JIDAM

CASE REPORT

“An Official Journal of IDA - Madras

Available online

ATTACHMENT RETAINED CAST PARTIAL

DENTURE - AN ALTERNATIVE OPTION TO

DISTAL EXTENSION PARTIAL EDENTULOUS

SPACE - A CASE REPORT

Dr. Arthi Ambayiram , Dr. Ahila Singaravel Chidembaranathan , Dr. Muthukumar Balasubramanium

Department of Prosthodontics, SRM Dental College, Ramapuram,Chennai, India.

To access & cite this article

ABSTRACT

Website: jidam.idamadras.com

Rehabilitating the partial edentulous patients, especially distal

extension situations are mostly challenging to a Prosthodontist.

Successful restoration can be achieved with the attachment

retained cast partial denture. The use of semiprecision

attachments enhances the retention and stability of the removable

partial denture where fixed treatment is not possible in the

posterior region. This case report describes a method of using

semiprecision attachment in bilateral distal extension partial

edentulous case.

KEYWORDS: Distal extension, Precision attachment, Partially

edentulous

Address for correspondence:

Dr.S.C.Ahila, MDS

Associate Professor,

Dept of Prosthodontics,

SRM Dental College,

Ramapuram,Chennai, India.

Email id: ahilasc@yahoo.co.in

Received

: 17.05.2020

Accepted

: 23.05.2020

Published

: 27.06.2020

JIDAM/Chennai/Volume:7/Issue:2/Pages 63 - 66/April-Jun 2020

Arthi et al: Attachment retained Cast Partial Denture an Alternative option to distal extension partial edentulous

INTRODUCTION:

Functionally

successful

rehabilitation

requires careful examination and treatment planning.

In Kennedy’s class 1 and class 2 condition, fixed

treatment is not possible because of missing terminal

abutment. Implant supported prosthesis cannot be

considered in elderly patients due to age factors.

So, in such situations attachment retained cast

partial dentures can be given as a treatment option.¹

Attachments are of intracoronal and extracoronal type.

Fig 2: Intra - oral View of Right Quadrant

Intracoronal type has male and female components

positioned within the normal contour of the abutment

tooth. Extracoronal attachments are those that have

male and female components positioned outside

the normal contour of the abutment tooth.² This

case report describes about a patient with maxillary

bilateral distal extension Kennedy’s classification 1

modification 2 condition which is restored with a cast

partial denture retained using extracoronal bilateral

semiprecision attachment.

CASE REPORT:

Fig 3: Intra- oral View of Left Quadrant

A 60 year old male patient reported to the

Department of Prosthodontics at SRM Dental

College, Ramapuram, Chennai, India with a chief

complaint of missing teeth in the maxillary right and

left back teeth region. On clinical examination, it was

found that 13, 22 were missing on maxillary anterior

region. In maxillary posterior region all teeth were

missing bilaterally except the first premolar 14 on the

right side. The clinical condition was diagnosed as

Kennedy´s class I modification 2(Fig 1-4). The first

premolar was restored with glass ionomer cement

Fig 4: Orthopantomogramgraph

on the distal side adjacent to the edentulous area.

On radiographic examination, it was found that the

TREATMENT PROCEDURE:

central incisors 11 and 21 were endodontically treated

and the other teeth were found to be periodontally

Diagnostic impressions were made

with

sound. Thus attachment retained cast partial denture

irreversible hydrocolloid impression material

was given as a treatment option for this patient.

(Zelgan plus, Dentsply) and poured with

dental stone. Diagnostic casts were obtained

and mounted on a mean value articulator.

The type of attachment was decided based on

the space available. Tooth preparation of

14,

12, 11, 21, and 23 for porcelain fused to metal

fixed partial denture was done with occlusal

clearance assessed (Fig-5). Temporary FPD

was fabricated and provisionalization was

done.

Fig 1: Intra- oral frontal view

JIDAM/Chennai/Volume:7/Issue:2/Pages 63 - 66/April-Jun 2020

Arthi et al: Attachment retained Cast Partial Denture an Alternative option to distal extension partial edentulous

was recalled after 24 hours for postinsertion

check-up.

Fig 5: Anterior FPD with semiprecision attachment

Definitive impression was made with

polyvinylsiloxane

impression

material

Fig 6: Rehabilitation with cast partial denture intra-

(Aquasil, Dentsply) and then poured with die

oral view

stone. Interocclusal records were taken and

the casts were articulated.

