Extracoronal Attachments Research Articles

AMOUNT OF BONE LOSS AND DIGITAL OCCLUSAL ANALYSIS OF DIFFERENT ATTACHMENT DESIGNS IN BILATERAL DISTAL EXTENSION PARTIAL DENTURE CASES

Background: OT unilateral extra-coronal attachmentconsidered as one of the best choices for distal extension partially edentulous cases. Aim: Comparing OT unilateral extra-coronal attachment with modified OT unilateral extra-coronal attachment RPDs with bracing arm regardingamount of bone loss and occlusal load (using T-scan system). Methods: Ten patients have missing bilateral mandibular molars teeth were treated according to split-mouth design using protocol A (OT unilateral extra-coronal attachment) and protocol B (modified OT unilateral extra-coronal attachment with a bracing arm). Amount of bone loss was evaluated radiographically at time of denture insertion, 3months, 6month, 9months, 12month and 18 months after denture delivery to measure the bone height changes. Also, occlusal load was evaluated using T-scanner (Digital occlusal analysis). Results: Regarding bone loss: Protocol B was significantly lower than protocol A after 6 and 12 months, while in occlusal load analysis Protocol B was insignificantly lower than protocol A. Conclusion: Less vertical bone height resorption and less occlusal forces in bracing side (OT unilateral extra-coronal attachment RPDs with a bracing arm) when compared with the non-bracing side.

Comparison in Bone Density Changes for Two Different Designs in Treatment of Mandibular Bilateral Free End Saddle with Osseointegrated Implants

AIM: The aim of this study is to evaluate two different designs in mandibular bilateral free end saddle cases with the use of osseointegrated implants. The designs evaluated were OT-strategy extracoronal attachment and bar attachment. Radiographic evaluation was carried out for implants and natural abutment in terms of bone density.
 MATERIALS AND METHODS: This study was conducted on 10 patients with bilateral distal extension area with missing molars bilaterally; the patients were divided into two groups after implant insertion on the second molar area. Group I: Patients received extracoronal attachment distal to the last natural abutment teeth with the construction of metallic removable partial denture (RPD). Group II: Patients received bar attachment with the construction of metallic RPD. Both groups have the maxillary arch edentulous with the construction of complete maxillary dentures within our study. Radiographic evaluation for bone density was done for both groups at the time of prosthesis insertion, 3, 6, and 9 months later. A comparison between the two groups regarding each follow-up period was performed by an independent t-test.
 RESULTS: Although there were some differences between both designs in the 1st-time intervals, generally, there were no significant differences between the two designs all over the 3-time intervals.
 CONCLUSION: From the results of this study, it was concluded that: Although there were no significant differences between both designs, bar-attachment showed better results which should be confirmed with more future researches.

Prosthodontic Rehabilitation of Missing Dentition Using Multi Unit Precision Attachment Hybrid Overdentures–Clinical Report of Two Patients

Prosthodontic rehabilitation of a patient with terminal dentition is very challenging. Any conservative treatment that can delay or eliminate future prosthodontic problems should be considered. Complete and partially edentulous patients are generally unsatisfied due to the inherent instability of dentures during functional and parafunctional movements which results due to the lack of adequate supporting hard and soft tissues. Inspite of rapid development and good success rate in the field of implantology, preservation of remaining natural teeth or roots is more desirable which supports Devan’s dictum. Overdenture is a complete or partial denture prosthesis supported partly by soft tissues and partly by retained natural teeth or its roots or implants. Overdenture increases the retention, stability and support, improves the masticatory efficiency, preserves the alveolar bone and muscular patterns and preserves sensory receptors within the periodontal ligament which increases manipulative skills in handling the denture. Retention and stability of overdentures can be improved by attachments or magnets. Fixed partial denture is not an option when there is no distal abutment. The solution of such a critical situation is to give combined or hybrid prosthesis. A combined prosthesis carries the advantage of fixed removable prostheses without surgical intervention, where an acrylic prosthesis is retained with an extra coronal attachment to tooth. This paper presents a twin patient report of rehabilitation of a mandibular and maxillary terminal dentition with a combined prostheses of acrylic retained by extra coronal precision attachment system (Rhein 83, Italy)

Rehabilitation of partially edentulous patient using Precision Attachment denture– A case report

Satisfactory restoration in a patient with a partially edentulous situation can be challenging especially when unilateral or bilateral posterior segment of teeth is missing. Successful restoration can be done with various conventional and contemporary treatment options. One such treatment modality is attachment-retained cast partial dentures. This paper describes a case report of a patient with mandibular bilateral distal extension edentulous span restored with a cast partial denture having an extracoronal castable precision attachment (RHEIN 83 OT CAP attachments system). Keywords: Precision attachment, Removable denture, Retentive denture.

