Precision attachments1./ orthodontic seminars

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Indian Dental Academy: will be one of the most relevant and exciting training center with best faculty and flexible training programs for dental professionals who wish to advance in their dental practice,Offers certified courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic Dentistry, Periodontics and General Dentistry.

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Precision attachments1./ orthodontic seminars

  1. 1. Precision AttachmentsPrecision Attachments INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.comwww.indiandentalacademy.com
  2. 2. ContentsContents  IntroductionIntroduction  HistoryHistory  UsesUses  GoalsGoals  Mechanism of actionMechanism of action  IndicationsIndications  ContraindicationsContraindications  AdvantagesAdvantages  DisadvantagesDisadvantages  ClassificationClassification www.indiandentalacademy.comwww.indiandentalacademy.com
  3. 3.  Materials used in attachment fabricationMaterials used in attachment fabrication  Treatment planningTreatment planning  The free end saddleThe free end saddle  The bounded saddleThe bounded saddle  Over denturesOver dentures  Auxiliary attachmentsAuxiliary attachments  Milling using a precision parallelometerMilling using a precision parallelometer  Use of precision attachments with implantsUse of precision attachments with implants  ConclusionConclusion  BibliographyBibliography www.indiandentalacademy.comwww.indiandentalacademy.com
  4. 4. www.indiandentalacademy.comwww.indiandentalacademy.com
  5. 5. IntroductionIntroduction  Precision attachments offer considerablePrecision attachments offer considerable advantages in dentistry because of theiradvantages in dentistry because of their flexibility.flexibility.  Nevertheless they have in the past been largelyNevertheless they have in the past been largely ignored by most dental professionals forignored by most dental professionals for understandable reasons.understandable reasons.  Precision attachments consist of two halves, aPrecision attachments consist of two halves, a matrix and a patrix, that form a precise butmatrix and a patrix, that form a precise but separable joint.separable joint. www.indiandentalacademy.comwww.indiandentalacademy.com
  6. 6.  Precision attachments are defined as ;Precision attachments are defined as ; A retainer used in fixed and removableA retainer used in fixed and removable prosthesis construction consisting of a metalprosthesis construction consisting of a metal receptacle and a closely fitting part. Thereceptacle and a closely fitting part. The former is usually contained within the normalformer is usually contained within the normal or expanded contours of the crown and theor expanded contours of the crown and the later is attached to the pontic or denturelater is attached to the pontic or denture framework.framework. www.indiandentalacademy.comwww.indiandentalacademy.com
  7. 7. www.indiandentalacademy.comwww.indiandentalacademy.com
  8. 8. SynonymsSynonyms  Internal attachmentsInternal attachments  key and key-way attachmentskey and key-way attachments  parallel attachmentsparallel attachments  slotted attachmentslotted attachment Male attachment female attachmentMale attachment female attachment -patrix -matrix-patrix -matrix -flange -slot-flange -slot -insert, fitting part -receptacle-insert, fitting part -receptacle -key -keyway, crypt-key -keyway, crypt www.indiandentalacademy.comwww.indiandentalacademy.com
  9. 9. HistoryHistory  Prior to 1888, both winder and parr invented devicesPrior to 1888, both winder and parr invented devices which were clearly attachments in principles andwhich were clearly attachments in principles and construction.construction.  In 1906 Dr. Herman E.S. Chayes invented aIn 1906 Dr. Herman E.S. Chayes invented a detachable suspender device which formed thedetachable suspender device which formed the fundamental feature of his dental attachment.fundamental feature of his dental attachment.  In 1912 he designed the Chayes attachment calledIn 1912 he designed the Chayes attachment called bucco-lingual attachment which forms the basicbucco-lingual attachment which forms the basic pattern for the modern frictional grip attachment.pattern for the modern frictional grip attachment.  1951 Mc collum made the greatest progress in the1951 Mc collum made the greatest progress in the development of precision attachment.development of precision attachment. www.indiandentalacademy.comwww.indiandentalacademy.com
  10. 10. UsesUses  They are used to overcome alignmentThey are used to overcome alignment problems where abutments have differingproblems where abutments have differing paths of withdrawal.paths of withdrawal.  As connecters in fixed partial dentureAs connecters in fixed partial denture construction.construction.  To retain removable partial dentures.To retain removable partial dentures.  To retain overdentures.To retain overdentures. www.indiandentalacademy.comwww.indiandentalacademy.com
  11. 11. GoalsGoals  To provide an efficient masticatoryTo provide an efficient masticatory replacement of lost dental organs.replacement of lost dental organs.  To relate the designed platform to theTo relate the designed platform to the available tooth support.available tooth support.  To allow normal anatomic forms to theTo allow normal anatomic forms to the abutment teeth.abutment teeth. www.indiandentalacademy.comwww.indiandentalacademy.com
  12. 12.  Should be removable and replaceable withoutShould be removable and replaceable without stress and strain on the abutment teeth.stress and strain on the abutment teeth.  Should be capable of being tissue supported inShould be capable of being tissue supported in a controlled manner.a controlled manner.  Should allow for various Occlusal patterns.Should allow for various Occlusal patterns.  Should provide many years of comfortableShould provide many years of comfortable service.service. www.indiandentalacademy.comwww.indiandentalacademy.com
