Precision Attachments

INTRODUCTION

By definition, the term precision denotes ‘the quality or

state of being precise’.

Misconceptions about the use of intracoronally retained

prosthesis have discouraged many practitioners to use them in

their dental practices. However the prosthodontist who employs

this form of treatment quickly learns of its benefits in providing

patients with an esthetic prosthesis.

Precision attachments are sometimes said to be a

connecting link between the fixed and removable type of partial

dentures because it incorporates features common to both

types of construction. Precision attachments in dentistry is a

means of bodily function for a removable bridge or partial

dentures (Steiger and Boitel).

Precision attachments retain and attach a removable

bridge or partial denture on natural teeth vital or nonvital. Some

serve as retainers for full dentures (overdentures) where few

abutments remain. The main purpose of each precision

attachment besides retention is its concealment within or under

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 Precision Attachments

a restoration as an esthetically better alternative to a visible

clasp retainer.

Inherent in the conceptions which have led to the

development of precision attachments are two basic objectives.

These are :

1. To relate the desired platform to the available tooth

support.

2. To distribute as far as possible the load to be thrust on the

teeth by the appliance.

In order to achieve these two objectives precision

attachments have been constructed into two halves, a matrix

and a patrix, the two halves being so arranged that they

articulate with one another to form a precise but separable

joint. The two halves are also referred to as the male and female

parts. The abutment retainers houses a slot (female) which fits,

(embraces or envelops) the male portion.

An attachment is a precision connector made up of two or

more parts. One part is connected to a tooth, root or implant.

The other to an artificial prosthesis to provide mechanical

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 Precision Attachments

connection between the two (Michael Sheering Lucas and Paul

Martin). An attachment is a mechanical device for the fixation,

retention and stabilization of a dental prosthesis. Precision

attachment may be prefabricated by a manufacturer or in the

dental laboratory. This is differentiated by calling the former

‘precision’ and the latter’ semiprecision’ attachments. The

manufactured type is made of precious metal. The fit of the two

working elements is machined to very close tolerance and is

more precise in construction than the laboratory type. The male

portion takes the shape of a “T” or “H” which fits an

appropriately shaped slot. The female attachment is fitted into

the restoration in the tooth either by casting the gold to it or

placing it in a prepared receptacle in the restoration and by

attaching the two together with solder. The male and female

parts are matched to interlock together and provide direct

retention for the partial denture.

The semiprecision attachment is referred to as ‘precision

rest’ ‘milled rest’ or ‘internal rest’. This type of retainer takes the

form of a dovetail shaped keyway built into the proximal

surfaces of wax pattern of a gold crown.

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 Precision Attachments

DEFINITIONS

Precision attachment

1. A retainer consisting of a metal receptacle (matrix) and a

closely fitting part (patrix). The matrix is usually contained

within the normal or expanded contours of the crown on the

abutment tooth and the patrix is attached to a pontic or the

removable partial denture frame work (Glossary of

prosthodontic terms Sixth Edition 1994).

Synonyms

Internal attachment, parallel attachment, frictional

attachment, key and key way attachment, slotted attachment.

2. A retainer used in fixed and removable partial denture

construction consisting of a metal receptacle and a closely

fitting part, the former is usually contained within the

normal or expanded contours of the crown of the abutment

tooth, and the latter is attached to a pontic or to the denture

frame work (Jack H. Swepston – Dental laboratory

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 Precision Attachments

Proceedings, Removable partial dentures – Rhoads, Rudd,

Morrow).

3. Implies a partly or wholly machined device consisting of a

male and female components which is used in restorative

dentistry to retain removable or semi-removable prosthesis

(D.H. Roberts – Fixed bridge prosthesis)

4. Are wholly or partially machined accessories used in

dentistry for the retention of removable or semi-removable

prosthesis (G.E.Ray precision attachments).

INTRACORONAL PRECISION ATTACHMENTS

The bulk of the soldered or cast on portion of the joint lies

within the anatomical contours of the treated teeth (G.E. Ray –

Precision Attachments).

EXTRACORONAL PRECISION ATTACHMENTS

Are used to join a prosthesis to a retainer, part of all of

their mechanisms is outside the contour of the retainer (Merrill

C. Mensor – Dental Laboratory Procedures, Fixed Partial

Dentures, Rhoads, Rudd, Morrow).

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 Precision Attachments

HISTORY

Although earlier both Winder and Parr invented devices

which are clearly attachments both in principle and design,

credit is usually given to George Evans 1888 for introduction of

precision attachment retainer system.

Early pioneers such as Peeso (1894), Carr (1898) Goslee

(1913) Gilmore (1913), Fossume (1906), Bennett (1904), Brown,

Bryant, Conduit, Golobin, Kelley, McCollum, Morgan, Roach,

Sorensen, Supplee (all from Unites States of America) were

highly innovative with their deigns, had only limited insight into

the biologic dynamics of fixed and removable prosthodontics as

related to the periodontal apparatus.

Development of intracoronal and extracoronal

attachments has been traced from antiquity to modern times.