English

English

EVALUATION OF DIFFERENT PROSTHETIC DESIGNS OF IMPLANT ASSISTED REMOVABLE PARTIAL DENTURES USED IN MANDIBULAR KENNEDY CLASS II CASES. A THREE –DIMENSIONAL FINITE- ELEMENT ANALYSIS.

The puroose:The aim of this study was to evaluate the effect of different designs of removable partial denture (RPD) supported with distal implant for the treatment of mandibular Kennedy class II cases on the behavior of oral structures by using Three-dimensional (3D) finite-element analysis (FEA). Materials and methods: A three models of mandibular class II Kennedy arch received three RPD designs were evaluated. The first model involves the use of RPI clasp on the first premolar. The second model involves the use of an extra coronal attachment at the distal aspect of the splinted first bicuspid and canine abutments. The third model received a bilateral (RPD) with RPI clasp on the first premolar and a double Aker clasp on the second premolar and first molar of the opposite side. For all models a single implant was placed at the second molar region with a conventional ball and socket attachment. For each model, a vertical and oblique loads of 100N were applied to the second molar area . The created model components were then imported to FEA software (ANSYS). Results: The first model recorded a significant less stresses at the bone, mucosa and abutment teeth in comparison to the other models but insignificance differences occurred in the total deformations. Conclusion: The von Mises stress and deformation produced in case of model 1 (clasp design) was better than that occurred with the other two models ( bilateral and extracoronal attachments)

THE BIOMECHANICAL COMPARISONS OF DIFFERENT PERIODONTAL CONDITIONS UNDER THE DIFFERENT EXTRACORONAL PRECISION ATTACHMENT RESTORATIONS FOR THE MANDIBULAR KENNEDY I DENTITION DEFECT

Extracoronal precision attachment provides an available solution for complicated periodontal conditions in patients with dentistry defect. The mandibular Kennedy I dentition defect refers to the dentition defect at bilateral free-end molars. The bilateral nearby teeth are used as the abutment of extracoronal precision attachment to offer supporting forces. However, it is difficult to choose the quantities of abutments for patients with various periodontal conditions. The aim of this study is to suggest quantities of abutments based on stress distributions under various periodontal conditions for patients with mandibular Kennedy I dentition defect. Models were constructed from computed tomography, and they were assembled and analyzed in ANSYS. Seven models were used in our study based on different periodontal conditions and quantities of abutments (three models in healthy periodontal condition using single, double and triple abutment(s) restorations, two models with one absorbed abutment using double and triple abutments restorations and two models with two absorbed abutments using double and triple abutments restorations). The degree of absorbed abutments was 1/3. The mandible and other structures were considered as an orthotropic material and isotropic materials, respectively. Loads and boundary conditions corresponded to the realistic occlusion. Poor periodontal conditions enlarge the stress on abutments and surrounding structures. In addition, the increase in quantity of abutments causes the decrease and distribution of stress to differ. Different periodontal conditions require different quantities of abutments for recommendation in rehabilitation. The double abutments restoration is suitable for patients without absorbed abutment. The triple abutments restoration should be considered for patients with only one absorbed abutment. If more than two absorbed abutments exist, the extracoronal attachment denture restoration is not recommended for patients.

Class II Kennedy implant assisted mandibular removable partial dentures with and without cross arch stabilization: A strain gauge in vitro study.

Introduction Dental implants and extracoronal attachments were used with Kennedy class II implant assisted removable partial dentures (IARPD) without a major connector. strain gauges were used to detect the microstrains generated around the abutments and dental implants. Materials and Methods Thirty acrylic resin models of a mandibular class II Kennedy received 3 RPD designs; a clasp retained RPD in group I, a unilateral clasp retained RPD without a major connector supported by a dental implant placed once at the first molar and once at the second molar position in group II, and in group III, a clasp free RPD, with extracoronal attachments, supported by a dental implants placed in similar positions to group II. Strain gauges were used to determine which design generated more significant loads, and recorded microstrains were statistically analyzed using the Kruskal-Wallis and Mann-Whitney tests. Results Significantly greater loads around abutment teeth were reported in group II and group III than in group I. The distal placement of the implants resulted in significantly greater microstrains more than the mesial placement in groups II and III, and both placements were of more intensity in group II than in group III. Conclusions A Kennedy class II IARPD can be effectively altered to a bounded space prosthesis by placement of a dental implant in the first rather than the second molar position, and together with an extracoronal attachment, the clasp and major connector can be omitted once the edentulous span is short, and the clinical situation is favorable.

