clasps

Undercuts

attachments

Definition
An attachment is a mechanical device made up of two components, one located in or on the abutments tooth and the other housed in the denture. When the two matched parts are linked together they produce very positive retention.

Classification
Size: Macro or Micro

Fabrication: Precision or Semiprecision

Attachments

Location: Intracoronal or Extracoronal

Functional characteristics: Rigid or Movable

Intracoronal Attachments -1
Two components: Matrix and Patrix. Sliding joint configuration. Retain, support and stabilise the removable partial denture.

Intracoronal Attachments -2
Crowns. At least 4 mm vertical space. At least 3 mm buccolingual space. Parallelism.

Intracoronal attachment -3
Location : Intracoronal. Size : Micro attachments. Functional characteristics: Rigid attachments. Fabrication: Precision or semi precision attachments.

Extracoronal attachments -1
Two components: e.g. Dalbo (Patrix) and other component (Matrix) held in denture. Sliding joint configuration. Retain and stabilise removable partial dentures.

Extracoronal attachments -2
Reside entirely outside the normal clinical contour of abutments. Need no space within the abutment crown. May be employed where buccolingual space is limited. often employed to retain bilateral distal extension prostheses.

Extracoronal attachments -3
Location: Extracoronal. Size: Micro attachments. Functional characteristics: Rigid or movable attachments. Fabrication: Precision or semi precision attachments.

Extracoronal attachments -4
Rigid : only allow movement in one direction. Movable: movement allowed should be regarded as a safety valve and not as a means of anchoring an unstable prosthesis to natural teeth.

Macro attachments
E.g. Telescopic crowns

Indications
When neither fixed bridge nor clasp retained denture would be satisfactory. Small bounded saddles with considerable bone loss. Retain bilateral distal extension prosthesis. Join a series of crowns which dont have common path of insertion. Overdentures. Implants.

Contraindications
Short clinical crowns of abutment teeth (Intracoronal attachments). Limited buccolingual space of abutment teeth (Intracoronal attachments). Large size of pulp (Intracoronal attachments). Poor periodontal health of abutment teeth (Rigid attachments). Lack of experience and clinical skills (Extra and Intracoronal attachments). Bad oral hygiene (Extra and Intracoronal attachments).

Advantages
Better aesthetic results and more effective retention than clasps. More apical functional load transfer to abutments than rests (Intracoronal attachments). Diminish rotational movements of abutments (Intracoronal attachments). Improved cross arch load transfer and stabilisation of prosthesis. Limit the potentially damaging force imparted to abutments (Extracoronal attachments and Intracoronal attachments).

Disadvantages
Abutment teeth usually have to be crowned. Occupy a lot of space. Encourage plaque accumulation. Require ongoing maintenance. Clinical and technical skills are demanding. Relatively expensive.

Other attachments and retention devices 1

Stud attachment Used with overdentures.

Other attachments and retention devices 2

Magnets No demands on the periodontal tissues of abutment teeth.

Other attachments and retention devices 3

Two parts denture Needs good manual dexterity.

How to choose appropriate attachments for different cases? -1

Personal design philosophy Rigid or movable? How much resiliency?

How to choose appropriate attachments for different cases? -2

Condition of the abutment teeth Intra or extracoronal attachments?

How to choose appropriate attachments for different cases? -3

Condition of the nonabutment supportive structures (periodontal tissues and alveolar ridge) Rigid or movable ?

How to choose appropriate attachments for different cases? -4

Manual dexterity Intra or extracoronal attachments ?

References
Stewarts Clinical Removable Partial Prosthodontics, Third Edition. Chapter 20, Attachments for removable partial dentures, pages 507-515. Preiskel, H. W. (1974). "Precision attachments for the partially dentate mouth." Annals of the Royal College of Surgeons of England 55(6): 294-298.