The history of intracornal retainer systems began in ancient

times with the Phoenicians, between the 4th and 5th centuries.

B.C. where artisans and Goldsmiths created artificial

replacements. Usually anterior teeth were replaced with

extracted human teeth and these were bound with gold wire to

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 Precision Attachments

each other and to adjacent remaining teeth. During the old

kingdom (3100.2181 BC) in Egypt anterior replacements were

created by artisans who threaded gold wire through extracted

teeth and then wrapped the gold wire around these

replacements and anchored them to the adjacent remaining

teeth. About the 4th century BC, the Etruscans constructed

fixed removable prostheses replacing one or more missing teeth

by using soft, pure gold bands that were soldered together,

surrounding the remaining teeth and carrying the replacement.

Dubois De Chemant anchored the partial dentures with

clasps in its simplest form and developed it later. Delabarre had

constructed a kind of supported prosthesis in 1820. a saddle

shaped spring was introduced by the London dentist. De la Fons

1826 which exerted its force partially in the open position and

partially in the closed and extended within the row of teeth

between the points of contact similar to the Jacksons clasp.

In the 19th Century the various extracoronal and

intracornal attachments were developed. Among the first

custom crafted intracoronal types of attachments system used

was the winged lug attachment. This consisted of an

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 Precision Attachments

intracoronal rest seat soldered into a restoration and a rest

soldered to the partial denture framework. Manufactured

attachment system were developed and introduced during the

late 19th and early 20th century. These attachments simplify

construction of the restorations. They allow standardization of

the component parts and permit easy repair of the sections.

The Griswold attachment introduced in 1889 was a

triangular tube and sleeve. The inner patrix was soldered to the

abutment restoration and the outer matrix was attached to the

gold or vulcanite denture base.

Bryant in 1894 fabricated an attachment system by

soldering iridoplatinum wire guide posts, the size of a large pin

to the proximal surfaces of the abutment crowns.

The conduit attachments 1895 was a circular type of

system. It consisted of a tubular patrix open at the side facing

the edentuolous area and at its ends. The patrix was soldered

to the abutment restoration.

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 Precision Attachments

Morgans attachment was patented in 1901. it consisted of

a “keeper”, the matrix which was soldered to the abutment

restoration as an extracoronal device.

Roach in 1904 published an article describing as hand

made intracoronal attachment system. Chayes in 1908 stated

that the biological principle that govern function of normal teeth

could not be violated without consequences. He stressed the

importance of movement of teeth in their resilient socket during

function.

Ash 1912 introduced the split bar attachment system.

This retentive system was laboratory fabricated and required

that the abutment teeth be nonvital. The Yiridian intracoronal

attachment system introduced in 1918 consisted of split post

and split bar device. J. Wright Beach in 1916 published the

rationale for incorporating a lug rest in al removable partial

dentures. He argued that the lug rest was an integral part of the

clasp to maintain the retainer in its pre-determined position.

Henry W. Gillett developed a deep rest system for use with

movable removable partial dentures in 1923. This was the first

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 Precision Attachments

semiprecision attachment. It was laboratory fabricated and had

a solid metal deep rest that fit into a rest seat carved into the

abutment restoration.

Victor H. Jackson in New York used only round spring

action, plantinum, iridum wire for his treatment aid designated

as “crib”. In 1887 he developed in into a universal tool. The

appliance was fastened with clasps which overlapped the

interdental space between crowns of premolar and molar.

Without doubt, the most important character in the

development of precision attachment dentistry was Dr. Herman.

E. S. Chayes He can be called the father of precision intra

coronal retainer. Chayes was born in 1880 in Poland, from

where he emigrated to New York in 1893. before entering dental

college, he worked in a corset factory where he invented a

detectable suspender device which formed the fundamental

feature of his dental attachment. Chayes qualified with honours

at New York college of dentistry in 1900. between 1908 and

1910, he invented a parallelometer and in 1912 he deigned

Chayes attachment. This was the first attachment to be placed

in the general market and still forms the basic pattern for most

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 Precision Attachments

of the modern attachments. It is an intracoronal mesiodistal

attachment.

Since then, the technology of attachments have progressed

at such a rapid rate, that from a very T shaped attachments and

bar attachments (1915-1935) various attachments of most

diversified designs are available today.

In Europe, particularly Switzerland known as the country

of watch makers and fine mechanics development in the field of

attachment picked momentum before, during and after the

second would war.

Steiger, Boitel, Muller and Biaggi were the force runners.

In 1959, Alfred Steiger and Raoul B. Boitel perfected

channel shoulder – pin (C.S.P. system)

In Europe, laboratory made attachments because known

during first world war, when readymade attachments from

United States were unobtainable.