EVALUATION OF BITING FORCE FOR THREE DIFFERENT PARTIAL DENTURE MODALITIES IN BILATERAL DISTAL EXTENSION CASES (CROSSOVER STUDY)

The purpose of the present study was to assess the magnitude of biting force in three different partial denture designs. Methodology: A total of ten patients with mandibular bilateral free end saddles without modification (Unmodified class I) were included in this study. All patients received three successive partial denture designs (conventional, extra-coronal attachment and posterior implant with bar attachment successively). Each design was used for 4 months intervals. The mean biting force was measured at the time of insertion and after 4 months for each design. Results: One way ANOVA followed by Post Hoc test was made to check the significance within each group and between groups of different designs for the biting force measurements. The data revealed that the magnitude of biting force at insertion was 44.425+6.21398, 84.1050+5.93779 and 129.1900+7.92749 for conventional, extracoronal attachment and implant bar attachment design respectively, while after 4 month it was 49.4900+5.41002, 90.1850+6.36713 & 142.5700+7.49098 for conventional, extracoronal attachment and implant bar attachment design respectively. Conclusion: Within the limitation of this study it can be concluded that: 1- Using a posterior implant with bar supporting and retaining removable partial denture is a viable treatment option for free end saddle cases. 2- Significant improvement in biting force occurred by changing the design from conventional to extra-coronal attachment and from extra-coronal to implant bar attachment.

Radiographic Evaluation of Two Different Designs for Treatment of Mandibular Bilateral Free End Saddle with Osseo-integrated Implants

Purpose: Thegoal of this study was to evaluate radiographically two different designs for mandibular freeend saddle with osseointegrated implants.Materials and Method: Ten lower Kennedy class I partially edentulous patients were selected to receiveimplant at the second molar area, then patients were divided into 2 groups according to the implantsuperstructures either (extra-coronal attachment or bar attachment). Patients of both groups receiveremovable partial denture of the same design. Patients were followed up for 0, 3, 6 and 9 months clinically.Results: Showed statistical difference between the 2 designs.Conclusion: It could be concluded that Tooth-implant supported partial denture may be reasonable andsimple solution for Kennedy class I partial denture.

A case report of esthetic rehabilitation by extracoronal attachment

A case report of esthetic rehabilitation by extracoronal attachment

Effect of lingual bracing arm incorporated with extracoronal attachment for mandibular distal extension base on abutment alveolar bone height change

Effect of lingual bracing arm incorporated with extracoronal attachment for mandibular distal extension base on abutment alveolar bone height change

Use of a Semi-Precision Attachment to Fabricate A Removable Partial Denture: A Case Report

Use of attachment in providing retention to removable prosthesis is an old treatment modality with better success. It highly improves the comfort, aesthetic, function, and patient satisfaction, especially in the patients with long span edentulism where implants and fixed partial denture (FPD) are not indicated and cast partial dentures are barely satisfactory. Proper diagnosis and treatment planning is necessary for selection of appropriate attachment type. A comprehensive evaluation, multi-disciplinary approach and sequential treatment planning is needed for long-term successful outcome. This case report describes the use of an extra coronal semi-precision attachment to enhance retention of removable prosthesis.

Marginal bone level evaluation for combined tooth-implant retained Kennedy Class I Partial denture versus implant retained partial denture using extracoronal attachments

Aim: This study was conducted to evaluate and compare marginal bone level for Tooth-implant supported Kennedy class I partial denture compared to implant supported Kennedy class I partial denture using extracoronal attachments. Subjects and Methods : Ten male partially edentulous patients (Kennedy class I) with the canines are the last standing abutments were selected and all patients were rehabilitated with metallic partial denture supported by osseointegrated implants one on each side of the arch positioned in the premolar area and were randomly divided into two equal groups according to type of abutments, Group I; Patients were rehabilitated with Tooth Implant Retained partial denture with extra coronal attachment, Group II; Patients were rehabilitated with splinted Implant Retained partial denture with extra coronal attachment on each side. Evaluation by measuring marginal bone level for last main abutments was made at the time of insertion, after 6 month, after 12 month and last after 18 month using radiographic evaluation. Results: Partial dentures retained by two splinted implants showed better non-significant difference in marginal bone loss as compared with tooth implant retained Partial dentures. Conclusion: Using tooth implant retained partial dentures shows better effect on supporting structure as compared compared with tooth implant retained Partial dentures.

The stress model of abutment tooth and periodontal tissues with unilateral mandibular dissociation and loss by precision extracoronal attachment.

In order to explore the application of the precision extracoronal attachment based on three-dimensional finite element stress model in the repair of unilateral mandibular dissociation and loss, the stress distribution of the butment and periodontal tissues when the precision extracoronal attachment was used in unilateral mandibular dissociation and loss was analyzed, so as to provide reference for the application of materials in clinical repair. In this study, the biomechanics of oral cavity and its attachment were analyzed to provide theoretical basis for model construction. Because the degree of periodontal tissue absorption and the number of abutment teeth affected the restoration effect of the coronal precision attachment, the models were established from these two perspectives. The results showed that when the periodontal tissue absorption of both abutment teeth exceeded 1/3, the method of double abutment restoration was not recommended. When three abutments were used, there was a significant decrease compared with the absorption of the periodontal tissue of the double abutment. In clinic, the stress distribution of the distal abutment teeth and its periodontal tissues can be improved by increasing the number of abutment tooth. However, since increasing the number of abutments required an increase in the amount of healthy tooth tissue, it couldn’t be blindly selected in the clinic. After comprehensive consideration, it is appropriate to choose two abutment teeth for restoration.

