David R.

Burns, OMD
Assistant Professor

lohn E. Ward, ODS, MSO

Associate Professor
A Review of Attachments
Department of Removable Prosthodontics
for Removable Partial Virginia Commonwealth University
School oí Dentistry
Denture Design: Part 1. Box S66 MCV Station
Classification and Selection Richmond, Virginia 23298

An attachment is a mechanical device, other than a clasp

assembly, that functions as a direct retainer. Attachments for
removable partial denture treatment are reviewed and a
method for classifying different types of attachments is
provided. Attachments are categorized as precision or
semiprecision, depending upon the method of manufacture;
internal or external, according to their intracoronal or
extracoronal location relative to the abutment tooth; and
rigid or resilient, as determined by the amount of movement
allowed between the component parts. They are also
classified by design. The advantages and disadvantages of
attachment use as well as indications and contraindications
are considered. Additionally, the conventional clasp-type
direct retainer is compared to attachments. Int J Prosthodont
1990:3:98-102.

ttachments have always been surrounded by
A an aura of mystery, primarily because of a lack
of knowledge and experience. Not all practitioners
may consider tbe use of attachments as essential,
but a basic understanding is useful and important.
Tbe purpose of this two-part paper is to present the
fundamentals of attachments for removable partial
dentures. Part 1 defines attachments and discusses
their function and indication. Part 2 discusses treat-
ment planning and attachment selection.
Definition of Attachment
By definition, an attachment is a mechanical
device for the fixation, retention, and stabilization
of a dental prosthesis.' For removable partial den-
ture prosthodontics, it is a mechanical device, other
than a clasp, that functions as a direct retainer.^ As
the direct retainer, it must provide: (1) support—
resistance to movement of the prosthesis toward the
tissue; (2) reíe/ii/on—resistance to movement of the
prosthesis away from the tissue; (3) reciprocation—
counteraction of the forces exerted by the retentive
component; (4) siafe;7/zaf/on—resistance to horizon-
tal movement of the prosthesis, and (5) fixation—
resistance to movement ofthe abutment tooth away
from the prosthesis and movement of the prosthesis
away from the tooth. Additionally, the direct retainer
should be passive when the prosthesis is in its ter-
minal position. An attachment derives its functions
tiirough closely fitting, coupling parts. It incorpo-
rates one component into the removable partial
denture and the connecting component is tradi-
tionally incorporated into a cast crown or fixed par-
tial denture (Fig 1). Recent advances in resin-
retained prostheses have led to the introduction of
the resin-bonded connecting component that is
luted directly onto the enamel of the abutment
tooth.
Classification of Attachments
Attachments may be classified in a number of
ways.'" They may be classified as cither precision
or semiprecision, depending on the method of fab-
rication and tolerance of fit. Precision attachments
have prefabricated, machined components with
precisely manufactured metal-to-metal parts with
close tolerances. The fabrication methods for semi-
precision attachments yield a less precise tolerance.
These may be either manufactured patterns (made
of plastic, nylon, or wax) or hand waxed.

The International Journal of Prosthodontics 98 Volume 3, Number t, 1990

 Attachments for Removable Partial Oentures, Part 1 Burns/Ward

Anachments are classified according to their rela-

tionship to the abutment tooth. If the attachment is
incorporated within (he body of the abutment tooth
intracoronally, it is an internal attachment; when
located extracoronal ly, it is an external attachment.
Neither type of attachment is applicable to all cir-
cumstances. Selection of an internal or external
attachment is based on design considerations for the
prosthesis and the anatomic morphology, location,
and position of the abutment tooth. Internal attach-
ments have the advantages of maintaining forces
more in line with the long axis of the tooth and
having a more desirable resistance to vertical and
lateral forces, while external attachments require Fig 1 An attachment derives its tunction through closely fit-
less reduction of the abutment tooth. ting, coupling parts. One component of the attachment is
Attachments are also classified as either rigid or incorporated into the removable partial denture. The con-
necting component is incorporated into the abutment tooth.
resilient. Rigid attachments are those that theoreti-
cally allow no movement of their component parts
during function. However, even under the best of
conditions, minute movement of the prosthesis will
occur when occiusal forces are applied. The amount
of movement will increase with wear of the com-
ponents.
Resilient attachments provide a defined amount
and direction of movement of their component
parts, permitting movement of the denture base
toward the tissue under function, while theoretically
minimizing the amount of force being transferred to ^Ê
the abutment teeth.'' Thus, the resilient attachment
acts as a "stress director,"'* Resilient attachments
may provide a hinged motion, allowing movement
along one plane ¡Fig 2), or a rotary motion, allowing
movement along many planes (Fig 3), The precision
intracoronal attachments ate usually designed to
Fig 2 Hinged resilient attachment allowing movement only
function as rigid attachments, while the extracoronal along the sagittai piane, thus restricting lateral movement.
attachments are usually resilient. (Dalbo attachmeht, APM-Sterngoid, San Mateo, California.)
Rigid intracoronal attachments provide all of the
necessary functions of a direct retainer." The resil-
ient extracoronai attachments, in contrast, do not
always supply suitable support and bracing because
of their resilient nature. This represents a point of
controversy, because for the resilient attachments
to maintain their ability to move freely in all planes
without binding or torquing the teeth, the connec-
tion between the components of the resilient
attachments must be the only contact between the
removable partial denture and the teeth. When this
premise is followed, the removable partial denture
derives little more than retention from the abutment
teeth, while support, bracing, and stability are
derived primarily from the residual ridge. Therefore,
some believe that additional components must be
incorporated into the removable partial denture
design to provide the necessary functions of a direct T f ^•^' ^ilowing movement along
retainer and follow sound principles of prosthodon- attachment, Preat Corp, San Wateo, Cail:

•mber 1, 19% 99 The

International lournal of Prosthodonlics
 Burns/Ward
tics. Specially designed rests and guiding planes on
surveyed crowns contacted by the major connector
may be used to supply support and bracing for the
prosthesis" (Fig 4), The rests and guiding planes also
provide the positive relationship between the rigid
framework and teeth necessary to evaluate the fit
of the framework and the relationship of the denture
base to the residual ridge. Unfortunately, when this
feature is incorporated, the movement of the pros-
thesis is more restricted, but proponents feel that
the benefits of such a design outweigh some loss
of movement of the prosthesis.
Finally, attachments are classified according to
design, and there are many designs and combina-
tions. The following are examples: The key and key-
Fig 4 Rests and guiding planes incorporated in surveyed
crowns are contacted by tne removable partiai denture major
connector and provide increased support and bracing. This
design also provides a method for evaiuation of the fit of the
frarnework to the teeth.
Fig 5 (Left) Key and keyway (semipre-
cision) attachment design.
Fig 6 (Right) Ball and socket design.
The Internatiaral Journal oí Prost h odor tic 5
Attachmeni! hu Removable Parlial Derilures, Part I
way design is representative of the rigid type (Fig
5]. The ball and socket is a multidirectional resilient
design incorporating a ball freely moving within a
socket (Fig 6], The bar attachment design consists
of a prefabricated metal bar of specific dimensions
and shape that extends across an edentulous area
just superior to the tissue of the residual ridge. It is
permanently attached to cast crowns or resin
bonded to the enamel of the abutment teeth (Fig
7). Retention is usually gained with a precisely fitted
clip incorporated intotheacrylic resin of the denture
(Fig 8).
Deciding on Attachment Use
Attachments have a number of desirable qualities
that indicate tbeir use in place of conventional
ciasps. The primary indication is esthetics.^ Con-
ventional clasp assemblies and rests may be visible
and unesthetic, whereas the attachment is con-
cealed within the contours of the abutment tooth
or within the body of the removable partial denture.
Another appropriate indication for the use of
attachments is for divergent abutment teeth with
high survey lines. The use of conventional clasps
would require the placement of clasp arms high on
the tooth, or lowering of the height of contour
through tooth modification or placement of sur-
veyed crowns. Although attachment use may also
require crowns, the preparations do not need to be
made parallel to one another. This is because the
path of placement of the removable partial denture
is determined by parallel placement of the attach-
100 Volume 3, Nurrber 1, 1990
 AltachmeiKs for Removable Pardsl Oentures, P.Hrt [i urns/Ward

ments within the surveyed crowns, independent of

the parallelism of the crowns themselves.'"
A major advantage of the use of attachments is
that the point of force application to the tooth is
more apical than for occlusal or incisai rests, thus
shortening the lever arm and decreasing torquing
forces. Attachments may also allow better cross-
arch force transmission and stabilization than clasps,
but this is determined by the type of attachment
used, the number of guiding surfaces, and the
design and adaptation of the framework and attach-
ment. Fig 7 Bar attachment design.
There are a number of negative aspects to the
use of attachments,' In general, whenever a con-
ventional clasp can be used it is the retainer of
choice. The use of attachments requires additional
expense to the patient, for both the crowns or resin-
bonded retainers on the abutment teeth as well as
the attachments themselves. Poor dental motivation
and manual dexterity of the patient may result in
earlier failure than with the use of conventional
clasping. Repairs or alterations are difficult or impos-
sible with some attachments.
Short clinical crowns contraindicate the use of
attachments. A minimum of 4 mm of vertical space
is necessary for most attachments." Therefore, a
minimum of 6 mm of clinical crown would be nec-
essary to retain the attachment without overcon-
tour. This occlusogingival length is required so that
there is adequate space hetween the plane of occlu-
sion and the gingiva for placement of both the
Fig S Clip incorporated into the denture base iocks tightly
attachment and the prosthetic teeth. Likewise, for over the bar. providing retention.
attachments that rely on frictional resistance for
retention, the occiusogingival length is important in
providing enough length of parallel contact
hetween the components of the attachment to en- Fig 9 Placement of attach-
able adequate retention. It is possible, however, to ments in the incisor and
provide supplemental means of retention, such as oanine areas can be difficult

