Precision Attachments in Prosthodontics - Orthodontics Short Term Cour

3/10/2015
Precisionattachmentsinprosthodontics/orthodonticsshorttermcour
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1.www.indiandentalacademy.comwww.indiandentalacademy.com
2.PRECISIONATTACHMENTSINDIANDENTALACADEMYLeaderincontinuingdentaleducationwww.indiandentalacademy.com
www.indiandentalacademy.comwww.indiandentalacademy.com
3.CONTENTS Introduction History Definitionandsynonymsofattachments Classification Indications/Applicationsofprecision
attachments Contraindication Advantages Disadvantages Selectionoftheabutmentteeth Requirementoftheabutmentteeth Selection
oftheretainer Selectionoftheattachmentwww.indiandentalacademy.comwww.indiandentalacademy.com
4. IntracoronalattachmentPrecision/SemiprecisionattachmentsMechanicsofretention ExtracoronalattachmentRigid/Resilient
attachmentExtracoronalresilientattachment(ERA)Oringattachment Roleofattachmentasstressbreaker:Brokenstressphilosophy Bar
attachments Studattachments(DEB+overdentureattachments) Magnetsasattachment Auxillaryattachments Conclusion
6. OneofthepurposesintheOneofthepurposesintheHealingArtHealingArtistopreserveandistopreserveandmaintaineachbodily
organtoitsfullestextent.Themaintaineachbodilyorgantoitsfullestextent.Thefunctionsofteethandmouthareasimportantindailyfunctionsof
teethandmouthareasimportantindailyexercisesinhumanendeavorasthatofanyotherpartoftheexercisesinhumanendeavorasthatofany
otherpartofthebody.body. WeliveinademandingsocietyasstandardofWeliveinademandingsocietyasstandardofeducation,wealthand
leisurerise,sodoexpectations.Oureducation,wealthandleisurerise,sodoexpectations.Ourpatientsarebeginningtoapplytheseexpectations
aspatientsarebeginningtoapplytheseexpectationsasforciblytodentistryastoanyotheractivityandincreasingforciblytodentistryastoanyother
activityandincreasingtheirdemandforthehighstandardsofdentalcarethattheirtheirdemandforthehighstandardsofdentalcarethattheirwealth
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canbuyandthegoodappearancethatsocietyteacheswealthcanbuyandthegoodappearancethatsocietyteachesthemtovalue.themtovalue.
7. Insomesituations,usuallyintheanteriorsegmentsInsomesituations,usuallyintheanteriorsegmentsofthemouththeFPDcannotfulfillthe
cosmeticofthemouththeFPDcannotfulfillthecosmeticneedsofapatientwithoutimposinghygieneneedsofapatientwithoutimposinghygiene
problems,inthatcaseRPDismostuseful.Buttheproblems,inthatcaseRPDismostuseful.Buttheclaspsontheanteriorteetharenot
cosmeticallyclaspsontheanteriorteetharenotcosmeticallyacceptable.acceptable. ThebalancebetweenthefunctionalstabilityandThebalance
betweenthefunctionalstabilityandcosmeticappealisamajorchallengetothedentist.cosmeticappealisamajorchallengetothedentist.Avariety
ofsolutionshavebeenproposedintheAvarietyofsolutionshavebeenproposedintheformofinterlockingdevicesoftencalledPrecisionformof
interlockingdevicesoftencalledPrecisionAttachmentdesignedtoconnecttheprosthesistoAttachmentdesignedtoconnecttheprosthesistothe
abutmenttheabutmentwww.indiandentalacademy.comwww.indiandentalacademy.com
8.GOALSGOALS TheThegoalsgoalsforfabricationofPApartialdentureareaasforfabricationofPApartialdentureareaasfollows:follows:
ToprovideanefficientmasticatingreplacementofToprovideanefficientmasticatingreplacementoflostdentalorgans.lostdentalorgans. Tobe
removableandreplaceablewithoutstressorToberemovableandreplaceablewithoutstressorstrainontheabutmentteeth.strainontheabutment
teeth. Toallownormalanatomicformtotheabutmentteeth.Toallownormalanatomicformtotheabutmentteeth. Tobecapableofbeingtissue
supportedinaTobecapableofbeingtissuesupportedinacontrolledmannercontrolledmanner
9. ToallowforvariousocclusalcorrectionandToallowforvariousocclusalcorrectionandprovidemanyyearsofcomfortableservicesprovide
manyyearsofcomfortableservices TobeestheticallyacceptableandMinimalTobeestheticallyacceptableandMinimalamountoftoothstructure
removed.amountoftoothstructureremoved. ToavoidendodonticproceduresandtobeToavoidendodonticproceduresandtobehygienically
cleanhygienicallyclean ToplaceminimumamountofstrainontheToplaceminimumamountofstrainontheabutmentteethabutmentteeth
10.Late19thcentury:Dr.Herman,ESChayesFirstattachmenttobeavailableinthegeneralmarketTshapedPrecisionAttachment(1906)H
shapedChayesAttachment(1912)www.indiandentalacademy.comwww.indiandentalacademy.com
11.PrecisionqualityorstateofbeingpreciseAttachmentMechanicaldeviceforthefixation,retentionandstabilizationofdentalprosthesis.A
retainerconsistingofametalreceptacle(matrix)andacloselyfittingpart(patrix)thematrixisusuallycontainedwithinthenormalorexpanded
contoursofthecrownontheabutmenttooth/dentalimplantandthepatrixisattachedtoaponticortheremovabledentalprosthesisframework.