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 Precision Attachments

GOALS

The goals for fabrication of precision attachment

prosthesis are as follows :

a. To be removable and replaceable without stress or stain

on abutment teeth

b. To permit normal anatomic contour to the abutment teeth

c. To provide many years of comfortable service

d. To be made of materials that are compatible with oral

tissues.

e. Resistance to abrasion

f. Resistance to corrosion

g. To be esthetically acceptable

h. To require minimal amount of tooth structure to be

removed

i. To be hygienically clean

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 Precision Attachments

INDICATIONS AND CONTRA INDICATIONS

Indications

1. Movable joints in fixed movable bridge work

2. As stress breaker in free end saddles and bridges

3. Intracoronal attachments are effective retainers for

removable partial dentures

4. As a connector for sectional dentures

5. Sections of a fixed prothesis may be connected with intra

coronal attachments

6. To lock a connector joining a saddle sin the opposite side

of the arch

7. As contingency devices for the extension or conversion of

existing fixed appliances.

8. Periodontal involvement that contraindicates fixed partial

dentures

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 Precision Attachments

9. Labial clasp arms which would otherwise be displayed in

the anterior part of the mouth and would be esthetically

displeasing

10. To retain hybrid dentures

Contraindications

1. Sick and the senile (prosthesis with attachments must be

inserted along one precise path of insertion, the patient

must posses an average degree of manual skill).

2. Periodontosis

3. Abnormally high caries rate

4. Inadequate space to employ them (Teeth that are very

narrow facio-lingually).

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 Precision Attachments

ADVANTAGES AND DISADVANTAGES

Advantages

1. The labial or bucal clasp arm can be eliminated altogether.

This makes spectacular improvement in the esthetic

excellence of a denture especially in the maxillary arch.

2. Precision attachments are less stressful to the abutment

teeth than conventional clasps. Precision attachment is

located deep within the confines of the tooth therefore all

stress is directed along long axis of the teeth.

Disadvantages

1. The tooth may have to be extensively cut to provide

requisite space to accommodate intracoronal attachment

2. A bulge in the crown is created by intra coronal attachment

3. The attachment is subject to wear as a result of friction

between metal parts. As wear occurs, male portion fits more

loosely thus permitting excessive movement and threat of

injury to abutment teeth.

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 Precision Attachments

4. The extra coronal type of retainer extends out from the

tooth near the gingival border there may be a gingival

irritation followed by usual inflammatory sequela.

5. The extracoronal type of attachment must occupy the space

immediately adjacent to abutment tooth, which is precisely

where a replacement tooth should ideally be positioned.

PRECISION VERSUS SEMIPRECISION

Advantages of precision attachments

1. Standardization of sizing within an individual

manufacturer’s line providing easy inter changeability

of male and female attachments for replacement or

repair purposes.

2. Lesser degree of technical competency

3. Pre fabricated precision attachment has the advantage

of being fabricated from metal alloys which are harder

and more wear resistant.

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 Precision Attachments

Disadvantages

1. Expensive and not economical for the patient

2. Poor proximal contour occurring on restoration

3. Proximal, parallel sides striker plate impinges on the

gingiva when an attempt is made to achieve maximum

possible attachment.

Advantages of semi precision attachments

1. Greater adaptability to a variety of clinical situations

2. Variation in tooth size and shape are easily accommodated

3. More economical

4. Crown contour is better achieved in the gingival area with

laboratory fabricated precision attachment

Disadvantages of semi precision attachments

1. Greater degree of skill is required

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 Precision Attachments

2. Repair and replacement is more difficult than with

prefabricated precision attachment because of the lack of

interchangeability of custom attachment.

3. The long-term wear of custom made attachments becomes

a problem because of the softness of the gold alloys used.

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 Precision Attachments

Intracoronal attachments

This type of attachement is within the anatomical contour

of the crown of natural tooth. It provides rigid connection

between the saddle and abutment tooth and provides frictional

contact between the parallel surfaces of the flange and slot.

Modern attachments utilize a H-shaped flange which is stronger

and has double the frictional surfaces areas of the earlier T-

shaped flange. At least four of these attachments are included

in denture and they have to be aligned so that all the slots are

parallel to each other to ensure insertion and removal.

The main problem encountered in the use of intraocoronal

attachments is providing sufficient room within the contour of

the abutment tooth to accommodate the female part. It is

essential that this part does not project over the gingival margin

nor interfere with occlusal contacts. Hence, adequate depth of

preparation is required anterior-posteriorly to avoid the gingiva

and sufficient height must be available to provide as large an

area of frictional contact as possible between the slot and flange.

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 Precision Attachments

Intracoronal attachments are indicated for bounded

saddles unilateral dentures in class III when tooth contours are

unsuitable for clasps. When these are used for free and saddle

dentures, the rigid connection between the denture and the

abutment teeth requires that at least two teeth are splinted

together on either side to form double abutments and if only six

anterior teeth remain they should all be splinted together to

form one abutment.

To reduce the load on the attachments it is desirable to

incorporate into the denture a rigid lingual bracing arm to he

most distal abutment tooth. This arm will add to the stability of

the denture and will also provide a guiding plane for the

insertion.

Extra coronal attachment

These attachments have all or a part of their mechanism

lying outside the contour of the crown of the abutment tooth.

As a result loads falling on the tooth via the attachment are

applied outside the long axis of the tooth. These attachments

require a well supported abutment tooth.