  13. 13.  To have minimum amount of tooth structureTo have minimum amount of tooth structure removed.removed.  To place minimum amount of strain onTo place minimum amount of strain on abutment teeth.abutment teeth.  To be esthetically acceptable.To be esthetically acceptable. www.indiandentalacademy.comwww.indiandentalacademy.com
  14. 14. Mode of action of precisionMode of action of precision attachmentsattachments  FrictionFriction  BindingBinding  Wedging of conical bodiesWedging of conical bodies  Internal spring loadingInternal spring loading  Active retentionActive retention www.indiandentalacademy.comwww.indiandentalacademy.com
  15. 15. Friction:Friction:  It occurs when parallel walls ofIt occurs when parallel walls of closely fitting bodies pass over oneclosely fitting bodies pass over one another.another.  The frictional force is directly relatedThe frictional force is directly related to the area of the opposing surfacesto the area of the opposing surfaces as well as to the length of axial walls.as well as to the length of axial walls.  The shape of the passage also plays aThe shape of the passage also plays a substantial role.substantial role. www.indiandentalacademy.comwww.indiandentalacademy.com
  16. 16.  The holding ability of the frictionalThe holding ability of the frictional attachments can be enhanced by addition ofattachments can be enhanced by addition of active retention elements .active retention elements .  They areThey are spring loaded bolts or plungers.spring loaded bolts or plungers. Ring springsRing springs Leaf springsLeaf springs BoltsBolts Rubber devices.Rubber devices. www.indiandentalacademy.comwww.indiandentalacademy.com
  17. 17. Binding:Binding:  It occurs when a parallel walledIt occurs when a parallel walled body tips with in the receptor site.body tips with in the receptor site.  Eccentric loads or frictionalEccentric loads or frictional elements produce tippingelements produce tipping movement,which enhances transmovement,which enhances trans additional binding effectadditional binding effect significantly increases resistance tosignificantly increases resistance to withdrawal.withdrawal. www.indiandentalacademy.comwww.indiandentalacademy.com
  18. 18. Wedging of conical bodies:Wedging of conical bodies:  Friction comes to play onlyFriction comes to play only in the terminal position andin the terminal position and is lost as soon as the bodiesis lost as soon as the bodies began to separate.began to separate. www.indiandentalacademy.comwww.indiandentalacademy.com
  19. 19. Internal spring loadingInternal spring loading  This is produced by a clip with inThis is produced by a clip with in a cylinder.a cylinder.  The friction with in retainers isThe friction with in retainers is often increased by loading withoften increased by loading with internal spring clips.internal spring clips.  Slots in the male portion allowsSlots in the male portion allows the pressure to be adjusted.the pressure to be adjusted. www.indiandentalacademy.comwww.indiandentalacademy.com
  20. 20. Active retention:Active retention:  That is when one body must beThat is when one body must be temporarily deformed to betemporarily deformed to be withdrawn from its fully seatedwithdrawn from its fully seated position.position.  Active retention means a physicalActive retention means a physical obstruction to separation of otherobstruction to separation of other parts.parts.  One part must undergo elasticOne part must undergo elastic deformation before separation candeformation before separation can occur.occur. www.indiandentalacademy.comwww.indiandentalacademy.com
  21. 21. IndicationsIndications Depending on what the attachment is designedDepending on what the attachment is designed to accomplish.to accomplish.  Primary indication is for clasp eliminationPrimary indication is for clasp elimination when esthetics is of prime importance.when esthetics is of prime importance.  For patients with reduced periodontal support.For patients with reduced periodontal support.  In patients where cross arch stabilization isIn patients where cross arch stabilization is desired.desired. www.indiandentalacademy.comwww.indiandentalacademy.com
  22. 22.  The attachment is indicated in combination withThe attachment is indicated in combination with fixed and removable prostheses.fixed and removable prostheses.  The attachment is indicated where removableThe attachment is indicated where removable partial denture design require stress equalizationpartial denture design require stress equalization which is of paramount importance.which is of paramount importance.  Long span edentulous areas.Long span edentulous areas.  To stabilize unilateral saddles.To stabilize unilateral saddles. www.indiandentalacademy.comwww.indiandentalacademy.com
  23. 23. ContraindicationsContraindications  Poor mental attitude of the patient is a definitePoor mental attitude of the patient is a definite contraindication.contraindication.  Poor oral hygiene.Poor oral hygiene.  One of the primary contraindications for theseOne of the primary contraindications for these prosthesis is space, whether it be vertical,prosthesis is space, whether it be vertical, bucco-lingual, mesio-distal, circumferential, orbucco-lingual, mesio-distal, circumferential, or interproximal.interproximal.  In healthy mouths not requiring restoration forIn healthy mouths not requiring restoration for other reasons.other reasons. www.indiandentalacademy.comwww.indiandentalacademy.com
  24. 24. AdvantagesAdvantages  The principal advantage of attachments forThe principal advantage of attachments for removable partial denture is esthetics.removable partial denture is esthetics.  Retention is an advantage for overdenturesRetention is an advantage for overdentures abutments.abutments.  Stress distribution.Stress distribution.  Cross arch stabilization.Cross arch stabilization. www.indiandentalacademy.comwww.indiandentalacademy.com