GPT8www.indiandentalacademy.comwww.indiandentalacademy.com
12.MechanicaldeviceDirectretainerTheyaredesignedtoreplaceocclusalrest,bracingarm,andretainingarmoftheconventionalclaspretained
partialdenture.Theyfunctiontoretain,supportandstabilizetheremovablepartialdenture.
13.SYNONYMSOFATTACHMENTSPatrixPatrixMatrixMatrixFlangeFlangeSlotSlotInsertInsertCryptCryptKeyKeyKeywayKeywayFitting
partFittingpartReceptacleReceptacleInternalattachmentsFrictionalattachmentsParallelattachmentsSlottedattachmentsKeyandKeyway
attachments. MaleattachmentsFemaleattachmentswww.indiandentalacademy.comwww.indiandentalacademy.com
14.CLASSIFICATIONOFATTACHMENTSBasedonmethodoffabricationandthetoleranceoffitI.Precisionattachment(prefabricatedtypes)
II.Semiprecisionattachment(custommade/laboratorymadetypes)Prefabricatedwax/plastic/nylon
patternswww.indiandentalacademy.comwww.indiandentalacademy.com
15. AccordingtotheirrelationshiptotheabutmentteethIntracoronal(Internalattachment)Extracoronal(Externalattachment) Basedon
stiffnessoftheresultingjointRigidattachmentsResilientattachments(Nonrigid)www.indiandentalacademy.comwww.indiandentalacademy.com
16.Basedongeometricconfigurationanddesignoftheattachment.KeyandKeywayInterlocksBallandsocketBarandclip/sleeveHinge
TelescopicPushbuttonLatchScrewunitswww.indiandentalacademy.comwww.indiandentalacademy.com
17.M.C.Mensor(1973)Classificationaccordingtoshape,designandprimaryareaofutilizationofattachment.CoronalCoronalRadicularRadicular
AccessoryAccessoryIntracoronalIntracoronalExtracoronalExtracoronalTelescopestudsTelescopestuds(pressurebuttons)(pressurebuttons)Bar
attachmentBarattachment(BarjointsandBar(BarjointsandBarunits)units)AuxillaryAuxillaryScrewunitsScrewunitsBarconnectorsBar
connectorsBoltsBoltsStabilizersStabilizersBalancesBalancesInterlocksInterlockswww.indiandentalacademy.comwww.indiandentalacademy.com
18.Becceraandothers(1987)IntradentalattachmentsFrictionalMagneticExtradentalattachmentsCantileverattachmentBarattachment
19.ADVANTAGESImprovedestheticsandelevatedpsychologicalacceptanceMechanicaladvantageDirecttheforcesalongthelongaxisofthe
teeth/moreapicallyForceapplicationclosertothefulcrumofthetoothReducesNonaxialloadingDecreasesTorquingforcesReducesrotational
movementoftheabutmentwww.indiandentalacademy.comwww.indiandentalacademy.com
20.InDistalextensionbasecasesBrokenstressphilosophy Reducedstresstotheabutment Stressfreerotational/verticalmovementsCross
archloadtransferandprosthesisstabilizationComparedtoconventionalclaspretainedpartialdentureLessliabletofracturethanclaspLessbulky
andmoreestheticsBetterretentionandstabilityLessfoodstagnationwww.indiandentalacademy.comwww.indiandentalacademy.com
21.DISADVANTAGESComplexityofdesign,proceduresforfabrication&clinicaltreatmentMinimumocclusogingivalabutmentheight(46mm)
ToincorporateattachmentwithoutovercontouringEnoughlengthofparallelcontactAnatomyofthetoothLimitedfaciolingualtoothwidth(incisor
andcanineareas)ExpensiveComplexityoflaboratoryandclinicalprocedureAttachmentmaintenance(repairorperiodicreplacement)Wearingof
attachmentcomponentswww.indiandentalacademy.comwww.indiandentalacademy.com
22.RequirehightechnicalexpertiseDentistandlaboratorytechnicianRequiresaggressivetoothpreparationCooperationonthepartofthepatient
DifficulttoinsertandremoveMentallychallengedpatientIncreasedemandonoralhygieneperformance
23.INDICATION/APPLICATIONSOFPRECISIONATTACHMENTSRemovableProsthodontics Asaretainerinaremovabletoothsupported
partialdentureForestheticconcernintheanteriorpartofthemouth StressBreakersFreeendsaddles/DistalExtensionBasecases(DEB)When
cantileveredponticistobeusedasabutment Formovablejointsinsectionaldentures PeriodontalinvolvementofthetoothContraindicatesrigid
FPDsMostefficientbilateralbracingandsupportareessentialwww.indiandentalacademy.comwww.indiandentalacademy.com
24. Divergentabutmentteethwithhighsurveylinesparallelpathofplacement. AsaretainersintoothsupportedoverdentureFixed