Wax patterns were fabricated for porcelain

fused to metal fixed partial denture in

the maxillary anterior region. The male

components

‘matrix’ was attached to the

axial surface of the abutment with the help

of a dental surveyor. This was followed by

investing and casting.

The fit of the framework was verified in the

definitive cast and in the patient’s mouth.

Ceramic build up was done after sand blasting.

Fig 7: Rehabilitation with cast partial denture sagittal

The bisque try in was done.

view

Using a correct size tray, pick up impression

DISCUSSION:

was made with polyvinyl siloxane impression

material along with the porcelain fused to

In 1960, Dr.Herman E. S. Chayes designed

metal FPD.

century. His

and invented attachments in the 20th

The wax pattern of the metal framework

attachments have been modified and being used in

was fabricated using a dental surveyor and

Prosthodontics today. Attachments are classified

palatal strap major connector was given.

into precision and semiprecision attachments based

The framework was invested, casted and the

on the method of fabrication and tolerance to fit.³

female component matrix was inserted in the

Semiprecision attachment is a laboratory fabricated

metal framework.

rigid metallic matrix of a fixed or removable partial

The fit and retention of the metal framework

denture that fits into a matrix in a cast restoration,

was verified in the patient’s mouth and jaw

allowing some movement between the components.⁴

relation was done. Teeth arrangement and

wax try in was done. The processing of the

Hedzelek has done a study to evaluate

denture was then followed by finishing and

the longevity by a stimulated, repeated denture

polishing the removable partial denture.

placement and removal and he investigated the

components wear. He stated that casting defects and

The porcelain fused to metal fixed partial

laboratory procedures have influenced the fit of the

denture was luted with Glass Ionomer type

semiprecision attachments.⁵

1 luting cement (GC, Gold label) and the

denture was inserted (Fig 6 & 7). Patient

JIDAM/Chennai/Volume:7/Issue:2/Pages 63 - 66/April-Jun 2020

Arthi et al: Attachment retained Cast Partial Denture an Alternative option to distal extension partial edentulous

Evaluation of the retentive characteristics of

Reeta et al stated that extracoronal attachments

semi-precision extracoronal attachments. J

reduce the stress on the abutment teeth and transfer

Oral Rehabil 2011;38:462-8.

to the denture bearing area.⁶ The disadvantages

of intracoronal attachments are excessive tooth

Jain R, Aggarwal S. Precision attachments-

reduction and atleast 3mm of height is needed.⁷

An overview. Ann Prosthodont Restor Dent

Extracoronal OT caps are of various colors and have

2017;3:6-9.

different retentive properties. These OT caps are

castable attachments with elastic retention.⁸ In this

Shetty NB, Shetty S, Nagaraj E, Shetty O,

case report, yellow colored extracoronal OT caps

D’Souza R. Precision attachments for aesthetics

were used which provides extra soft retention.

and function: A case report. J Clin Diagnostic

Res 2014;8:268-70.

CONCLUSION:

Gupta C, Sharma H, Nongsiej M, Shekhar A.

Use of semiprecision attachments based on

Attachment retained cast partial denture using

the patient demands and comfort have increased the

Rhein 83 OT- Cap. Indian Dent J 2016;8:35-9.

retention of the prosthesis when compared with the

conventional removable partial denture. In cases

where fixed prosthesis are contraindicated, the

combination of fixed and removable dental prosthesis

aids in better treatment outcome.

FINANCIAL SUPPORT AND

SPONSORSHIP:

Nil

CONFLICTS OF INTEREST:

There are no conflicts of interest.

REFERENCES:

Gupta N, Bhasin A, Gupta P, Malhotra P.

Combined Prosthesis with Extracoronal

Castable Precision Attachments. Case Rep

Dent 2013;10:1-4.

Rosenstiel SF, Land MF, Fujimoto J.

Contemporary Fixed Prosthodontics. Mosby

2016: 590-593 p.

Khanam H, Bharathi M, Reddy K, Reddy S.

Attachments in Prosthodontics: Different

Systems of Classification: a Review. J Evol

Med Dent Sci 2015;3:7937-44.

The glossary of prosthodontic terms

-9. J

Prosthet Dent 2017;117(5s):1-105.

Hedzelek W, Rzatowski S, Czarnecka B.

JIDAM/Chennai/Volume:7/Issue:2/Pages 63 - 66/April-Jun 2020