Attachm

ments for
Overde
O rdentures
nt r
Ref: Overdentures made easy. Preiskel
Preiskel,, Chap. 5 & 6, pp. 81
81--137.
137.

Attach
hment
A mechanical device for the fixation,
fixation retention,
retention
osthesis.
and stabilization of a pro
A retainer consisting of a metal receptacle and a
closely fitting parts:
The former, matrix com
mponent (keyway)
The latter, patrix comp
ponent (key)

Attach
hments
Coronal

Intra
Coronal

Radicular

Extra
Stud
Bar
Coronal Attachmen
nt Attachment

Accessory

Auxiliary
attachment

Stud (pressure button) attachments

Resilient (non(non-rigid)

Non--Resilient (Rigid)
Non

Incorporation of spring
or other devices

Very few

The Pro Fix is a convventional

ventional stud retainer

Stud attaachment

Extraradicular

Intraradicular

P t i element
Patrix
l
t project
j t
from abutment surface

P t i element
Patrix
l
t forms
f
partt
of denture base and
engage depression within
abutment contour

Microfix. An example of an extraradicular

extraradicular stud attachment.

The Ceka Revax can be useed

ed as an intraradicular unit.

Stud Attaachment
Straight forward
d to use
Favourable
bl retention
i
Used
U d with
i h roots and
d iim
mplants
l
Easily
E il aligned
li
d with
i h path
h off iinsertion
i off the
h d
denture
(extraradicular)

Stud attachments can be employyed with the Branemark and other

systems, forming a substitute for
fo the transmucosal abutments.

Stud attachmen
nt requirement
1. Sound periodontal tissu
ue
2. Adequate zone of attached gingiva
3. Meticulous oral and deenture hygiene
4. The denture must be made
m
inherentlyy stable and
retentive (very importan
nt in case of implant)
5 Enough inter arch spacce and buccolingual space
5.
(reasonable thickness of
o acrylic resin
surrounding
g the attachm
ment))

An attachment must be surrounded with

h an adequate thickness of acrylic resin
of at least 2-3 mm. All that projects abo
ove the mucosa represents a hole within
the
h overdenture
d
with
i h corresponding
di weakness.
w k
V
Vertical
i l space iis precious.
i

Diagnostic mo
ounting J inter
arch
h space
s

Lack of treatment planning with

w mounted diagnostic casts
can lead to this type of mishap. Space assessment is essential.

Selection off attachments

1. Shape and size
2. Ancillary devices
3. Available space (verticcal and buccolingual)
4. The leverage effect forr the root

The alignment off stud attachments

1. The alignment of stud
d attachments with one
another <10
<10.
2. The alignment
g
of the attachment with the
denture path of insertiion.
3. The taller the attachm
ment, the more difficult the
alignment
g
mayy be.

St d attachments
Stud
tt hm nt work
rk best
b t when
h n they
th
are aligned with one another and the
path of insertion of the denture.

Intraradiculaar attachment
The alignment is determ
mined by the roots.
Rapid rate of wear of thee patrix projections.
Divergence of the roots will
w lead to fracture of
patrix element.

Exploded view of the Ceka Revaxx

extraradicular unit

Microfix. An example of an extraradicular

extraradicular stud attachment.

Exploded view of the Ceka Revaxx

employed as an intraradicular unitt

Denture path
h of insertion
Soft and hard tissue undeercut (alternative path of
insertion or surgery) usin
ng surveyor is mandatory.

When conflicting undercuts exist that can

nnot be reduced by surgical intervention,
the
h b
base extension
i must b
be reduced.
d d Thiis
i will
ill compromise
i b
both
h iits stiffness
iff
and
d
retention. A metal denture base with ad
dditional retention is therefore required.

The number off stud attachment

One stud attachment on
n each side of the arch
K no. of attachments may increase stability
K no. of attachments J weaker denture

Only one stud attachmentt is necessary on each side:

(a) preoperative photograph; (b) following placement of retainers
and co
opings.