  25. 25. DisadvantagesDisadvantages  The cost of the service is major factor.The cost of the service is major factor.  Attachments are expensive.Attachments are expensive.  Additional post-insertion care is required.Additional post-insertion care is required.  Additional chair and laboratory time is needed.Additional chair and laboratory time is needed.  Greater experience and knowledge on the partGreater experience and knowledge on the part of the dentist and laboratory technician areof the dentist and laboratory technician are essential.essential.  Require repair and replacement.Require repair and replacement. www.indiandentalacademy.comwww.indiandentalacademy.com
  26. 26. ClassificationClassification www.indiandentalacademy.comwww.indiandentalacademy.com
  27. 27. Classified in number of ways:Classified in number of ways:  Based on fabricationBased on fabrication 1.Semi precision1.Semi precision 2.Precision.2.Precision.  Based on functionBased on function 1.Resilient1.Resilient 2. Non-resilient.2. Non-resilient. www.indiandentalacademy.comwww.indiandentalacademy.com
  28. 28. By RayBy Ray Active attachmentsActive attachments e.g.: split patrix, crismani.e.g.: split patrix, crismani. Passive attachmentsPassive attachments e.g.: passive mega attachmentse.g.: passive mega attachments www.indiandentalacademy.comwww.indiandentalacademy.com
  29. 29. By Collin. R. Corwell.By Collin. R. Corwell.  Based on the shape and locationBased on the shape and location 1.coronal-Intracoronal ---frictional1.coronal-Intracoronal ---frictional mechanicalmechanical -Extra coronal eg:Dalbo hinge-Extra coronal eg:Dalbo hinge - circumcoronal eg:Telescopic crown- circumcoronal eg:Telescopic crown 2.Radicular-eg:Rotherman2.Radicular-eg:Rotherman 3.Interdental-eg:Ackerman3.Interdental-eg:Ackerman 4.Auxiliary-eg:Ipsoclip4.Auxiliary-eg:Ipsoclip www.indiandentalacademy.comwww.indiandentalacademy.com
  30. 30.  Based on location or placement [by preiskel]Based on location or placement [by preiskel] 1.Intracoronal1.Intracoronal 2.Extracoronal2.Extracoronal 3.Studs3.Studs 4.Bars4.Bars www.indiandentalacademy.comwww.indiandentalacademy.com
  31. 31. According to Gareth JenkinsAccording to Gareth Jenkins 1.Extra Coronal1.Extra Coronal 2.Intra Coronal2.Intra Coronal 3.Auxiliary3.Auxiliary 4.Achors4.Achors 5.Bars5.Bars www.indiandentalacademy.comwww.indiandentalacademy.com
  32. 32. Extra Coronal PrecisionExtra Coronal Precision Attachments:Attachments:  It can be Rigid orIt can be Rigid or Resilient.Resilient.  Distributes the potentialDistributes the potential harmful forces awayharmful forces away from the abutment to thefrom the abutment to the edentulous ridges.edentulous ridges.  This is useful with freeThis is useful with free end saddles.end saddles.  The Patrix is completelyThe Patrix is completely outside the normaloutside the normal contour of that retainer.contour of that retainer. The Matrix is housedThe Matrix is housed with in the prosthesis.with in the prosthesis. www.indiandentalacademy.comwww.indiandentalacademy.com
  33. 33. Extra coronal Rigid Slide AttachmentsExtra coronal Rigid Slide Attachments:: Bi-Nat AttachmentsBi-Nat Attachments  HeightHeight : 4mm.: 4mm.  ApplicationApplication: Bilateral free: Bilateral free end saddles,Removable andend saddles,Removable and fixed partial dentures.fixed partial dentures.  ActivationActivation:There is a:There is a synthetic friction buffersynthetic friction buffer housed in the patrix , turn thehoused in the patrix , turn the locking screw to expand thelocking screw to expand the synthetic friction buffer andsynthetic friction buffer and increase the retention.increase the retention. www.indiandentalacademy.comwww.indiandentalacademy.com
  34. 34. www.indiandentalacademy.comwww.indiandentalacademy.com
  35. 35. www.indiandentalacademy.comwww.indiandentalacademy.com
  36. 36. Extra coronal resilient attachmentExtra coronal resilient attachment:: Dalbo-s resilient joint:Dalbo-s resilient joint:  HeightHeight : 5mm.: 5mm.  ApplicationApplication: Bilateral: Bilateral and unilateral free endand unilateral free end saddles,long denturesaddles,long denture saddles.saddles.  ActivationActivation:Bend:Bend lamellae of the matrixlamellae of the matrix towards the center withtowards the center with an instrument.an instrument. www.indiandentalacademy.comwww.indiandentalacademy.com
  37. 37. www.indiandentalacademy.comwww.indiandentalacademy.com
  38. 38. PR Hinge Attachments:PR Hinge Attachments:  HeightHeight : 4.5mm.: 4.5mm.  ApplicationApplication: Bilateral: Bilateral and unilateral free endand unilateral free end saddles.saddles.  ActivationActivation:To increase:To increase retention ,screw in theretention ,screw in the locking screw which islocking screw which is housed in the matrix.housed in the matrix. www.indiandentalacademy.comwww.indiandentalacademy.com
  39. 39. www.indiandentalacademy.comwww.indiandentalacademy.com
  40. 40. Intra Coronal Precision AttachmentIntra Coronal Precision Attachment  Here the matrix is contained with in theHere the matrix is contained with in the contour of the crown.contour of the crown.  It is useful during the preparation to haveIt is useful during the preparation to have either the attachment or plastic dummy to helpeither the attachment or plastic dummy to help ensure that sufficient space is provided.ensure that sufficient space is provided.  There are two groups of intra coronalThere are two groups of intra coronal attachments, non adjustable and adjustable.attachments, non adjustable and adjustable. www.indiandentalacademy.comwww.indiandentalacademy.com
  41. 41. Non adjustable intra coronal AttachmentsNon adjustable intra coronal Attachments:: Rod and tube attachmentsRod and tube attachments  ApplicationApplication:Fixed partial:Fixed partial dentures with a minor alignmentdentures with a minor alignment problem of the abutments.problem of the abutments.  Used as a connector for denturesUsed as a connector for dentures and to support one end of theand to support one end of the removable partial denture whichremovable partial denture which is retained at the other end by anis retained at the other end by an adjustable retentive attachment.adjustable retentive attachment. www.indiandentalacademy.comwww.indiandentalacademy.com