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 Precision Attachments

e.g. Dalbo 669.

Dalbo 669 which is supplied in two sizes. There are 3 types

of Dalbo attachments, rigid, resilient and stress broken. The

rigid Dalbo attachment has a cyclindrical male unit with a

rounded head. The resilient attachment, the smallest and most

commonly used of the types, allow vertical and horizontal

movement of the used of the types, allow vertical and horizontal

movement of the female around a sphere shaped male unit

made possible because of a relief space between the unit. This

allows some vertical movement of denture base before contact

of male and female occurs.

Advantages of intracoronal over extraocoronal retainers

1. They are more esthetic because retention is achieved

through frictional resistance and not by visible retentive

arms located around the tooth contours.

2. They provide for more effective cross arch stabilization of

the abutment teeth.

3. They direct the vertical forces of occlusion along the long

axis of the abutment teeth because rest seats are located

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 Precision Attachments

within the contours of the abutment teeth and closer to

the horizontal axis of rotation.

4. The efficiency of retention is not affected by contours of

abutment teeth

5. The number of components of denture is reduced and

hence tolerance should be better.

6. When used with lower free and saddle posterior

movement is prevented

Disadvantages of intracoronal over extraocoronal retainers

1. They require placement of cast restoration on the

abutment teeth which limits their use

2. They are effective in proportion of their length and are

therefore least effective on short teeth and hence

contraindicated for short teeth.

3. They should not be placed on teeth with large pulps

because it might lead to pulp exposure. It involves the

removal of tooth structure so that anatomical contours

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 Precision Attachments

can be developed on the cast restorations in which the

attachments are placed.

4. They frequently tend to loosen during use because of

frictional wear of the parts with subsequent placement of

removal with resultant loss of retention and increased

torquing stress on the teeth.

5. They require complicated clinical and laboratory

procedures

6. They are expensive and difficult to repair, reline on rebase.

7. Intracoronal retainers are contraindicated in distal

extension removable partial dentures unless an effective

types of stress breaking device is used between the

denture base and intra coronal retainer. A stress breaker

is necessary to relieve the abutment teeth of all or part of

the torquing forces exerted on them by movable distal

extension saddle.

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 Precision Attachments

CLASSIFICATIONS

I. ATTACHMENT CLASSIFICATION BY GOODKIND AND

BAKER 1976

1. Intra coronal attachments

a. Resilient intracoronal attachments (Resilient

attachments allows a degree of permitted movement

to take account of disparity between resilience of

teeth and supporting tissues).

E.g. Crismani 689-A, Crismani 689-D.

b. Non-resilient intracoronal attachments (Rigid

attachments).

2. Extracoronal attachments

a. Resilient extra-coronal attachments

E.g. Crismani Resilience joint, Dalbo resilience joint.

b. Non- resilient extra-coronal attachments

E.g. Spang Stabilex, Spang Conex

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 Precision Attachments

II. ATTACHMENTS CAN BE CLASSIFIED DEPENDING ON

WHETHER THEY ARE PRE-FABRICATED OR FABRICATED

IN THE LABORATORY

1. Those pre-fabricated by the manufacturer is called as

precision attachment.

Pre-fabricated type of attachment is usually made of

precious metal.

Eg. Channel shoulder pain attachments (C.S.P.)

2. Plastic attachments

Simple, yet precise, indicated for removable and fixed

dentures. Easy to handle, no soldering, and all of them

burn without any residue.

e.g. Reinefert’s Unirest B, Mortise Rest

III. PRECISION ATTACHMENTS CAN BE CLASSIFIED

ACCORDING TO RIGID OR MOVABLE ARTICULATIONS

(G.E.RAY)

a. Rigid articulations : (These are separable joints designed to

prevent movement when fully articulated)

Group I : Attachments used principally with vital teeth

Group II : Anchorage used principally with pul less

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 Precision Attachments

b. Moveable articulations : (These are separable joints

designated to permit specific movement when fully

articulated)

Group I : Conjunctors used principally with vital teeth

Group II : Connectors used principally with pulpless teeth

IV : PRECISION ATTACHMENTS ARE CLASSIFIED INTO :

(BY G.E. RAY)

a. Intracoronal attachment

b. Extracoronal attachment

c. Conjunctors

d. Anchors

e. Bars

f. Accessory components

Intracoronal attachments

They are esthetic and provide cross arch stabilization

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 Precision Attachments

Extracoronal attachments

Extracoronal attachments have two adavantages over

Intracoronal designs namely.

1. They can be used without prejudicing the design of the

preparation

2. They are less restricted in size and there can be greater

freedom in designs

Therefore they can be fashioned to give greater retention

and can include locking screws of latches

e.g. Stabilex extra coronal attachment

Flecher extra coronal attachment

Conjunctors

A conjunction is a precision attachment made by the

conjunction of an attachment to a stress breaker.

The primary role of a conjunctor is to permit movement

between tissue borne and tooth borne.

E.g. Cuenod conjunctor

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 Precision Attachments

Dalla bona conjunctor

Anchors

Anchors are intended to provide retention and support for

bars, partial and overdenture.

