IP Annals of Prosthodontics and Restorative Dentistry 2020;6(3):162–166

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IP Annals of Prosthodontics and Restorative Dentistry

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Case Report
Rehabilitation of partially edentulous patient using Precision Attachment
denture– A case report
Danush Kumar R1 , B. Devi Parameswari1, *, H Annapoorni1
1 Dept. of Prosthodontics, Meenakshi Academy of Higher Education and Research, Kanchipuram, Tamil Nadu, India

ARTICLE INFO ABSTRACT

Article history: Satisfactory restoration in a patient with a partially edentulous situation can be challenging especially when
Received 18-06-2020 unilateral or bilateral posterior segment of teeth is missing. Successful restoration can be done with various
Accepted 18-07-2020 conventional and contemporary treatment options. One such treatment modality is attachment-retained cast
Available online 24-09-2020 partial dentures. This paper describes a case report of a patient with mandibular bilateral distal extension
edentulous span restored with a cast partial denture having an extracoronal castable precision attachment
(RHEIN 83 OT CAP attachments system).
Keywords:
Precision attachment © 2020 Published by Innovative Publication. This is an open access article under the CC BY-NC license
Removable denture (https://creativecommons.org/licenses/by-nc/4.0/)
Retentive denture

1. Introduction system).
Rehabilitation of partially edentulous arch can be
challenging when it is a distal extension situation classified 2. Case Report
under Kennedy’s class I and class II situations. 1 In such
a condition, a fixed partial denture cannot be fabricated A 65-year-old male reported with missing mandibular
because of missing distal abutment. Implant-supported molars bilaterally. He gave a history of heart surgery one
prosthesis can be planned, but it is sometimes not feasible and half years back. On intraoral examination, it was noted
due to insufficient amount of bone and economic reason. So, that patient had missing mandibular first, second and third
in such situation an acrylic partial denture or a cast partial molars bilaterally (Kennedy’s Class 1) and he had missing
denture is largely preferred. Cast partial dentures are made 14 and 26 in maxillary arch. He also had existing metal
retentive by the use of retainers and precision attachment ceramic fixed partial prosthesis on 21, 11, and 12 and in 31,
components. 2 Precision attachments could be extracoronal 32, 33, and 34 (Figures 1, 2 and 3).
and intracoronal. Attachment-retained cast partial dentures
After complete clinical and radiographic examination, a
facilitate both esthetic and functional replacement of
prosthetic treatment plan was set up. A cast partial denture
missing teeth. Studies have shown a survival rate of 83.35%
with extracoronal precision attachment was planned for
for 5 years, of 67.3% up to 15 years, and of 50% when
mandibular bilateral distal extension arch and metal ceramic
extrapolated to 20 years. 3,4 This paper describes a case
fixed partial denture prosthesis for missing maxillary teeth.
report of a patient with mandibular bilateral distal extension
After getting the consent from the patient’s physician for
Kennedy’s class I condition which is prosthetically restored
this treatment, we started with the tooth preparation of 13,
by a cast partial denture retained using a extracoronal
15 and 16 abutment teeth (Figure 4). A metal ceramic bridge
precision attachment (RHEIN 83 OT CAP attachments
was then prepared for 13, 14, 15 and 16, and luted with
* Corresponding author. type1 Glass ionomer cement. The preparation of adjacent
E-mail address: drdeviparameswari@gmail.com (B. D. arch 24, 25 and 27 abutment teeth were done and provided
Parameswari). with similar metal ceramic fixed prosthesis (Figure 5).

https://doi.org/10.18231/j.aprd.2020.034
2581-4796/© 2020 Innovative Publication, All rights reserved. 162
 Kumar R, Parameswari and Annapoorni / IP Annals of Prosthodontics and Restorative Dentistry 2020;6(3):162–166 163

After restoring maxillary teeth, we proceeded with the

preparation mandibular teeth 34, 35, 44, and 45 abutment
teeth were done and temporized after making a definitive
impression (Figure 6).