  42. 42. Key and Keyway Laboratory madeKey and Keyway Laboratory made attachment:attachment:  ApplicationApplication: used to: used to correct minor alignmentcorrect minor alignment problems in fixed partialproblems in fixed partial dentures and in fixeddentures and in fixed and semi fixed denturesand semi fixed dentures when minor and majorwhen minor and major retainers are used.retainers are used. www.indiandentalacademy.comwww.indiandentalacademy.com
  43. 43. Adjustable Intra Coronal AttachmentsAdjustable Intra Coronal Attachments:: Ancra AttachmentsAncra Attachments  ApplicationApplication : Removable: Removable fixed partial dentures,Crossfixed partial dentures,Cross arch stabilization,partialarch stabilization,partial dentures and minordentures and minor alignment problems withalignment problems with posterior abutment teeth.posterior abutment teeth.  ActivationActivation: Expand the slot: Expand the slot with a suitable instrument.with a suitable instrument. www.indiandentalacademy.comwww.indiandentalacademy.com
  44. 44. AnchorsAnchors  These attachments are used on either roots orThese attachments are used on either roots or implants to retain overdentures or removableimplants to retain overdentures or removable partial dentures.partial dentures.  The patrix is soldered to the diaphragm of aThe patrix is soldered to the diaphragm of a cast post and the matrix contained in thecast post and the matrix contained in the denture.denture.  There are two basic types-Rigid and Resilient.There are two basic types-Rigid and Resilient.  Rigid attachments are used in boundedRigid attachments are used in bounded unilateral or bilateral saddle cases.unilateral or bilateral saddle cases.  Resilient attachments are used in bilateral freeResilient attachments are used in bilateral free end saddle cases.end saddle cases. www.indiandentalacademy.comwww.indiandentalacademy.com
  45. 45. www.indiandentalacademy.comwww.indiandentalacademy.com
  46. 46. Rigid Anchors:Rigid Anchors: eccentric rothermann attachmenteccentric rothermann attachment  Height: 1.1 mmHeight: 1.1 mm  Application: to retainApplication: to retain rigid hybrid dentures.rigid hybrid dentures.  Activation: bend theActivation: bend the clasp arms of the matrixclasp arms of the matrix towards the centre.towards the centre. www.indiandentalacademy.comwww.indiandentalacademy.com
  47. 47. www.indiandentalacademy.comwww.indiandentalacademy.com
  48. 48. www.indiandentalacademy.comwww.indiandentalacademy.com
  49. 49. Resilient AnchorsResilient Anchors compact anchors:compact anchors:  Height: 2.85mmHeight: 2.85mm  Application: To retainApplication: To retain over dentures.over dentures.  Activation: bend theActivation: bend the lamellae of the matrixlamellae of the matrix towards the centre.towards the centre. www.indiandentalacademy.comwww.indiandentalacademy.com
  50. 50. Bar AttachmentsBar Attachments  The bar being in the patrix is attached to theThe bar being in the patrix is attached to the retainers while the matrix sleeve or clips orretainers while the matrix sleeve or clips or riders are processed into the dentures.riders are processed into the dentures.  They are used to retain overdentures orThey are used to retain overdentures or removable partial dentures.removable partial dentures.  They can also be used in conjunction withThey can also be used in conjunction with crowns and implants.crowns and implants.  They are either commercially or laboratoryThey are either commercially or laboratory manufactured.manufactured.  Bars can be Resilient or Rigid.Bars can be Resilient or Rigid.www.indiandentalacademy.comwww.indiandentalacademy.com
  51. 51. Rigid BarsRigid Bars Rigid Dolder bar:Rigid Dolder bar:  Height: 3.5mmHeight: 3.5mm  Application: partial,Application: partial, hybrid and implanthybrid and implant dentures.dentures.  Activation: Bend bothActivation: Bend both sides of the sleevesides of the sleeve towards the centre withtowards the centre with an activating tool.an activating tool. www.indiandentalacademy.comwww.indiandentalacademy.com
  52. 52. www.indiandentalacademy.comwww.indiandentalacademy.com
  53. 53. Resilient bar:Resilient bar: Ackermann Bar and Clip:Ackermann Bar and Clip:  There are two types ofThere are two types of Ackerman bar:Ackerman bar: 1] round1] round 2] egg shaped2] egg shaped The round bar is most frequentlyThe round bar is most frequently used as it can be bend moreused as it can be bend more easily to follow the contour ofeasily to follow the contour of the ridge and arch.the ridge and arch. www.indiandentalacademy.comwww.indiandentalacademy.com
  54. 54.  Applications: Partial dentures,over denturesApplications: Partial dentures,over dentures and implant dentures.and implant dentures.  Activation: Bend both sides of the clip towardsActivation: Bend both sides of the clip towards center with an instrument.center with an instrument. www.indiandentalacademy.comwww.indiandentalacademy.com
  55. 55. www.indiandentalacademy.comwww.indiandentalacademy.com
  56. 56. www.indiandentalacademy.comwww.indiandentalacademy.com
  57. 57. Auxiliary AttachmentsAuxiliary Attachments  This group of attachments covers a wide rangeThis group of attachments covers a wide range of applications.of applications.  They serve these situations ;They serve these situations ; a.] Allows planning which will enable thea.] Allows planning which will enable the clinician to remove the prostheses for repair orclinician to remove the prostheses for repair or conversion.conversion. b.] Overcome alignment problems which ariseb.] Overcome alignment problems which arise when abutments converge, making itwhen abutments converge, making it impossible to prepare them so that they can beimpossible to prepare them so that they can be mutually withdrawn when constructing fixedmutually withdrawn when constructing fixed partial dentures.partial dentures. www.indiandentalacademy.comwww.indiandentalacademy.com