Wherever possible anchorage should be used with

attachments, in order to relieve the soldered joints of the shear

strain to which rigid designs are susceptible.

Anchors can be divided into those with ;

a. Screwed retention (Screw blocks)

b. Slide blocks

1. Friction grip

2. Snap grip

Screw-Block Anchors

Are 3 basic types Hruska screw block are solid cores,

notched, and tapped occlusally to accept small grub screws with

tapered heads.

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Schubiger system

Consists basically of a threaded post mounted on a

circular soldering plate. A recessed collar slips over the post

which is held in place by means of a cap nut that screws over

the post to bear on an internal ledge within the collar. The collar

can be either long or short. The collar is removable and used to

provide fixation for a bar (by soldering the head of the bar to the

collar) or can be provided with tagging for use within a bridge

on an isolated crown. Short collar are used for usually for bars

and long collars for crowns etc.

Harkowitsch System

Is based on one of two size of self tapping root canal posts

which is used with a soft gold washer to hold a cemented root

cap in place.

Slide block anchors

Slide block friction grip anchorage consist of circular posts

which either enter a matrix cast within the diaphragm or when

mounted on a soldering discs (for soldering to root raps) from

patrices which enters a removable matrix.

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Most friction grip slide block anchorage can be converted

into resilient slide blocks by use of spacing washers which will

permit a degree of vertical resilience

e.g. Gmur slide block anchor

Dalla Bona Slide block or Dalbostud anchor.

Snap grip slide blocks cannot be converted into resilience

anchor because the active element locks into a predetermined

groove but in other respects are similar to corresponding friction

grip varieties.

Rothermann eccentric cylindrical snap grip anchor.

Huser anterior slide block anchor

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 Precision Attachments

Bars

Bars are used for retention and support of removable

bridges removable partial dentures and overdentures. Their

advantage lies in splinting action which they provide between

isolated abutments.

Round, U shaped and avoid bars are provided with tagged

clips for processing within saddles.

e.g. U-shaped Dolder – Bar.

Accessory components

Accessory components include retentive elements,

transverse stabilizers or locks, and stress breakers.

Example are :

Retention elements

a. Isoclip by Guigelmetti

Stress breakers

a. Strini hinge

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 Precision Attachments

b. Vertical cylindrical cone stress breaker

Transverse stabilizer or lock

a. Push lock designed by spang

b. Huser lock

V. PRECISION ATTACHMENT CAN BE DESCRIBED AS

PASSIVE, ACTIVE, LOCKED (G.E. RAY)

Passive attachments

Are made in solid section so that patrix fits into the matrix

in the fashion of interlocking parts of a jig saw, the retention

between two parts depends on accuracy of the fits, shape of the

joint, and area of contact.

e.g. Passive Omega attachment

Passive Beyler attachment

Active attachments

Differs from passive attachments that some form of spring

is used to give additional retention. Devices which incorporates

leaf-springs, split rings or expanded collars are referred to

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Active friction grip attachments. They function by forcing part

of the patrix against matrix, thereby increasing area of contact

and effort required to separate them. The force exerted by these

springs can be controlled by expanding the spring either with a

razor blade of kit provided, hence these are also called as

adjustable attachments

Example of active friction grip attachments are Omega

attachments active friction grip. McCollum attachment; active

friction grip.

Another variety of active attachments use a spring loaded

stud or split ring to engage in a prepared recess within the

matrix so that the frictional retention is enhanced by a

mechanical resistance to separation. When two halves of this

type of joint complete their articulation the retention stud or

ring snaps into groove or pit prepared for it, hence they are

called as Active snap grip attachment. The tension of activating

spring of a snap-grip attachment can be altered. They are called

also adjustable attachments.

Eg. Schatzmann Snap – Grip attachments

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 Precision Attachments

Locked precision attachments are either bolted together by

means of a sliding bolt or latch (latch grip) or may by pinned or

screwed together.

VI. PRECISION ATTACHMENTS HAVE BEEN CLASSIFIED

ACCORDING TO ATTACHMENTS SHAPE. (HAROLD W.

PREISKEL – PRECISION ATTACHMENTS IN DENTISTRY)

A. Intracoronal attachments

The two parts of an intracoronal attachments consists of a

flange and a slot. The flange is joined to one section of the

prosthesis and the slot unit embedded in a restoration forming

part of another section of the prosthesis.

Two types of intracoronal attachments are available

a. Those whose retention is entirely frictional

E.g. The McCollum intra coronal unit. A well tried unit with

entirely frictional retention

b. Those whose retention is augmented by a mechanical lock.

Eg. The Schatzmann unit

Additional retention is provided by a spring loaded plunger.

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 Precision Attachments

Depending on the cross sections intra coronal attachments

(Harold W. Preiskel) can be classified into.

1. H-Shaped flanges (Most of the modern attachments have it

and they have nearly double the frictional surface area. The

external frictional flange of H-Shaped unit strengthen the

attachment, without increasing the size of the female part.