Prosthodontics Asaconnectorinfixedpartialdentureconstruction(longspanbridges) Toovercomealignmentproblemswhereabutmentshave
differingpathofwithdrawal.www.indiandentalacademy.comwww.indiandentalacademy.com
25.IMPLANTPROSTHODONTICSImplantsupportedoverdentureTheyareusedforconnectionbetweenthetoothandtheimplant
26.CONTRAINDICATIONSOFPRECISIONATTACHMENTS Poorperiodontalsupport. Poorcrowntorootratio Poororalhygiene
habits Abnormallyhighcariousrate Inadequatespace/roomtoemploytheattachment Compromisedendodonticandrestorativeconditions
27.SELECTIONOFTHEABUTMENTTEETHFactors:SoundabutmentteethNumberoftheabutmentteethLocationoftheabutmentteeth
PeriodontalconditionCrownrootratioPeriodontalsupportPulpalstatusVitalityofthepulpSizeofthepulpchamber
28.Minimumattachmentlength4mmInadequateattachmentlength<4mmMaximumattachmentlength67mmAxialspacerequirementSufficient
clinicalcrownlengthforminimumof4mmattachmentlengthAdequatespacebetweenthepulpandthenormalcontourofthetoothBuccolingual
spacerequirementREQUIREMENTSFORTHEABUTMENTTEETHwww.indiandentalacademy.comwww.indiandentalacademy.com
29.SELECTIONOFTHETYPEOFRETAINERFullcrownretainersIntracoronalattachmentsMoreretentive/rigidIdealcontoursCaries
protectionPartialcoverageretainersKennedysClIIIpartialdentureSplintedabutmentteethMostvulnerableInadequateretentionMarginalleakage
Inlays/onlays/pinledgesNotusedforintracoronalattachmentsLackofretentionMarginalcariesLesslife
30.SelectionoftheattachmentsIntracoronalvsExtracoronalResilientvsNonresilient75mminlengthRed 34mmYellow 56mmBlack
78mmEMattachmentgauge(Matsuo(1970)www.indiandentalacademy.comwww.indiandentalacademy.com
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31.EMAttachmentSelectorEMAttachmentSelectorSystem:System: Mensor,withhisEMAttachmentselectorsystem,lists23Mensor,withhis
EMAttachmentselectorsystem,lists23attachmentsintheintracoronalclassification.17arelistedasattachmentsintheintracoronalclassification.
17arelistedasnonresilienttypesand5asresilienttypes.Theyrangefromanonresilienttypesand5asresilienttypes.Theyrangefromamaximum
lengthof5to10mm.TheEMattachmentSelectormaximumlengthof5to10mm.TheEMattachmentSelectorsystemutilizesacolourcoded
millimeterattachmentgaugesystemutilizesacolourcodedmillimeterattachmentgaugetodefinetheverticalclearanceavailableinthe
edentuloustodefinetheverticalclearanceavailableintheedentulousregionofoccludedcastsforattachmentselection.regionofoccludedcastsfor
attachmentselection. Thegaugeismadeofplasticandmeasures75mminlength.ItThegaugeismadeofplasticandmeasures75mminlength.It
isgraduatedfrom3to8mmin1mmincrementswithaisgraduatedfrom3to8mmin1mmincrementswithacorrespondingcolourcode.Red
designates3to4mmyellowcorrespondingcolourcode.Reddesignates3to4mmyellowdesignates5to6mmandblackdesignates7to
8mm.designates5to6mmandblackdesignates7to8mm.www.indiandentalacademy.comwww.indiandentalacademy.com
32. ThegaugeisplacedbetweentheoccludedcastsadjacenttoaThegaugeisplacedbetweentheoccludedcastsadjacenttoatooththatwillcarry
anattachment.Themeasurementisthustooththatwillcarryanattachment.Themeasurementisthusreadnumericallyandaccordingtocolour.The
verticallimitsreadnumericallyandaccordingtocolour.TheverticallimitsmeasuredbytheEMgaugearethecommonareaofconcernmeasuredby
theEMgaugearethecommonareaofconcernFORACONNECTORSYSTEM.TheavailablespacewillFORACONNECTORSYSTEM.The
availablespacewillgovernthetypeofattachmentsystemthatcanbeused.governthetypeofattachmentsystemthatcanbeused. Aclosedvertical
spacewillnarrowtheselectionofavailableAclosedverticalspacewillnarrowtheselectionofavailableorrecommendedattachments.Where
verticalintermaxillaryorrecommendedattachments.Whereverticalintermaxillaryspaceisabundant,thechoiceofattachmentsystemscanbespace
isabundant,thechoiceofattachmentsystemscanbemuchlessrestricting.TheEMattachmentSelectorsystemmuchlessrestricting.TheEM
attachmentSelectorsystemcanbeusedasaguidetoattachmentselectioncanbeusedasaguidetoattachmentselection..