2.1. Lab Procedure

Waxing up of abutments 34, 35, 44 and 45 was done and
design of attachment structure was waxed and then they
were also cast along with the copings of the abutments.
Metal try-in was done to check the overall fit of the
copings and attachments (Figure 7). Articulation spaces and
Fig. 1: Pre-Op frontal view
bulkiness were also evaluated. After metal trail, the ceramic
powder was added to the abutments and porcelain firing was
done.

2.2. Cast Partial Denture Design and Fabrication

After proper planning and surveying, an appropriate cast
partial denture framework was designed for the patient and
then fabricated with attachment in the laboratory. The metal
framework trail was done in the patient’s mouth for the
accuracy of fit. Cast structure framework was checked up
for stability and precision. Inter-occlusal records were then
made.

2.3. Wax-Up Trial

Waxing up of teeth was performed and teeth setting trial
was done in patient’s mouth. The trial denture was sent
for acrylization and cast partial denture finished (Figures 8
and 9).

2.4. Prosthesis Insertion

Fig. 2: Intraoral view of maxilla showing missing teeth
Trial seating of the finished prosthesis was performed and
cementation of crowns was done using Glass Ionomer
cement. Attachments are protected with a thin layer of
petroleum jelly (Vaseline) in order to easily remove cast
partial denture after joint PFM crowns with attachment
have been seated. Complete seating of finished mandibular
prosthesis with extracoronal distal extension precision
attachment was seated in the patient’s mouth and the
patient was recalled after 24 hrs for post-insertion checkup
(Figure 10). The patient was happy and satisfied with the
treatment.

3. Discussion
There are several treatment options for the rehabilitation of
partial edentulism. Depending on several given diagnostic
factors and a patient’s perspective, best treatment plan
should be selected for the patient. In recent years, dentistry
has witnessed the use of Computer aided design and Fig. 3: Intra oral view of mandible showing Kennedy’s Class 1
Computer assisted milling (CAD-CAM), 5 precision milled bilateral edentulous spaces
and semi-precision attachments, improved impression
materials, improved techniques and designs which would
164 Kumar R, Parameswari and Annapoorni / IP Annals of Prosthodontics and Restorative Dentistry 2020;6(3):162–166

Fig. 7: Metal try-in done with cast copings with RHEIN

attachments

Fig. 4: Tooth preparation done on maxillary teeth 13,15,16,25 and

27

Fig. 8: Fabricated cast partial denture framework with acrylic teeth

for wax trial

Fig. 5: FPD prosthesis cemented in 13,14,15,16 and 25, 26 and 27.

Fig. 6: Tooth preparation done in 34,35,44 and 45 Fig. 9: CPD Wax trial done and occlusion checked.
 Kumar R, Parameswari and Annapoorni / IP Annals of Prosthodontics and Restorative Dentistry 2020;6(3):162–166 165

of the intricacies and special problems associated with

attachments. In treatment using the attachment-retained
distal extension removable partial denture, the development
of a stress-directing attachment design as well as the
proper distribution of forces between the residual ridge and
abutment teeth should be goals for successful treatment.

