|Year : 2014 | Volume
| Issue : 3 | Page : 152-156
Attachments: Boon to preventive prosthodontics: Two case reports
Aman Arora, Viram Upadhayaya, Itanshu Goyal, Ashima Chowdry
Department of Prosthodontics and Crown and Bridge, J.N. Kapoor D.A.V (C) Dental College, Yamuna Nagar, Haryana, India
|Date of Web Publication||8-Dec-2014|
Department of Prosthodontics and Crown and Bridge, J.N. Kapoor D.A.V (C) Dental College, Yamuna Nagar, Haryana
Source of Support: None, Conflict of Interest: None
To plan and execute rehabilitation of a decimated dentition is probably one of the most intellectually and technically demanding tasks faced by any prosthodontist. Attachments are small interlocking devices, which are used to connect prosthesis and abutments that offer a variety of solutions to challenge of balance between functional stability and cosmetic appeal. This clinical report describes a multidisciplinary approach for complete oral rehabilitation of a patient with few remaining natural teeth using precision attachment (ceka Preci-Clix Radicular RC) for mandibular overdenture and semi precision attachment (ceka revax extracoronal and ceka vertix) for maxillary cast partial denture.
Keywords: Cast partial denture, ceka, overdenture, precision attachment
|How to cite this article:|
Arora A, Upadhayaya V, Goyal I, Chowdry A. Attachments: Boon to preventive prosthodontics: Two case reports. J Dent Res Rev 2014;1:152-6
|How to cite this URL:|
Arora A, Upadhayaya V, Goyal I, Chowdry A. Attachments: Boon to preventive prosthodontics: Two case reports. J Dent Res Rev [serial online] 2014 [cited 2019 Nov 21];1:152-6. Available from: http://www.jdrr.org/text.asp?2014/1/3/152/146496
| Introduction|| |
Dental professional must be able to relate the patients concern both physically and psychologically. Attachments provide a very important psychological union in treating patients as a whole and not merely as a disease. Just as patient's need differs so do attachments.
Many times patients with few remaining teeth report to dental clinics. Most often they are unaware that a better prosthesis can be made preserving those teeth. According to GPT-6 overdenture is the removable partial or complete denture that covers and rests on one or more remaining natural teeth, roots, and or/dental implants. 
Attachment retained overdenture helps in distribution of masticatory forces, minimizes trauma to abutments and soft-tissue, attenuate ridge resorbtion, improves esthetics and retain propioception. Attachment retained cast partial dentures offer a variety of solutions to challenge of balance between functional stability and cosmetic appeal. 
Precision attachment has long been considered the highest form of partial denture therapy. Attachment retained removable partial denture (RPD) is the treatment modality that can facilitate both esthetic and a functional replacement of missing teeth and oral structures. The few retrospective studies available show a survival rate of 83.3% for 5 years, of 67.3% up to 15 years and of 50% when extrapolated to 20 years. , This article describes a series of case reports of patients being treated by different types of attachments in different case scenarios.
| Case Reports|| |
A 65-year-old exacting female patient reported to the Department of Prosthodontics with the chief complaint of inability to chew food. Patient was teacher by profession so was much concerned for retention stability and esthetics.
On clinical examination, teeth present were 13, 14, 17, 24, 26, 33, 35, 44.
Mandibular ridge was severely resorbed posteriorly (Atwood's class IV) with knife edge ridge between abutment teeth anteriorly. Palatal torus was present.
Considering the patient complaint, background, and condition of the oral cavity mandibular overdenture with ceka Preci-Clix Radicular RC attachment and maxillary cast partial with ceka revax extraradicular attachment was planned.
The treatment planning included endodontic phase, surgical phase and prosthodontic phase.
Endodontic phase involved intentional endodontic treatment in 33 and 44 followed by surgical phase of extraction of 35 as it was Grade II mobile. After a period of 15 days complete healing was observed and prosthodontic phase was started.
For maxillary cast partial (ceka revax extraradicular)
- A primary impression was made with irreversible hydrocolloid impression material and poured in dental stone to obtain the diagnostic cast
- Tooth preparation steps were undertaken in tooth no. 13 and impression was taken with additional silicone impression material and was poured in die stone to get the first master cast
- The prepared teeth were waxed up in a conventional manner and the plastic female part of the attachment was attached to the mesial aspect of the wax patterns [Figure 1]
- After casting and finishing the restoration veneering of the fixed component was done [Figure 2]
- The fixed component including veneered metal-ceramic crowns and the patrices (female part) were tried in the patient mouth, a pick-up impression was made and cast was poured in die stone.
- The matrices (male part) of the attachments were placed in the patrice of the attachments (female part) which were in the crowns on the refractory cast
- After surveying distal occlusal rest was planned on 14 and 25 and anterio-posterior palatal bar major connector was planned because of palatal torus present in patient
- The wax-up of framework of the RPD was done, invested and casted
- Framework was tried in patient's mouth and occlusal rims were fabricated over it.