33.INTRACORONALATTACHMENTSIntracoronalprecisionattachment(Dr.HermanE.SChayes)Precisionattachment(prefabricatedtype)
Semiprecisionattachments(custommade)ConventionalattachmentTshapedattachmentsModernattachmentHshapedattachmentsContactplate
AdjustmentslotTubeHeadReinforcingplatewww.indiandentalacademy.comwww.indiandentalacademy.com
34.Beyelerattachment:Beyelerattachment:Activefrictiongripattachments:Activefrictiongripattachments: Inmanywaystheseresemble
passiveattachments,Inmanywaystheseresemblepassiveattachments,butastheyareusedinsituationswherethebutastheyareusedinsituations
wherethearticulationneedstobeseparatedrepeatedlyeg.articulationneedstobeseparatedrepeatedlyeg.Removablebridgeworktheyincludea
spring,usuallyRemovablebridgeworktheyincludeaspring,usuallyasplitpatrixdesign.asplitpatrixdesign. Usedinanteriorandpremolar
regions.Usedinanteriorandpremolarregions.www.indiandentalacademy.comwww.indiandentalacademy.com
35.MECHANICSOFRETENTIONFrictional:PreiskelgroupIRetentionSurfaceareacontactFunctionofthelengthControlledbyheightof
clinicalcrownIntermaxillaryspaceavailableFunctionofcrosssectionaldimensionsMechanical:PreiskelgroupIIAuxillarymechanicalretentive
featuresEx.Springloadedplunger/clipswww.indiandentalacademy.comwww.indiandentalacademy.com
36.PassiveAttachment:PatrixandMatrixinterlockinajigsawfashion..Retentiondependsonshapeofthejoint,areaofcontactandaccuracyoffit
Channelsofpassiveattachmentmayberound/ellipticalslidesDEPENDINGONARTICULARRETENTIONPassiveattachmentActive
attachmentLockedprecisionattachmentOmegaBeyelerwww.indiandentalacademy.comwww.indiandentalacademy.com
37.ACTIVEATTACHMENTActivefrictiongripattachmentActivesnapgripattachmentsMcCollumCrismaniCrismaniMc.Collumactivefriction
gripusedinposteriorareasandavailablesizes4mmand5.5.mmCrismaniactivefrictiongripavailablesizerange3mmto7mmusedinanterior
andpremolarareaswww.indiandentalacademy.comwww.indiandentalacademy.com
38.McCollumattachment:HshapedattachmentSingleadjustmentslotAnHshapedattachmentindicatedforfixedmovablebridgework,
removablepartialdenturesanddistalextensionpartialdentureswhencrossarchstabilized.
39.SternattachmentTwoadjustmentslotsHshapedconfiguration.Thisattachmentisanintracoronal,activefrictiongripattachmenttowhicha
distalhingeblockhasbeenadded.UsedasastressbreakerattachmentandinfixedremovalbridgeworkandRPDs.
40.Crismaniattachment:AvailableasRigid/ResilientRigidcrismaniattachmentFrictionalgripMechanicalgripThesecomeinresilientandrigid
forms.Therigidtypesareavailablewithbothfrictionandmechanicalspringclipretentionmechanisms.Theycomeinintracoronalactivefriction
gripaswellassnapgripvarieties.Thehinged,resilienttypeattachmentcanbeusedindistalextensioncases.
41. ThisresilientattachmentcanbeusedasaverticalThisresilientattachmentcanbeusedasaverticalstressbreaker,asahingedstressbreaker,or
astressbreaker,asahingedstressbreaker,oracombinationofboth.combinationofboth. TwotypesofresilientcrismaniattachmentsareTwo
typesofresilientcrismaniattachmentsareavailable,oneallowingapurehingemovementavailable,oneallowingapurehingemovementandthe
otherallowinglateralmovementinandtheotherallowinglateralmovementincombinationwithhingemovement.combinationwithhingemovement.