2. T-shaped flanges

Eg. The chayes attachment. This T-shaped unit is still in

production today.

3. Attachments with a circular cross section. They are suitable

only for joining two sections of a fixed prosthesis.

The friction fit intracoronal attachments with adjustment

potential are :

e.g.

a. Chayes unit can adjusted by opening the two halves with

a razor blade or scalpel.

b. The crismani series of intracoronal attachments

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c. McCollum unit

d. Ancra attachment unit features a ‘H’ shaped profile with

external frictional flange while the male unit incorporates

slots either side to allow for modification of retention.

e. The T-Geschiebe 123 has an external frictional flange cast

together with a bracing arm

The attachments with auxillary retentive features :

Auxillary retentive features are incorporated in some

attachments in an effect to provide more retention for a given

frictional area although no extra stability is provided. A

minimum of 4 mm vertical space is still usually necessary.

a. The wides Crismani units incorporate a wire clip to

increase retention. Access to the clip is obtained by

removing the screw in the male unit. The female unit

contains two depressions for the retaining wire and is 7,00

as tall. No significant shortening should be carried out.

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b. Some devices basically consists of a spring loaded piston

on the male part engaging a socket within the female

element like a simple cup board door catch.

E.g. Schatzmann attachment the retention of which is

increased by a spring – loaded plunger assembly.

c. The Stern gingival latch attachment offers a novel method

of additional retention. The base of the male unit is split

and formed in the shape of a door latch. The result is to

provide a lock as the male slide is engaged. Adjustments

for retention are made with a purpose – built tool. Two

sizes of unit are produced, standard and miniature. On the

standard unit the splint is 2,5 mm and in the miniature

unit it is 1.5 mm high.

d. Micro which is among the smallest of intracoronal

attachments with auxillary (It is a modification of G/L

system) include a unit with squared lateral surfaces

thereby allowing the bucco-lingual divergence to be

reduced.

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e. The Dovetail and ESI versions are modifications of the

tagging of the male unit. The dovetail design simplified

soldering. The ESI features a long extension plate that

simplifies electrosoldering the male to the denture frame

work. Alternatively the extension can be roughened to

permit retention by the acrylic resin.

Before choosing an attachment with auxillary retentive

devices the following factors should be considered.

a. Bulk

b. Adjustment

c. Retention mechanism

d. Trimming the attachment

e. Plaque control

The friction fit intracoronal attachments without

adjustment potential :

Lack of adjustment potential renders this type of unit

unsuitable for removable prosthesis, as repeated insertion and

removal will cause the attachment to wear. They are useful for
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joining a series of crowns without a common path of insertion.

Round profiles are useful when anterior teeth are concerned.

e.g. Interlock attachment

Beyler attachment offers more frictional surfaces area and is

used in posterior quadrants.

Applications of intracoronal attachments

1. Retainers : Intra coronal attachments are effective and

almost invisible retainer for bilateral and unilateral

prostheses.

2. Connectors : Sections of a fixed prosthesis may be joined

with intracoronal attachments. This possibility can be

useful where;

a. Prosthesis do not share a common path of insertion yet

can be connected rigidly in the mouth.

b. The operator prefers to limit the length of individual

castings while making a large span fixed prosthesis.

c. The prognosis of a distal abutment is dubious.

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Connecting the posterior segment with an attachment

allows to subsequent removal without damage to the

main restoration. The attachment slot can be used for

later construction of an attachment retained denture

B. EXTRACORONAL ATTACHMENTS

These attachments have part or all of their mechanism

outside the crown of a tooth. Many of these unit allows a certain

amount of movement between the two sections of the

prosthesis. Their main application is for distal extension

prosthesis. They may be used to retain restorations for bounded

spaces. Extracoronal attachments can be subdivided into

following groups.

a. Projection units

The units are attached to the proximal surface of a crown.

These groups can be divided in turn into;

1. Those that provide a rigid connection. Eg. Conex

attachment (it has parallel walls that provide a precise

patch of insertion)

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2. Those that allow play between the components. Eg. Dalbo

extracoronal projection unit, ceka system with retaining

ring.

b. Connectors

These units connect two sections of a removable

prosthesis and allow a certain degree of play.

Two basic types of joints are manufactured

1. The axial rotation joint

It provides restricted vertical travel together with

predetermined hinge movement. A small window is cut out of

the female section around the screw. The male section is

therefore free to travel up and down within the narrow confine

of the window. Rotation and lateral movements can be provided

by dismantling the attachment and very slightly trimming the

male unit. This joint can be incorporated within the Scott

attachment. Steiger originally envisaged the axial rotation joints

as connector for distal extension denture.