For mandibular overdenture: (Preci-Clix Radicular RC)
- Teeth were reduced to level of adjacent gingiva and sharp edges of teeth were rounded up
- Root canal space was prepared with the predrilling bur and the diamond burr was used to prepare the base of the Preci-Clix post [Figure 3]. Reamer was used to prepare for the diameter of the post
- Post was sandblasted and was cemented with Glass inomer cement [Figure 4]
- Primary cast was made using irreversible hydrocolloid impression material. Special tray was made by giving two layer thick spacer around the posts. Border molding was carried out in conventional manner
- Secondary impression was made with monophase rubber base and analogue was re indexed into recess created in impression and master cast was poured with die stone [Figure 5]
- Metal housing with rentention caps were placed over the cast and were blocked with wax. Record bases were fabricated and occlusal rims were prepared.
|Figure 4: Overdenture ceka Preci-Clix Radicular RC attachments cemented in mouth|
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Jaw relation was recorded using both upper and lower occlusal rims. Teeth arrangement and try in of denture was done to check centric relation, vertical dimension and esthetics.
For mandibular denture fabrication, denture was flasked and dewaxing was done in conventional manner. Black rubber spacers supplied in kit were placed over the posts and female housing was placed over post and denture was packed in conventional manner.
Acrylisation of cast partial removable denture was done in conventional manner with matrices (male part) over patrices (female part) so that male part will be included in acrylic part of cast partial removable denture.
Finished maxillary cast partial and mandibular overdenture [Figure 6] and [Figure 7] was delivered and instructions were given to patient and recalled after 24 h for checkup.
|Figure 6: Finished maxillary cast partial and mandibular overdenture with counterpart attachment|
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Attachment retained cast partial removable denture: (Ceka vetix)
A patient with missing teeth 11, 14, 15, 21, 23, 24, 25, 26 reported in the department of prosthodontics with the chief complaint of poor esthetics. Root canal treatment followed by post and core w.r.t. to 12, 22 was done.
- Tooth preparation was done w.r.t. 12, 13, 16, 17, 22, 27 and 28
- During the wax up ceka vertix attachment was attached with crowns w.r.t. 13, 16, 22, 27 [Figure 8]
- Casting was done for the crowns and crowns were tried intra orally [Figure 9]
- The cast with the crowns was duplicated and cast partial framework was fabricated and tried in mouth [Figure 10]
- Porcelain firing was done and the crowns and framework was tried in the patient's mouth [Figure 11]
- The crowns were cemented and maxillomandibular relations were recorded using cast partial framework
- Teeth arrangement was done and tried in the patient's mouth
- The cast partial was acrylized in the usual manner and sleeves i.e. the patrix part was bonded with ceka bond in the cast partial [Figure 12]
- Patient was evaluated after one month post operatively [Figure 13].
|Figure 8: Castable ceka vertix attachment attached with wax pattern of the crowns|
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| Discussion|| |
Saving natural teeth and using them as abutments for attachments is a viable and tissue, and time tested alternative for those patients who cannot have implants due to various reasons such as medical contraindications, cost factors, etc., The use of attachments can redirect occlusal forces away from weak supporting abutments and onto soft-tissue, or redirect occlusal forces toward stronger abutments and away from soft tissues. They act as shock absorbers and stress redirectors as well as provide superior retention.
The key to success of an overdenture is the selection of strategic roots or teeth for retention. The shortened crown improves the crown-to-root ratio, thereby decreasing the motility of the abutment teeth under an overdenture.  In a 4-year-study, Renner et al. showed that 50% of roots, used as overdenture abutments remained immobile. In addition, 25% of roots that were initially mobile became less mobile. Hence, they suggested, that teeth that are generally compromised can be used for overdentures after root canal therapy and decoronation. ,,
Semi precision attachment has exceptional feature of being a removable prosthesis with improved esthetics, less postoperative adjustments and better patient comfort.  They are mostly indicated in long edentulous spans, distal extension bases and nonparallel abutments. Criteria to choose one system or the other is based on the principle of forces distribution in order to maintain the health of the remaining teeth and alveolar ridges and improving patient comfort and function. 
| Conclusion|| |
Preventive prosthodontics being the rationale, preservation of the existing teeth and extending an alternative to conventional dentures by the use of tooth supported overdentures would be the most plausible choice in the long run. It is reasonable to say that retention obtained on part of natural dentition allows the overdenture patient a gain in the neuro-muscular performance, thereby giving him an edge over his edentulous counterpart. Careful case and abutment selection, patient motivation and periodic recall are the keys to successful prosthetic rehabilitation.
| References|| |
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[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8], [Figure 9], [Figure 10], [Figure 11], [Figure 12], [Figure 13]