42.Neysattachment:LatchretainedConventionalHshapedNeylocsplitlingualwww.indiandentalacademy.comwww.indiandentalacademy.com
43. NeyattachmentsareintracoronalsnapgripNeyattachmentsareintracoronalsnapgripattachments,availablein2basicdesigns,
theattachments,availablein2basicdesigns,thefamiliarchayeswithadjustablewingsandthefamiliarchayeswithadjustablewingsandtheneyloc
designwithgingivalretentionfeature.neylocdesignwithgingivalretentionfeature.www.indiandentalacademy.comwww.indiandentalacademy.com
44.BakersattachmentSchatzmannattachmentTheseareintraconalnonresilientattachments.Theycomeinanterior,bicuspidandmolarsizes.H
shapedconfiguration.Thisattachmentisanintracoronal,activefrictiongripattachmenttowhichadistalhingeblockhasbeenadded.Usedasa
stressbreakerattachmentandinfixedremovalbridgeworkandRPDs.www.indiandentalacademy.comwww.indiandentalacademy.com
45.SemiprecisionattachmentsDefinedasrigidmetalicextension(patrix)ofafixedorremovabledentalprosthesisthatfitsintoaslottypekeyway
(matrix)inacastrestorationallowingsomemovementbetweenthecomponent.GPT8Gillete(1923):ThefirstsemiprecisionattachmentZinner
(1979)LockingsemiprecisionattachmentNonlockingsemiprecisionattachmentwww.indiandentalacademy.comwww.indiandentalacademy.com
46.Louisblatterfein(1969):FourrestseatpreparationOcclusalform/outlineformcontrolsamountofrotationCircularDovetailRectangular
Mortice(Rigidlockingtype)ResilientSomeresiliency(Nonlockingtype)Proximalform/sidewallslateralforcecontrolParalleloutline
TaperingoutlineTheangleoftheproximalwallwiththegingivalfloorwww.indiandentalacademy.comwww.indiandentalacademy.com
47.Gingivalfloorform:servesthefunctionofreciprocationFlatInclinedChanneledAddedreciprocationMorticeocclusalformRectangular
occlusalformwww.indiandentalacademy.comwww.indiandentalacademy.com
48.Advantages:Appliedinclinicalsituationsemployingvariousrestseatoutlineforms.Variationintoothsizeandshapesareeasily
accommodated.BettercrowncontourcomparedtoprefabricatedtypeDisadvantages:Longtermwearismoresoftnessofalloyused.No
standardizationofsizing:Lackofinterchangiabilityofmaleandfemaleattachment.Greaterdegreeoflaboratoryskillandattentionin
detail.www.indiandentalacademy.comwww.indiandentalacademy.com
49.EXTRACORONALATTACHMENTSIntroducedbyHenryR.Boos(1900)ModifiedbyFEwingRoach(1908)ApplicationKennedysclassI
andclassIIBoitel(1978) Rigidattachments Resilientattachments Barattachments
50.EXTRACORONALATTACHMENTRigidattachmentsHingedattachments(Stressbreakingaction)ResilientattachmentsERAOring
Advantages:NoalterationofcontouroftheabutmentcrownCanbeusedinshortabutmentteethGreaterfreedominthedesignEaseof
insertionandremovalwww.indiandentalacademy.comwww.indiandentalacademy.com
51.Disadvantages(WolfRE1980):LackofocclusalstabilityBulkyRebasingproblemsImpropercontrolofforcedistributionEncroachmentonthe
gingivalpapillauseofminiattachmentwww.indiandentalacademy.comwww.indiandentalacademy.com
52.RIGIDEXTRACORONALATTACHMENTSRoachattachment(ballandtubeattachment)OldestattachmentPatrixroundballMatrixtube
PinandtubeattachmentThesimplestPatrixpinMatrixtubewww.indiandentalacademy.comwww.indiandentalacademy.com
53.StabilexattachmentTworetentionpinsDisadvantageisincreasedlengthMatrixPatrixAssembledRigidconnectionbetweenthemaleandfemale
units.Additionalretentionbypinswhichmaybeunscrewedandreplacedifnecessarybyaspecialscrewdriver.Attachmentisbulky,plaquecontrol
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difficult>4mmverticalspacerequired.Application:Situationswheregenerousspaceavilable
54.ConexattachmentConexattachmentSidesprovidesprecisepathofinsertionthatresistrotationalforces.Pinsacttwotypes:Providingfrictional
retention,mechanicallock.ModifiedConex:Enablesoperatortoscrewtheremovablesectionofprosthesisinplace.Applicationtoothsupported
prosthesiswhereadequateplaquecontrolispossible,unilateraldistalextensionspaces,smallrestorationsforboundedspaces.Bracingarmsnot
requiredbecauseofthegenerouslateralsurfaceareaoftheattachment.www.indiandentalacademy.comwww.indiandentalacademy.com