2. The rotation joint

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Here there is no window around the screw and therefore

vertical movements cannot take place. The rotation joint was

designed for unilateral distal extension prosthesis as this type

of denture is usually tooth and mucosal supported on one side

and entirely tooth supported on the opposite side. Since vertical

movement could be damaging to the teeth on the tooth

supported side, Steiger designed the rotation joint to allow only

slight rotational and lateral movements in order to minimize

torque transmitted from the distal extension design would

therefore incorporate an axial rotation joint connecting the

distal extension base to the retainer and major connector, while

the retainer on the opposite, tooth supported, side would be

connected through a rotation joint. The Steiger joints are

models of careful designs and are one of the few attachments in

which the amount and direction of the movement allowance can

be precisely determined by the operator. If appreciable wear

takes place, both parts of the attachment can be removed from

the mouth and a replacement soldered on. Boitel now finds that

better results are obtained by using the rotation joint for

bilateral distal extension base prosthesis as well.

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C. Stud attachment

These attachments are so called because of the shape of

the male units that are usually soldered to the diaphragm of a

post crown. The female part fits over the male unit and is

embedded within the acrylic resin of the prosthesis or soldered

to a metal substructure.

There are a few systems in which the male section forms

parts of the denture and the female part of the root surface

preparation.

Few stud attachments are entirely rigid, since their size

makes it difficult to prevent a small mount of movement

between the two components.

In some attachments springs or other devices are

specifically incorporated to allow a controlled degree of

movement. Of all the stud attachments producd. Dalbo is by far

the most popular. Although 3 types of design were produced the

ball and socket design is most popular. It is smallest of the

series it is 4 mm high. It allows limited vertical and rotational

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movement between the two parts of the attachment and has a

spherical shaped male section that is easy to clean.

The rigid Dalbo attachment provides a firm connection

between the two components but cannot match the versatility

of the bal and socket unit.

The Battesti design are also of 3 designs. Two allow vertical

translation of which one is ball and socket design. The third

design is comparatively rigid.

Some of the other stud attachments available are Dr.

Conod’s rigid stud unit, Rothermann unit, Baer and Fah units.

Stud attachments have numerous applications to

1. Overdenture (being relatively small they can provide

additional stability, retention and support while the positive

lock of certain units can maintain the border seal of the

denture).

2. Non-vital parital denture abutments. The loads applied in

these circumstances can be considerable and for this

reasons, one of the larger and stronger, units is

recommended.

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3. For retention of a small tooth supported restoration with

non-vital abutment.

D. Bar Attachments

Bar attachments consists of a bar spanning an edentulous

area joining together teeth or roots. The denture fits over the

bar and is connected to it with one or more sleeves. Bar

attachments are of 2 categories.

a. Bar joints

These units allow play between denture and bar. The bar

is usually attached to diaphragms on root filled teeth, locking

the roots together and improving the crown / root ratio. A

common patch of insertion for the retaining posts is desirable

although divergence can be overcome by mechanical means.

Alternatively the abutment teeth can be crowned and these

crowns connected by the bar.

Bar joints can be subdivided into :

1. Single sleeve bar joints

The Dolder bar joints is an excellent example of this

attachment. This well tried bar is produced from wrought wire,

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pear shaped in cross section and running just in contact with

the oral mucosa between the abutments. An open sided sleeve

is built into the impression surface of the denture and engages

the bar when the denture is inserted.

Two sizes of Dolder bar joint are produced with heights of

3.5 mm and 4.5 mm. The cross sections are 2.3 mm x 1.6 mm

and 3.00 mm x 2.2 mm, respectively. Apart from the artificial

teeth, a sufficient bulk of acrylic resin must cover the sleeve to

prevent fracture, although a lingual metal plate may be used

when space is restricted. A spacer is provided with this bar joint

to allow a degree of movement potential. The spaces is removed

after the acrylic resin has been cured. The retention tagging

forms part of the sleeve ensuring excellent adherence to the

surrounding acrylic resin.

A bar joint that has become popular in the United states

in known as Baker clip. It is available in 12 to 14 gauge bar size.

The sleeve requires roughening to provide retention for the

acrylic resin, no retentive tags are provided. The sleeve can be

sectioned if the bar is not run in a straight line.

2. Multiple sleeve joints

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If several short sleeves are substituted for the continuous

one, there is no need for the bar to run straight and it can bent

to follow the vertical contours as well as the antero-posterior

curvature of the ridge.

Gilmore’s original design was an attachment of this type

and is still available today.

Ackerman’s bar is almost identical. It can be obtained in

various shapes of across section. But it is the bar with circular

cross section that tends itself to bending in all planes. As this

unit has a small cross section and can be bent, it can frequently

be positioned with a cleansable space under the bar, yet the bar

does not interfere with positioning of the artificial teeth. The

small sleeve units can be placed at most convenient sites.

More rigid bar with pear shaped and oval cross sections

are available, while a wax pattern of the bar is produced as well.

This wax pattern can be contoured to correct shape and then

cast in gold. The diameter needs reduction to about 1.8 mm

after the casting process.

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The Hader bar joint is provided by manufactures of

prefabriciated plastic patterns that are adapated to the master

cast and then cast in alloy of choice.

Multiple sleeve bar joints are more versatile that the single

sleeve units, but the bars seem to have slightly less rigidity.

b. Bar units

Bar units are comparatively rigid allowing no movement

between the sleeve and bar. Although some load may be

distributed to the mucosa these prosthesis are mainly tooth

borne. Bar units may be useful where;

1. There are 4 or more abutment teeth and large edentulous

spaces.