  58. 58. c.] Replace the loss of soft tissue in anteriorc.] Replace the loss of soft tissue in anterior fixed partial dentures. Supplements retentionfixed partial dentures. Supplements retention on bars and telescopic crowns.on bars and telescopic crowns. www.indiandentalacademy.comwww.indiandentalacademy.com
  59. 59. Presso -Matic:Presso -Matic:  ApplicationApplication: To supplement: To supplement the retention on milledthe retention on milled laboratory- made bars andlaboratory- made bars and telescopic crowns used totelescopic crowns used to retain removable partialretain removable partial dentures and over dentures.dentures and over dentures.  ActivationActivation:Replace the plastic:Replace the plastic cushion and plunger.cushion and plunger. www.indiandentalacademy.comwww.indiandentalacademy.com
  60. 60. Screw and Tube Attachments:Screw and Tube Attachments:  ApplicationsApplications : To overcome: To overcome minor and major withdrawalminor and major withdrawal problems where abutmentsproblems where abutments cannot be paralleled and tocannot be paralleled and to provide contingency planningprovide contingency planning for long span fixed partialfor long span fixed partial dentures and full archdentures and full arch restorations when used inrestorations when used in conjunction with inner thimbleconjunction with inner thimble crowns.crowns. www.indiandentalacademy.comwww.indiandentalacademy.com
  61. 61. www.indiandentalacademy.comwww.indiandentalacademy.com
  62. 62. Materials used in attachmentMaterials used in attachment fabricationfabrication  PlatinumPlatinum  IridoplatinumIridoplatinum  Gold and platinumGold and platinum  Gold and palladiumGold and palladium www.indiandentalacademy.comwww.indiandentalacademy.com
  63. 63. Treatment planningTreatment planning  Essential information which must be obtainedEssential information which must be obtained for an adequate treatment plan includes:for an adequate treatment plan includes:  Medical and dental historyMedical and dental history  Discussion of patient expectationsDiscussion of patient expectations  Extra oral examination.Extra oral examination. www.indiandentalacademy.comwww.indiandentalacademy.com
  64. 64.  Intraoral examinationIntraoral examination  Periodontal surveyPeriodontal survey  Occlusal analysisOcclusal analysis  RadiographsRadiographs  Study modelsStudy models www.indiandentalacademy.comwww.indiandentalacademy.com
  65. 65. Medical and dental historyMedical and dental history  It is important to know significant previousIt is important to know significant previous history.history.  If the patient has already undertakenIf the patient has already undertaken restorative work of a complex nature that hasrestorative work of a complex nature that has failed, then the reasons for such failure mustfailed, then the reasons for such failure must be examined.be examined.  The ability of the patient to withstand longThe ability of the patient to withstand long clinical procedures should be assessed at thisclinical procedures should be assessed at this early stage.early stage. www.indiandentalacademy.comwww.indiandentalacademy.com
  66. 66. Discussion of patient expectationsDiscussion of patient expectations  Patient should be encouraged to comment onPatient should be encouraged to comment on the appearance of their existing teeth, and tothe appearance of their existing teeth, and to discuss their desires for the new ones.discuss their desires for the new ones.  These are always the most difficult to satisfyThese are always the most difficult to satisfy and careful counselling may be necessary toand careful counselling may be necessary to achieve an acceptable compromise.achieve an acceptable compromise. www.indiandentalacademy.comwww.indiandentalacademy.com
  67. 67. Extra oral examinationExtra oral examination  An appraisal can be made almost before theAn appraisal can be made almost before the patient is seated in the dental chair.patient is seated in the dental chair.  Any asymmetry should be noted.Any asymmetry should be noted. www.indiandentalacademy.comwww.indiandentalacademy.com
  68. 68. Intraoral examinationIntraoral examination  This must include a meticulous examination ofThis must include a meticulous examination of all soft tissues, shape of the ridges, and theall soft tissues, shape of the ridges, and the amount of bone loss.amount of bone loss.  Where gross bone loss precludes the use ofWhere gross bone loss precludes the use of conventional fixed partial dentures, precisionconventional fixed partial dentures, precision attachments can often overcome the problem.attachments can often overcome the problem. www.indiandentalacademy.comwww.indiandentalacademy.com
  69. 69.  The teeth should be examined for caries, theThe teeth should be examined for caries, the extent of restorations, colour, vitality,extent of restorations, colour, vitality, angulations, mobility and bony support,angulations, mobility and bony support, tenderness.tenderness.  Consideration should be given to increase theConsideration should be given to increase the length of crown sufficient for the provision oflength of crown sufficient for the provision of a fixed partial denture or precision attachment.a fixed partial denture or precision attachment.  A full periodontal survey should be carriedA full periodontal survey should be carried out.out. www.indiandentalacademy.comwww.indiandentalacademy.com
  70. 70. Occlusal analysisOcclusal analysis The basic principles of occlusion should beThe basic principles of occlusion should be applied to the analysis of each case. Theseapplied to the analysis of each case. These are ,are ,  There should be a stable co-ordinated occlusalThere should be a stable co-ordinated occlusal contact of the maximum number of teeth incontact of the maximum number of teeth in centric relation.centric relation.  Forces ideally be in line with the long axis ofForces ideally be in line with the long axis of each teeth.each teeth. www.indiandentalacademy.comwww.indiandentalacademy.com