J
because cf limtted faciohn-
locks, retentive clasp arms, etc. Placement of attach- guai tooth width.
ments in the incisor and canine areas can also be
difficult because of limited faciolingual tooth width
(Fig 9). The anatomy of the abutment tooth and the
ipace requirements for the attachment must be
considered. Adequate space between the pulp and
the normal contours of the tooth is necessary for
the intracoronal component of an internal attach-
ment. If the pulp of the abutment tooth is large,
preparation of the tooth for a crown plus additional
reduction for placement of an internal attachment
may necessitate root canal therapy. This may not
preclude the use of attachments, but may be an
indication for the use of an extracoronal attachment.
Biologic conditions that contraindicate a conven-
f
tional removable partial denture also preclude the
use of attachments.'« These include poor periodon-

3, Numt)er1,iB90 101 The

internaüonal lournal of Prosthodont ¡es
 Alt.nínrnenis dir Ke

tal health of abulmenl teeth, poor tissue quality or
quantity, poor crown-to-root ratio, and enrlodontic
and restorative considerations.
The greatest deterrent to the use of attachments
is their complexily. The close tolerances demand
coordination between the denture base, partial den-
ture framework, and supporting tissues. The treat-
ment therefore becomes considerably more difficult
to plan, accomplish, and maintain.'- The use of
attachments requires a thorough knowledge of basic
prosthodontic principles, appropriate traininj; and
experience with the particular attachmenl used,
technical skills, and clinical ability and judgment.
Summary
An introductory review of attachments, including
classification, parameters for use, advantages, and
disadvantages, has been presented. Pari 2 discusses
treatment planning and attachment selection for
removable partial denture treatment.
References
1. Acidemy of Denture ProstbeMts: CImsiirv iit Prii<,tho-
dont,c Terms, ed S SI Louis, CV Mosby Co, I %7.
2. Tregiiskei |N, Ward |E: Removable Partial Denture Ciinial
Study Manual. Richmond. Virginia, Virginia Commiin-
Wfîallh University, Sthool (if Dentistry, I9H11, p 1.
i. Becerra C, Mattniee M: A Llawiiication ot pff-ciiron
•íltüchmenls. / Prasthet Dent i9li7,Sfl: i22 -127.
4. Preiskel HVW: Prctision .lilathments: Uws and abuses. I
Prasl/ierDenf 197),10.491 492.
5. Henderson D, McCivney GP, Caîlleberry D|:
McCraci<en's Removable Partial Prosthodiintics. ed 7. Si
Louii, CV Mosby Cr>, 1985, p 79.
6. Preiikcl tlW: Precisian Attachments in Prosthotiontii.s\
Vol I. The Applications of Intr.tcoronai anri Extracoronai
Attaciiments. Chicago, Quintessence Publ Co, 19it4, p
UlS.
7. Blatierfein L: Tbe use of ihe semiprecision resi in remov-
able parricii dentures. / Proslhet Dent I969;22:.î{)7-112.
8. Singer 1: improvemonis in predsion-ailached removable
partial dentures. / Prosthet Dent 1567;! 7:69-72.
9. Cunningham DM: inditalions and conlraindicalions for
precision ailachmenls. Denl C/m Nor//) Am 1970;14:595-
fjlll.
10. Lorencki SF: Planning precision attachment restoration;.
/ Proslhet Dent 1969:21 :.';06-.';08.
11. Preiskei HW: Precision Attachments in Prosthodontics:
Voi !. Tiie Applications of Intracoronal and Extracoronai
Attachments. Chicago, Quintessence Publ Co, 1904, p
32.
12. Sthuyier CH: An analysis of Ihe use and relative value of
Ihe precision atlachment and the clasp in partial denture
picinning / Proslhet Dent 195Í:^:711-714

Literature Abstract-

Stability in the Correction of Dentofacial Deformities: A

Comprehensive Review

Postoperative stability of skeletai segments repositioned during orthognattiic surgery was reviewed.
Factors ttiat atfected the stabiiity of orthognathic surgery procedures inciuded the type and duration of
masiilary-mandibular fixation, the number ot skeletal sections involved, condylar dispiacement following
surgery, ttie use cf presurgicai orthodontics, ttie direction of movement of the bone, the posterior face
height, and the tension of the suprahyoid muscuiature. The resuits showed that maxiilary superior
repositioning tends to be a stable operation, but maxillary inferior repositioning has a tendency tc be
unstabie. witti the upper lip generaliy lengttiening postoperatively. The greater the mandibular
advancement, the greater the tendency for relapse. Ttie clinicai implications of various stabilization
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Welch TB. J Oral Ma'illotac Surg 1989:471142-1149 References: 9S Repeints: Or Welch, Department ol Oral and
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a\ of Pros t h odontic 4 102 Volume 3, Nymber I, 1990