55.RESILIENTEXTRACORONALATTACHMENTDalbo/Dallabonaattachmenta)Patrixb)MatrixTheseareknownasDallabonaslide
blockorDalbostudanchor.Theyaresimpleattachmentsavailableinnonresilient,resilientandstressbrokentypes.Theyareusefulwhenthereis
minimalverticalspaceavailableandrotation,reesilienceandretentionaredesired.www.indiandentalacademy.comwww.indiandentalacademy.com
56.TheattachmentconsistsofasinglepiecemaleTheattachmentconsistsofasinglepiecemalestudsolderedtothecopingandasingleunitstud
solderedtothecopingandasingleunitfemaleprocessedwithinthedenture.femaleprocessedwithinthedenture.Types:Types:Rigidcylindrical
dollabonaRigidcylindricaldollabonaSphericalvariety(resilient)Sphericalvariety(resilient)StressbrokenStressbrokenThestressbrokenversion
issimilartotheThestressbrokenversionissimilartotheresilientwithexceptionthatfemalehousingisresilientwithexceptionthatfemalehousing
islongerandincorporatesacoilspring.longerandincorporatesacoilspring.www.indiandentalacademy.comwww.indiandentalacademy.com
57.CekaattachmentWasdevelopedbyKarlCluytens,1951andimprovedin1968TwotypesCekaNVattachmentCekarevax.Usedasadirect
retainerinpartialdenturesandoverdenturesIsrigidandalsononrigidcategoryofextracoronalattachments.AccordingtoWaltz1973doesnotseem
tohaveanyadverseeffectonhealthofabutmentteethandsurroundingtissues.www.indiandentalacademy.comwww.indiandentalacademy.com
58.ROLEOFATTACHMENTSASSTRESSBREAKERRigidsystemNonrigidsystemStressbreakerBrokenstressphilosophyMensor stress
canonlybeselected,alteredorblockedStressdirectorwww.indiandentalacademy.comwww.indiandentalacademy.com
59.ASC52attachmentSTRESSBREAKERDESIGNSThisisanexampleofanextracoronalresilientattachmentthatpossesuniversalresilience.It
consistsofanextracoronalslideattachmentwithaspringactivateduniversalhingejointandadjustableretention.Itisthesmalleststressdirectorin
dentistryandisusedfordistalextensionRPDs.www.indiandentalacademy.comwww.indiandentalacademy.com
60.NeysdistalextensionstressbreakerNeyattachmentsareintracoronalsnapgripattachments.Availablein2basicdesigns,thefamiliarchayes
withadjustablewingsandtheneylocdesignwithgingivalretentionfeature.www.indiandentalacademy.comwww.indiandentalacademy.com
61.SternstressbreakerHshapedconfiguration.attachmentisanintracoronal,activefrictiongripattachmenttowhichadistalhingeblockhasbeen
added.UsedasastressbrokenattachmentandinfixedremovalbridgeworkandRPDs.
62.Extracoronalresilientattachment(ERA):(ERA)ColourcodedretentioncapsMostflexibleWhite>Orange>Blue>GrayMostrigidTwotypes
ofERAStandardReducevertical(ERARV)malepartis0.5mmshorterwww.indiandentalacademy.comwww.indiandentalacademy.com
63.MatrixPatrixUseofERAinDEBcasesUseinoverdentureYenChenKuetal(2000):ERAprovidesesthetics,verticalresiliency,easy
replacementofworndentures Verticalresiliencyof0.4mm Universaljointhingeaction
64.OringattachmentPatrixpostwiththegrooveorundercut.MatrixOringsyntheticpolymergasketsOringaremadeupofSiliconeNitrile
FluorocarbonEthylenepropylenewww.indiandentalacademy.comwww.indiandentalacademy.com
65.AdvantagesofOringEaseinchangingtheattachmentWiderangeofmovementLowcostDifferentdegreesofretentionEliminationofthetime/
costofthesuperstructurewww.indiandentalacademy.comwww.indiandentalacademy.com
66.STUDATTACHMENTS(ANCHORS)AnchortherootsSimplestofalltheattachmentPartrixdowel/postretainedrestorationMatrix
denturebaseoftheprosthesisClassifiedas: Rigidstudunit Resilientstudunit Extraradicularunits IntraradicularunitsExtraradicular
Intraradicularwww.indiandentalacademy.comwww.indiandentalacademy.com
67.Spacerequirementoftheseattachmentisintermediatebetweendomeshapedcopingandthimbleshapedcoping.Theseshouldbeplacedparallel
tothelongaxisofthetooth.www.indiandentalacademy.comwww.indiandentalacademy.com
68.DALBOSTUDATTACHMENTRigidunitBallandsocketunit(Verticalandrotationalmovement) Retention
69.ROTHERMANECCENTRICATTACHMENTItisoneofthesmallestofstudattachmentsandhencerequiresverylittlespace(averagebt.