  71. 71.  There should be no non working inclineThere should be no non working incline contacts.contacts.  There must be a balance of anterior andThere must be a balance of anterior and posterior inclines.posterior inclines. www.indiandentalacademy.comwww.indiandentalacademy.com
  72. 72. RadiographsRadiographs  Radiographs are essential for assessing theRadiographs are essential for assessing the suitability of teeth and their supportingsuitability of teeth and their supporting structures for abutments and the retainer ofstructures for abutments and the retainer of precision attachments.precision attachments. www.indiandentalacademy.comwww.indiandentalacademy.com
  73. 73. The free-end saddleThe free-end saddle  These are classified in toThese are classified in to  Bilateral free-end saddleBilateral free-end saddle  And unilateral free-end saddleAnd unilateral free-end saddle  Extracoranal attachments are preferred againstExtracoranal attachments are preferred against intracoronal attachments.intracoronal attachments. www.indiandentalacademy.comwww.indiandentalacademy.com
  74. 74. Bilateral free-end saddle denturesBilateral free-end saddle dentures www.indiandentalacademy.comwww.indiandentalacademy.com
  75. 75. www.indiandentalacademy.comwww.indiandentalacademy.com
  76. 76. www.indiandentalacademy.comwww.indiandentalacademy.com
  77. 77. www.indiandentalacademy.comwww.indiandentalacademy.com
  78. 78. www.indiandentalacademy.comwww.indiandentalacademy.com
  79. 79. www.indiandentalacademy.comwww.indiandentalacademy.com
  80. 80. www.indiandentalacademy.comwww.indiandentalacademy.com
  81. 81. www.indiandentalacademy.comwww.indiandentalacademy.com
  82. 82. www.indiandentalacademy.comwww.indiandentalacademy.com
  83. 83. www.indiandentalacademy.comwww.indiandentalacademy.com
  84. 84. www.indiandentalacademy.comwww.indiandentalacademy.com
  85. 85. www.indiandentalacademy.comwww.indiandentalacademy.com
  86. 86. Unilateral free-end saddlesUnilateral free-end saddles  Unilateral saddles can be used in an otherwiseUnilateral saddles can be used in an otherwise intact arch ,or in combination with a boundedintact arch ,or in combination with a bounded saddle on the opposite side of the arch.saddle on the opposite side of the arch. www.indiandentalacademy.comwww.indiandentalacademy.com
  87. 87. CaseCase www.indiandentalacademy.comwww.indiandentalacademy.com
  88. 88. www.indiandentalacademy.comwww.indiandentalacademy.com
  89. 89. www.indiandentalacademy.comwww.indiandentalacademy.com
  90. 90. www.indiandentalacademy.comwww.indiandentalacademy.com
  91. 91. www.indiandentalacademy.comwww.indiandentalacademy.com
  92. 92. The bounded saddleThe bounded saddle  Bounded saddles can arise in either theBounded saddles can arise in either the anterior or posterior part of the mouth.anterior or posterior part of the mouth.  They can be found in combination with free-They can be found in combination with free- end saddles or with bounded saddles on theend saddles or with bounded saddles on the same arch.same arch.  These are easier to treat than free-end saddles.These are easier to treat than free-end saddles. www.indiandentalacademy.comwww.indiandentalacademy.com
  93. 93. Anterior bounded saddlesAnterior bounded saddles  Problems which might arise in this situationProblems which might arise in this situation and complicate the provision of conventionaland complicate the provision of conventional fixed partial dentures could be due to:fixed partial dentures could be due to:  Bone lossBone loss  Unit spacingUnit spacing  Lack of parallelism of abutment teeth andLack of parallelism of abutment teeth and preparation.preparation. www.indiandentalacademy.comwww.indiandentalacademy.com
  94. 94. Bone lossBone loss  Where bone loss has been only slight and aWhere bone loss has been only slight and a gum fitted fixed partial denture is acceptablegum fitted fixed partial denture is acceptable in appearance, no problem arises.in appearance, no problem arises.  Small deficiencies can be corrected by addingSmall deficiencies can be corrected by adding pink porcelain between the pontics.pink porcelain between the pontics. www.indiandentalacademy.comwww.indiandentalacademy.com
  95. 95. Bone lossBone loss case 1 case 2case 1 case 2 www.indiandentalacademy.comwww.indiandentalacademy.com
  96. 96. www.indiandentalacademy.comwww.indiandentalacademy.com
  97. 97. www.indiandentalacademy.comwww.indiandentalacademy.com
  98. 98. www.indiandentalacademy.comwww.indiandentalacademy.com
  99. 99. www.indiandentalacademy.comwww.indiandentalacademy.com
  100. 100. www.indiandentalacademy.comwww.indiandentalacademy.com
  101. 101. Posterior bounded saddlesPosterior bounded saddles www.indiandentalacademy.comwww.indiandentalacademy.com
  102. 102. Case-1Case-1 www.indiandentalacademy.comwww.indiandentalacademy.com
  103. 103. www.indiandentalacademy.comwww.indiandentalacademy.com
  104. 104. Over denturesOver dentures  Anchors or stud attachments:Anchors or stud attachments: Are made in rigid form for bounded saddleAre made in rigid form for bounded saddle situations and in resilient form for free –endsituations and in resilient form for free –end saddles.saddles. They are generally used in conjuction withThey are generally used in conjuction with posts and diaphragms placed in root canalsposts and diaphragms placed in root canals following root canal therapy.following root canal therapy. Anchors are usually retained by means ofAnchors are usually retained by means of posts with diaphragms.posts with diaphragms. www.indiandentalacademy.comwww.indiandentalacademy.com
  105. 105. Case-1Case-1 www.indiandentalacademy.comwww.indiandentalacademy.com