2. The number of distribution of the teeth does not allow

construction of a satisfactory clasp retained partial denture

3. These are edentulous areas with considerable resorption

4. Rigid splinting is required of the remaining teeth or roots.

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5. The appearance of the remaining natural teeth requires post

preparations

Bar units provide excellent retention and stability for a

denture while rigidly splinting the abutments. Artificial mucosa

can be provided by the denture flange and the removable section

can be reabased or repaired like a clasp retained prosthesis.

Drawbacks are that the bar provides a medium for

accumulation of plaque and the patient must maintain a good

standard of plaque control and denture hygiene.

Infirm patients with poor manual dexterity cannot be

expected to cope with such restorations. Other contra

indications are those in which there is limited vertical or bucco

lingual space.

Bar prosthesis are difficult to construct where heavy

occlusal forces may be applied. There are also considerable

technical difficulties in spanning a gap of more than 4 units

with a bar unit owing to distortions that can occur.

The Dolder bar unit is a well established and reliable unit.

The bar has parallel sides unlike the pear shaped profile of the
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bar joint. Retention for the sleeve is entirely frictional, provided

by the parallel vertical surfaces of both sections.

M.P. Channel system

These MP channels are extremely slim and save the

operator and technician the problems and expense of milling.

Additional retention between the two sections of the unit can be

provided by incorporating a plunger in the sleeve. Guiding

flanges should be incorporated to prevent rotation around the

plunger and to obtain maximum retention.

E. AUXILLARY ATTACHMENT

This miscellaneous group consists basically of

a. Screw units : These devices are useful for screwing and

dismantling parts of a prosthesis in the mouth, when there

is no common line of insertion of the whole. They are

particularly useful for joining the two components of a

telescopic crown.

Screw retained telescopic prosthesis

If the outer structure is retained by small screws, the

prosthesis can act as an effective splint between the abutments,

but still allows its removal by the dental surgeon.

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Screw retaining for vital teeth

These components usually consists of a threaded sleeve of

previous metal embedded within the inner copings, and a

matched screw that passes through the outer section.

Eg. CM screw retaining systems available in different sizes

and configurations

- HP screw and sleeve

Screw retaining for non-vital teeth

This system that has gained popularity consists of a

previous metal block with a threaded screw hole attached to a

post retained diaphragm. A removable section slides over the

block and is screwed in position.

E.g. Hruska unit with two different sizes of block units

available for anterior teeth together with a block unit suitable

for posterior teeth.

The Schubiger screw system is extremely versatile,

basically consisting of a threaded stud on base that can be

soldered to a post diaphragm

b. Friction devices
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Spring loaded plungers are commonly employed to increase

retention between the two sections of a telescopic prosthesis

E.g. Ipsoclip attachment. The spring loaded plunger mechanism

may be dismantled by undoing, the bayonets clip at the opposite

end of the plunger. The type of attachment is generally buried

lingually in the outer, removable section of the prosthesis.

- Mini pressomatic unit. It is only 1.75 mm long, a small spring

tensions the plunger.

Split posts : can be used in sectional dentures

E.g. P.W. Split post.

c. Bolts

Bolts units are used to connect the two parts of sectional

denture in the mouth. Each part of the denture is inserted

separately and the patient locks them together with the bolt.

VII. CLASSIFICATION OF PRECISION ATTACHMENTS

WHICH IS BASED ON THE USE OF WHICH THEY ARE PUT

(DEVISED AT THE INSTITUTE OF DENTAL SURGERY, BY

MR. R.VALENTINE IN COLLABORATION WITH

COLLEAGUES, EASTMAN DENTAL HOSPITAL, LONDON).

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Rigid - Rigid - Adjustable - Chayes

retainers attachments (non
vital teeth)

- McCollum

- Stern

- Crismani

- Non- - Beyeler
adjustable

- C & M 643

- Rigid anchorages - All - Eccentric

(on vital teeth) adjustable

- Bona

- Gerber

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Movable retainers - Movable - Dalbo

attachments
- Crismani
(Non vital teeth)
- Gerber hinger
- Stress breakers
(for partial - Ancorvis hinger
denture)
- Bona
- Movable
- Dolder bar
anchorages (non-
vital teeth) - Andrews bar

Auxiliary devices - Activators - Isoclip

- Latches, bolts, - Schubiger

screws
- Hruska

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VIII. ACCORDING TO TYPES OF INSTALLATION OF

PREFABRICATION ATTACHMENT ON ABUTMENT CROWNS

a. Intra coronal Eg. McCollum attachment Schatzmann

attachment

b. Extra coronal or paracoronal

c. Interproximal attachment E.g. Snaprox by Schatzmann

d. Within a cantilevered bridge pontic Eg. Biloc attachment

with wraparound

e. On a cantilevered pontic E.g. Conex attachment by spang.

f. Attachments in interabutment bridge pontics

g. Prefabricated cap post systems on root copings E.g.

Gerber retention cylinder

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