1.6mm).Itisavailableinnonresilientandresilientversions.Simpletousewithadequateretentionandeaseofmaintenance.Disadvantages:Chair
sideinsertionofkeywayisdifficult.www.indiandentalacademy.comwww.indiandentalacademy.com
70.ZESTANCHORATTACHMENTZestanchorisastudattachmentitconsistsofametallicfunnelshapedtubethatiscementedintotheroot
canalofthetoothandapolyethylenestudthatisattachedtothedenturebase.Theheadofthestudsqueezespasttheconstructionintheneckofthe
funneltoretainthedentureonthetooth.Itderivesitsretentionfromwithinthetoothwww.indiandentalacademy.comwww.indiandentalacademy.com
71.GERBERATTACHMENTThisisoneofthelargestofthestudunits.Providesgoodretentionstabilityhasadjustablespringsanditisreadily
replaceable.Disadvantages:ComplexattachmentsystemRequresmorespaceMaintenanceproblemsItpermitsverylittlerotationalactionto
torquingofabutmentteethoccurswithalveolarresorption.www.indiandentalacademy.comwww.indiandentalacademy.com
72.SCHUBIGERATTACHMENTPatrix:threadedpost/screwMatrix:recessedcollar,capnut/locknutCutsection
73.BARATTACHMENTSGilmoreclipsystem(1913)metalbarwithretainingsleeve/clip.Barcanbeattachedtothe:Copingorcrownsover
thevitalteethPostcopingonendodonticallytreatedteethScreweddownintothecoping(implantsystem)Typesofbarattachments:Customisedbar
DolderbarAckermannsbarCMriderbarHaderbarAndrewsbarwww.indiandentalacademy.comwww.indiandentalacademy.com
74.Twogroupsofbarattachments:1)Barunitsrigid2)BarjointspermitsrotationRound/circularOval/eggshapedUshaped/parallelsided
barsMultiplesleevebarjointsSinglesleevebarjointsDependingoncrosssectionBARJOINTS
75.DOLDERBAREggshapedbarincrosssectionOpensidedsleeveTwosizes3.5mmx1.6mm,3.0mmx2.2mmSpacerdegreeofmovement
76.MOVEMENTSSEENINDOLDERBARSagittalrotationRestpositionVerticaltranslationImplantsupportedover
denturewww.indiandentalacademy.comwww.indiandentalacademy.com
77.ACKERMANNBARAvailableindifferentcrosssectionCircularcrosssectioncanbebentinallplanesAshortextensionof5mmiscarried
behindthemostdistalrootandthesleevepositionedonthissectionpreventstendencyfordistalparttorisewhenstickyfoodsarechewed.Thisis
recommendedwherebarissetananteroposterirocurvetopreventhingerotationandmotion.Multiplesleevebarjointsaremoreversatilethan
singleonesexceptbarsthathaveslightlyrigidity.www.indiandentalacademy.comwww.indiandentalacademy.com
78.CMBARItissimilartocircularAckermannbarwithdiameterof1.9andisofpreciousandsemipreciousalloys,thelatterrecommendedfor
longspans.www.indiandentalacademy.comwww.indiandentalacademy.com
79.HADERBARHelmutHaderin1960AvailableasaprefabricatedplasticpatternPrefabricatedplasticpatternareadaptedtomastercastaccording
toitscontourandcastinalloyofchoice.Sleevesofplastichavetobereplacedforadjustments,hencemetalsleevescanbesubstituted.
80.ClipswithmetalencapsulatorAdvantage Prefabricatedplasticpatternnoneedforsoldering. Precisefit,simplicity.