  106. 106. www.indiandentalacademy.comwww.indiandentalacademy.com
  107. 107. www.indiandentalacademy.comwww.indiandentalacademy.com
  108. 108. www.indiandentalacademy.comwww.indiandentalacademy.com
  109. 109. www.indiandentalacademy.comwww.indiandentalacademy.com
  110. 110. www.indiandentalacademy.comwww.indiandentalacademy.com
  111. 111. www.indiandentalacademy.comwww.indiandentalacademy.com
  112. 112. Bar attachmentsBar attachments  Spaced teeth which are splinted by a bar are mutuallySpaced teeth which are splinted by a bar are mutually supportive.supportive.  Burnout resin patterns are available and custom-madeBurnout resin patterns are available and custom-made bars can be milled in the laboratory.bars can be milled in the laboratory.  There are two types of bar—round and egg shaped.There are two types of bar—round and egg shaped.  One advantage of round bar is that it can be bent inOne advantage of round bar is that it can be bent in all directions.all directions.  The egg shaped bar has extra rigidity making bindingThe egg shaped bar has extra rigidity making binding more difficult.more difficult. www.indiandentalacademy.comwww.indiandentalacademy.com
  113. 113. Case-1Case-1 www.indiandentalacademy.comwww.indiandentalacademy.com
  114. 114. www.indiandentalacademy.comwww.indiandentalacademy.com
  115. 115. www.indiandentalacademy.comwww.indiandentalacademy.com
  116. 116. www.indiandentalacademy.comwww.indiandentalacademy.com
  117. 117. www.indiandentalacademy.comwww.indiandentalacademy.com
  118. 118. www.indiandentalacademy.comwww.indiandentalacademy.com
  119. 119. www.indiandentalacademy.comwww.indiandentalacademy.com
  120. 120. www.indiandentalacademy.comwww.indiandentalacademy.com
  121. 121. www.indiandentalacademy.comwww.indiandentalacademy.com
  122. 122. www.indiandentalacademy.comwww.indiandentalacademy.com
  123. 123. www.indiandentalacademy.comwww.indiandentalacademy.com
  124. 124. Case-2Case-2 www.indiandentalacademy.comwww.indiandentalacademy.com
  125. 125. www.indiandentalacademy.comwww.indiandentalacademy.com
  126. 126. www.indiandentalacademy.comwww.indiandentalacademy.com
  127. 127. www.indiandentalacademy.comwww.indiandentalacademy.com
  128. 128. www.indiandentalacademy.comwww.indiandentalacademy.com
  129. 129. www.indiandentalacademy.comwww.indiandentalacademy.com
  130. 130. www.indiandentalacademy.comwww.indiandentalacademy.com
  131. 131. www.indiandentalacademy.comwww.indiandentalacademy.com
  132. 132. www.indiandentalacademy.comwww.indiandentalacademy.com
  133. 133. www.indiandentalacademy.comwww.indiandentalacademy.com
  134. 134. Auxiliary attachmentsAuxiliary attachments  a wide variety of attachments all in to thisa wide variety of attachments all in to this category.these are:category.these are: 1.screw and tube1.screw and tube 2.key and keyway2.key and keyway 3.presso-matic or ipsoclip3.presso-matic or ipsoclip 4.sectional denture4.sectional denture www.indiandentalacademy.comwww.indiandentalacademy.com
  135. 135. www.indiandentalacademy.comwww.indiandentalacademy.com
  136. 136. www.indiandentalacademy.comwww.indiandentalacademy.com
  137. 137. www.indiandentalacademy.comwww.indiandentalacademy.com
  138. 138. www.indiandentalacademy.comwww.indiandentalacademy.com
  139. 139. www.indiandentalacademy.comwww.indiandentalacademy.com
  140. 140. www.indiandentalacademy.comwww.indiandentalacademy.com
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  142. 142. www.indiandentalacademy.comwww.indiandentalacademy.com
  143. 143. www.indiandentalacademy.comwww.indiandentalacademy.com
  144. 144. www.indiandentalacademy.comwww.indiandentalacademy.com
  145. 145. www.indiandentalacademy.comwww.indiandentalacademy.com
  146. 146. Key and keywayKey and keyway www.indiandentalacademy.comwww.indiandentalacademy.com
  147. 147. Pressomatic or ipsoclipPressomatic or ipsoclip www.indiandentalacademy.comwww.indiandentalacademy.com
  148. 148. Sectional denturesSectional dentures www.indiandentalacademy.comwww.indiandentalacademy.com
  149. 149. www.indiandentalacademy.comwww.indiandentalacademy.com
  150. 150. www.indiandentalacademy.comwww.indiandentalacademy.com
  151. 151. Milling using a precisionMilling using a precision parallelometerparallelometer  The milling of crowns isThe milling of crowns is a precise procedure fora precise procedure for creating bracing, ledgescreating bracing, ledges and rests in full orand rests in full or partial veneer crownspartial veneer crowns which serve to retainwhich serve to retain conventional removableconventional removable partial dentures.partial dentures. www.indiandentalacademy.comwww.indiandentalacademy.com
  152. 152. Milling processMilling process www.indiandentalacademy.comwww.indiandentalacademy.com
  153. 153. www.indiandentalacademy.comwww.indiandentalacademy.com
  154. 154. www.indiandentalacademy.comwww.indiandentalacademy.com
  155. 155. www.indiandentalacademy.comwww.indiandentalacademy.com
  156. 156. www.indiandentalacademy.comwww.indiandentalacademy.com
  157. 157. www.indiandentalacademy.comwww.indiandentalacademy.com
  158. 158. The use of precision attachmentsThe use of precision attachments with implantswith implants  Use of precision attachments , in conjunctionUse of precision attachments , in conjunction with the Esthetic cone abutment and the Steri-with the Esthetic cone abutment and the Steri- Oss PME abutment, to overcome alignmentOss PME abutment, to overcome alignment problems between implants and teeth.problems between implants and teeth. www.indiandentalacademy.comwww.indiandentalacademy.com
  159. 159. EsthetiCone abutmentsEsthetiCone abutments  The estheticone abutment has an overall heightThe estheticone abutment has an overall height of 6.7mm and the abutment collars are eitherof 6.7mm and the abutment collars are either 1, 2 or 3mm in height so that marginal1, 2 or 3mm in height so that marginal placement can be varied to give the bestplacement can be varied to give the best esthetic results.esthetic results.  The interocclusal space must be sufficient toThe interocclusal space must be sufficient to accommodate the height of the abutment asaccommodate the height of the abutment as well as the superstructure, otherwise it cannotwell as the superstructure, otherwise it cannot be used.be used. www.indiandentalacademy.comwww.indiandentalacademy.com