4. Conclusion
Removable partial dentures still have a good place as a
treatment option for partially edentulous Kennedy’s class
I and class II conditions. With proper case selection
and treatment plan, precision attachment such as RHEIN
attachments system can be used to improve retention,
esthetics, and function of removable partial denture. The
above mentioned procedure using allows fabrication of
Fig. 10: Delivered precision attachment prosthesis very functional and comfortable prosthetic solution for
the edentulous bilateral distal extension patient cases.
eventually attain a comprehensive treatment. In case of Attachments retention can be monitored and upgraded
partially edentulous mouth, Retention provided by the during time just replacing retentive caps into the framework
usage of precision attachments which may be related to of dentures for patients comfort and satisfaction.
comfort, satisfaction, chewing ability, as well as adequate
distribution of occlusal loads to, and preservation of 5. Source of Funding
abutment teeth in patients with removable partial dentures.
None.
An attachment is defined as “A mechanical device for
the fixation, retention and stabilization of a prosthesis”.
6. Conflict of Interest
Retentive ability increases significantly over time in the
metal- alloy precision attachment group. It was Dr. Herman None.
Chayes who first reported the invention of attachment
in the early 20th century. 6 These attachments allowed References
prosthesis to combine the advantage of fixed and removable
1. Karr AB, Brown DT. Mc Craken’s Removable partial denture
restorations. 7 prosthodontics . Mosby Elsevier;.
Holst et al 8 cited as it is difficult to evaluate precision 2. Bakersandr JLJ, Goodkind RJ. Precision Attachment Removable
attachments’ effects on treatment longevity based solely on Partial Dentures. Calif, USA: Mosby, San Mateo; 1981.
3. Burns DR, Ward JE. Review of attachments for removable partial
in vitro results since other factors such as continuous ridge denture design: 1. Classification and selection. Int J Prosthodont.
resorption, changes in saliva flow and composition, and 1990;3(1):98–102.
occlusal considerations may affects its long-term success. 4. Burns DR, Ward JE. A review of attachments for removable partial
The decision to use attachments in removable partial denture design: part 2. Treatment planning and attachment selection.
Int J Prosthodont. 1990;3(2):169–74.
denture design should be carefully considered. Clasp- 5. Williams RJ, Bibb R, Eggbeer D, Collis J. Use of CAD/CAM
type removable partial dentures should be used whenever technology to fabricate a removable partial denture framework. J
practical because of their lower cost, ease of fabrication Prosthetic Dent. 2006;96(2):96–9.
and maintenance, and the predictability of results. 9 A 6. Preiskel HW. Precision Attachments in Prosthodontics: Over- dentures
and Telescopic Prostheses. vol. 2. Quintessence Publish- ing; 1985.
precision attachment prosthesis has advantages of better 7. Preiskel HW. Precision Attachment in Prosthodontics. vol. 1-2.
retention and stability similar to a fixed prosthesis and London, UK: Quintessence Publishing; 1995.
also better aesthetics and hygiene maintenance similar to 8. Holst S, Blatz MB, Eitner S, Wichmann M. In Vitro wear of different
conventional removable prosthesis. 10 The RHEIN 83 OT material combinations of intracoronal precision attachments. Int J
Prosthodont. 2006;19(4):330–32.
CAP attachments system used in the case discussed in 9. Patel H, Patel K, Thummer S, Patel RK. Use of precision attachment
this paper is extracoronal castable attachment positioned and cast partial denture for long-span partially edentulous mouth - A
on the distal of the crowns as an extension allowing a case report. Int J Appl Dent Sci. 2014;1(1):22–5.
10. Parameswari D, Konwar AK, Annapoorni H, and. Removable denture
lot of vertical space for optimal aesthetics. 11 However, if
options in rehabilitation of missing dentition: A series of case reports.
an attachment removable partial denture is the treatment Ann Prosthodont Restor Dent. 2020;6(2):110–3.
of choice because of esthetics, abutment alignment, or the 11. Gupta N, Bhasin A, Gupta P, Malhotra P. Combined Prosthesis
need for greater cross-arch bracing, it must be used with with Extracoronal Castable Precision Attachments. Case Rep Dent.
2013;2013:1–4.
a thorough knowledge and understanding of prosthodontic
principles and attachment use, as well as an awareness
166 Kumar R, Parameswari and Annapoorni / IP Annals of Prosthodontics and Restorative Dentistry 2020;6(3):162–166

Author biography Cite this article: Kumar R D, Parameswari BD, Annapoorni H.

Rehabilitation of partially edentulous patient using Precision
Danush Kumar R Post Graduate Student Attachment denture– A case report. IP Ann Prosthodont Restor Dent
2020;6(3):162-166.
B. Devi Parameswari Associate Professor

H Annapoorni Professor and HOD