Prosthetic rehabilitation using extra coronal attachments

Prosthetic rehabilitation using extra coronal attachments

The effect of using Different designs on distal implant for treatment of mandibular Kennedy class II cases

The Purpose of the current study was to evaluate radiographically the effect of using OT CAP, OT unilateral and magnet extra-coronal attachments placed on second premolars with different RPD designs on the distal implant placed in mandibular unmodified kennedy class II cases. Materials and methods: Twenty-one patients having unmodified mandibular kennedy class II with distal implant installed in the molar region. Group I patients were rehabilitated with an implant assisted removable bilateral partial denture retained by ball and socket extra-coronal attachment (OT CAP attachment Rhien 83, Italy). Group II were rehabilitated with an implant assisted removable bilateral partial denture retained by magnet attachment (Dyna system magnet). Group III Patients were rehabilitated with unilateral (side plate) removable partial denture retained by another design of extra-coronal attachment (OT unilateral Rhien 83, Italy). Peri-implant marginal bone loss was evaluated around the distal implant in each group using standardized periapical intra-oral radiographs using a long cone paralleling technique. The peri-implant marginal bone loss was measured at the time of loading of the distal implant (0 month), after 6 months and 12 months. Results: There was no statistically significant difference in the mean marginal bone loss (P> 0.05) between the OT unilateral, magnet and OT CAP attachment groups at 0-6 months follow up interval. There was a statistically significant difference in the mean marginal bone loss around the distal implant between the three groups in the (6-12 months) and (0-12 months) follow up intervals. The highest peri-implant marginal bone loss was recorded in group III with the unilateral partial denture design. Conclusion: Within the limitation of this study it could be concluded that although enrolling extracoronal attachments in the design of Kennedy class II is acceptable as a treatment modality, the unilateral design may cause the highest bone resorption around the distal implant.

Removable Prosthesis with Extra Coronal Attachment for the Management of Distal Extension Case: A Case Report

Even though dental attachments have a long successful history, many of the dental practioners are unaware about its benefits in daily clinical practice. It highly improves the comfort, aesthetic, function and patient satisfaction, especially in the patients with long span edentulism where implants and fixed partial denture (FPD) are not indicated and cast partial dentures are barely satisfactory. This case report describes the clinical and the laboratory steps for prosthetic rehabilitation of a patient with maxillary distal extension partially edentulism with cast partial denture using Preci Vertex attachments.

Stresses Induced By Integrated and’ Nonintegrated Extracoronal Semi-Precision Attachments For Maxillary Distal Extension Bases

Purpose: The aim of the present study is to compare the stresses induces on the splinted abutments by two different reciprocation designs in conjunction with extracoronal semi-precision attachments retained removable partial denture (RPD) using strain gauge analysis. Material and methods: For this study, two RPD designs were made A, and B. representing maxillary bilateral distal extension edentulous area. The two abutments, canine and first bicuspid was fixed splinted on both sides with porcelain facing crowns. For design (A) an extra coronal attachment with integrated interlock was used at the distal aspect of the splinted first bicuspid and canine. For design (B) a parallel interlock extra coronal attachment was used with a conventional lingual bracing arm. A strain gauge was used for this study to measure the micro-strain induced on the apical and lateral sides of the canine and first-bicuspid abutments. Results: SPSS software program was used in the statistical analysis of the results. The results revealed that maximum stresses induced at the apex of the canine and firstbicuspid abutments were in case of design (B). While no significant difference between the two designs when the lateral load was applied Conclusion: A more favorable stress applied on the canine and bicuspids obtained with integrated interlock attachment.

Esthetic and Functional Rehabilitation of an Adult Cleft Lip and Palate Patient Using Combined Fixed and Removable Prosthesis

Successful oral rehabilitation of adult patients with cleft lip and palate requires definitive fixed or removable prosthesis to assist orthodontic and orthognathic treatments. Prosthetic rehabilitation aims to improve the functional and esthetic demands and provides better oral health. The aim of this case report is to introduce a prosthetic approach for functional and esthetic rehabilitation of an adult male patient with surgically repaired cleft lip and unrepaired palate, by a combination of fixed dental prosthesis with an extracoronal attachment retained gingival veneer and a cast partial hollow-bulb obturator.