81.Advantagesofbarattachments:RigidlysplinttheteethProvidesgoodretention,stabilityandsupportProvidescrossarchstabilizationPositioned
closetothealveolarbone(exhibitlessleverage)Disadvantages:BulkofbarPlaqueaccumulationWearingSolderingprocedure
82.MAGNETSASATTACHMENTSince1950ToretainmaxillofacialprosthesisAlu,Ni,Iron,Cobaltalloy(alnico)Limiteduselargersize1960
useofrareearthelementHighfieldstrengthCanbeusedinsmallersize.Somariumcobalt(SmCo)(JosephBeckerHoffer1967)Neodymium
ironboron(NdFeB)20%strongerSomariumironnitrideHighmagnetizationUsedforretentionofmandibularoverdentures(toothandimplant
supportedoverdentures)www.indiandentalacademy.comwww.indiandentalacademy.com
83.Gillingsmagneticattachment(cobaltsomariumalloymagnets)SplitpolepairedmagnetsClosedfieldmagneticsystemMagneticretainerwith
6/41
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magnetsMagnetickeeperwww.indiandentalacademy.comwww.indiandentalacademy.com
84.Advantagesofmagneticattachment:SmallersizeandstrongattractiveforceProduceconstantforceconstantretentionEasytoincorporateinto
theprosthesisAutomaticreseatingBoonforelderlypatients(Parkinsonism,arthriticpatient)Lesslateralforcetotheabutmenttooth
85.Jacksonmagneticattachment(cobaltsomariumalloymagnets)CementedinkeeperScrewedinkeeper
86.Disadvantages:LossofretentionduetocorrosionorheatinstabilityRequiresencapsulationwithininertalloysCannotberepairedHighcost
LimitedforcetransmissionMagnetscanslideontheirkeepers.www.indiandentalacademy.comwww.indiandentalacademy.com
87.AUXILLARYATTACHMENTS Screwandtubeattachment Keyandkeyway/interlocks PressoMaticorIsoclip Barconnectors
Attachmentsforsectionaldentures/boltsScrewandtubeattachmentwww.indiandentalacademy.comwww.indiandentalacademy.com
88.Indications:ToovercomealignmentproblemsConnectingonerestorationoffixedpartialdenturetoanotherAllowingtheremovaloflongspan
fixedpartialdentureforrepairandexaminationofabutment.www.indiandentalacademy.comwww.indiandentalacademy.com
89.ATTACHMENTUSEDFORSECTIONALDENTURESTwopartdentures:OnepartchromecobaltbaseSecondpartremovableacrylic
flangewithteethAdvantageofsuperiorestheticsandimprovedretentionMethodofunion:Physicalinterference:BoltretainedprosthesisFrictional
resistance:Splitpostretainedprosthesiswww.indiandentalacademy.comwww.indiandentalacademy.com
90.SECTIONALDESIGNSIndividualsections/separatesections:usesmesialanddistalsurfaceoftheabutmentteethasguidingplanes.
92. Forcriticalanalysisoftheseattachments,theneedforForcriticalanalysisoftheseattachments,theneedforthroughknowledgeoftheir
principlesandthroughknowledgeoftheirprinciplesandapplicationsmaybeofhelpinobtainingabetterapplicationsmaybeofhelpinobtaininga
betterinsightintotheirdrawbackandareasofpotentialinsightintotheirdrawbackandareasofpotentialimprovement.improvement. The
attachmentretainerremovablepartialdentureTheattachmentretainerremovablepartialdenturepresentsachallengeintechnicalskillandpresentsa
challengeintechnicalskillandunderstandingofthebiomechanicsofmaxillounderstandingofthebiomechanicsofmaxillomandibular
function.mandibularfunction. Themainfunctionsoftheattachmentsareretention,Themainfunctionsoftheattachmentsareretention,stress
reductionandconcealmentforestheticstressreductionandconcealmentforestheticpurposes.Theattachmentretainedremovablepartialpurposes.
Theattachmentretainedremovablepartialdenturedoesattempttoreturnthepatienttoasneardenturedoesattempttoreturnthepatienttoasnear
normalfunctionandappearanceaspossible.normalfunctionandappearanceaspossible.
93.Advancedremovablepartialdentures.JamesS.BrudvickQuintInt.PubPg.115152.Contemporaryfixedprosthodontics.Rosensteil,Third
edition,MosbyPub.,pg.543566.OverdenturemadeeasyguidetoimplantandrootsupportedprosthesisHaroldW.PreiskelGeorgeZarb.
PrecisionattachmentsalinktosuccessfulrestorativetreatmentGarethJenkinsQuintPublishing.TheoryandpracticeofprecisionattachmentRPD
JamesLBakerRichardJGoodkins.www.indiandentalacademy.comwww.indiandentalacademy.com
94.JProsthetDent197329(5):494497JProsthetDent197329(2):165171.JProsthetDent198758(3):327327.DCNA197014(3):595601.
QuintInt200031(5):311317.QuintInt198718(1):451JProsthetDent200186:13742JProsthetDent198145(1):3743.IntJProsthet1990
3(1):98102.IntJProsthet19903(2):165173.www.indiandentalacademy.comwww.indiandentalacademy.com
95.Formoredetailspleasevisitwww.indiandentalacademy.comwww.indiandentalacademy.comwww.indiandentalacademy.com
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