  160. 160. Case-1Case-1 www.indiandentalacademy.comwww.indiandentalacademy.com
  161. 161. www.indiandentalacademy.comwww.indiandentalacademy.com
  162. 162. Short cantilever fixed partialShort cantilever fixed partial dentures and overdentures:dentures and overdentures:  If short implants are placed in the anterior partIf short implants are placed in the anterior part of the mandible in a very shallow curvature, itof the mandible in a very shallow curvature, it is unwise to cantilever more than a single unitis unwise to cantilever more than a single unit distally as stresses would be transferred to thedistally as stresses would be transferred to the screw and fixtures.screw and fixtures.  The design in the following case allows for aThe design in the following case allows for a complete restoration of the mandibular arch.complete restoration of the mandibular arch. www.indiandentalacademy.comwww.indiandentalacademy.com
  163. 163. CaseCase www.indiandentalacademy.comwww.indiandentalacademy.com
  164. 164. www.indiandentalacademy.comwww.indiandentalacademy.com
  165. 165. www.indiandentalacademy.comwww.indiandentalacademy.com
  166. 166. PME abutmentsPME abutments  The PME abutmentsThe PME abutments comes in the lengths ofcomes in the lengths of 2, 3, 4, 5 or 6mm.2, 3, 4, 5 or 6mm.  It is made of titaniumIt is made of titanium alloy and is capable ofalloy and is capable of as much as 40as much as 40 misalignment correctionmisalignment correction between implants.between implants. www.indiandentalacademy.comwww.indiandentalacademy.com
  167. 167. Applications are:Applications are: 1.Fixed-removable full arch reconstructions on1.Fixed-removable full arch reconstructions on six or more attachments.six or more attachments. 2.Overdentures supported on implants attached2.Overdentures supported on implants attached to bar on four to six implants.to bar on four to six implants. 3.Tissue supported overdentures attached to a3.Tissue supported overdentures attached to a bar on two implants.bar on two implants. 4.Fixed-removable partial denture on two or4.Fixed-removable partial denture on two or more implants.more implants. 5.Fixed-removable partial denture attached to5.Fixed-removable partial denture attached to natural teeth with precision attachment.natural teeth with precision attachment. www.indiandentalacademy.comwww.indiandentalacademy.com
  168. 168. www.indiandentalacademy.comwww.indiandentalacademy.com
  169. 169. www.indiandentalacademy.comwww.indiandentalacademy.com
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  171. 171. www.indiandentalacademy.comwww.indiandentalacademy.com
  172. 172. www.indiandentalacademy.comwww.indiandentalacademy.com
  173. 173. InterlocksInterlocks  Interlocks are extremely useful in restorativeInterlocks are extremely useful in restorative dentistry as they allow a degree of bothdentistry as they allow a degree of both splinting and retrievability.splinting and retrievability.  They are also relatively inexpensive.They are also relatively inexpensive.  It is necessary to consider the extent andIt is necessary to consider the extent and direction of the added force, the length anddirection of the added force, the length and diameter of the implant, the quality of the bonediameter of the implant, the quality of the bone and the angulation of the implants in that bone.and the angulation of the implants in that bone. www.indiandentalacademy.comwww.indiandentalacademy.com
  174. 174. www.indiandentalacademy.comwww.indiandentalacademy.com
  175. 175. ConclusionConclusion  The success of prostheses depends on carefulThe success of prostheses depends on careful treatment planning and attention to the Prosthodontictreatment planning and attention to the Prosthodontic problems. Careful use of precision attachments withproblems. Careful use of precision attachments with emphasis on advantages, disadvantages, indications,emphasis on advantages, disadvantages, indications, contraindications and mode of action is important forcontraindications and mode of action is important for the success of treatment.the success of treatment.  The dental surgeon who familiarizes himself withThe dental surgeon who familiarizes himself with precision attachments will add new dimension to hisprecision attachments will add new dimension to his treatment options.treatment options. www.indiandentalacademy.comwww.indiandentalacademy.com
  176. 176. BibliographyBibliography  Precision attachments-a link to successfulPrecision attachments-a link to successful restorative treatment---Gareth Jenkins.restorative treatment---Gareth Jenkins.  Precision attachments in Prosthodontics---Precision attachments in Prosthodontics--- preiskel.preiskel.  Removable Partial Prosthodontics –Removable Partial Prosthodontics – Ernest L. Miller & Joseph .E.Grasso.Ernest L. Miller & Joseph .E.Grasso.  Essentials of complete denture ProsthodonticsEssentials of complete denture Prosthodontics – Sheldon Winkler 2– Sheldon Winkler 2ndnd edition.edition. www.indiandentalacademy.comwww.indiandentalacademy.com
  177. 177.  Theory and Practice of Fixed Prosthodontics-Theory and Practice of Fixed Prosthodontics- - Tylman.- Tylman.  Prosthodontic treatment for edentulous Patients –Prosthodontic treatment for edentulous Patients – -Zarb & Bolender.-Zarb & Bolender.  Removable Partial Prosthodontics-Removable Partial Prosthodontics- - Mc.Cracken’s.- Mc.Cracken’s.  Removable Partial Prosthodontics-Removable Partial Prosthodontics- - Stewart.- Stewart. www.indiandentalacademy.comwww.indiandentalacademy.com
  178. 178. www.indiandentalacademy.comwww.indiandentalacademy.com

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