Connecting
C
i adjacen
dj nt copings:
i
at lleast
2-3 mm spac
p ce is needed
Disadvantages

Advantages

Weaken the denture

Resist well the

rotational load

Complicate
p
p
plaque
q conttrol
More preparation

Connecting adjacent copings compliicates plaque control and overdenture

construction. It does, however, result in inclined forces being resolved along
the
h long
l
axes off the
h roots. N
Note the
h liingual
i
l positioning
i i i off the
h stud
d to allow
ll
for the retroclined incisors of a Class
C
II, Division 2 malocclusion.

F
Factors
influence
i fl
th
h retention
he
i off stud
d
retained ovverdenture
The attachmen
nt type
Base extension
n
Adaptation
Attachment loccation

Popular
P
l attach
tt hment
h
t system
t

The Zest advanced generation is the latest in this series of well developed
intra--radicular units. A com
intra
mprehensive kit is provided.

The metal section (female) iss incorporated within the root

root.

The impression surface of the denturee incorporating Zest attachments. Note

th metal
the
t l base
b
for
f these
th
units,
it which
hi h nott only
l simplifies
i lifi th
the replacement
l
t
procedures of the male but makes relocation techniques unnecessary.

The ERA system maybe used

f overdentures.
for
d
C
Colour
l
coded
d d
resin units provide varying
degrees
g
of retention.

ERA retainer within an

overdenture
d

The Pro Snap by Metaux Precieux is another product with replaceable

retention elements providing 8, 10
10,, or 12 Newtons. The male unit is cast on.

The Pro Fix is a conventional stud retainer by the same manufacturer.

Repair and Maintenance

M
Proce
Proceedures
d

Removal of the male unit from the

t
impression surface of the denturre is
undertaken with the coring instrum
ment.
ment
The remains of the base should be
dissected with a blade or explorer.

The replacement male is carried

into place on the end of the
seating instrument.

Relining, rebasing or extensive

repair
p of a denture with an extraextraradicular stud retainer dictates the
use of a dummy male component
that is incorporated in the cast.
cast

The dummy
Dalbo stud
retainer

The dummy
Microfix stud
retainer

Should it prove necessary to locate an

n attachment directly to the denture,
always cut a vent hole. Self polymeriziing acrylic resin is applied through the
holle.

Magnetic Retainers
Magnets were made of cobalt
c
platinum alloy or
AlNiCo alloy
High magnetic field strength alloy
Low intrinsic coercivity (the
(
ability of the material
to resist changes in its magnetization
m
J large size

Magnets made of raare earth alloys, iron

neodyniu
um alloy
High magnetic fielld strength
Higher intrinsic co
oercivity J small size

Magnetic Retainers
Magnet assembly placed
d in denture and flat
keeper on abutment roott.

Advantages for magnetic

m
retainers
1. Not affecting the deenture path of insertion
2. Self
Self--seating denture
3. Maintenance is simp
pler

Problem of the magnetic

m
retainers
Intra--oral Corrosion
Intra

Sandwich design

Electrro
ro--plating

Encapsulated
magnate

Two examples of the modern encap

psulated magnetic retainer using
the sandwich
h principle

The Magfit 600*

600* unit

The innovadent (Gillings) system

Bar attaachments

Bar Joints
( li h movement))
(slight

Bar Units
(rigid)
i id)

A bar attachment conneected

ected to root filled teeth.

Advantages of bar
b attachment
1. Effective retainers
2. Common path of inserttion for the dowels not
essential (implant).
(implant)
o the roots
3. Decrease the leverage on
4. Resolves the forces into
o more apical direction
5 K the
5.
h stability
bili
6. Through
g connecting
g ro
oots J load sharing
g

Disadvantages of bar attachment

1 Bulkness of the bar aattachment
1.
2. Require more plaquee removal skills
3. Need well retentive retainers
r
4. Technical skills
5. Complicated rebasin
ng and repair
6. Pushing out the neck
ks of lower anterior teeth

Bar Joints
J

Single Sleeve

Multiple Sleeve

The Dolder bar is an example of

of a well tried single sleeve bar.
bar

The Gilmore,
Gilmore Ackermann,
Ackermann and derivatiive bars are examples of multiple sleeve
systems.

Single sleevve bar joints

Ex.
Ex Dolder bar joint
Produced from wrought wire, pearpear-shaped in cross
section
Open
O
Open-sided
id d sleeve
l
with
ith retention
r t ti tag
t
Spacer to allow a degree of movement
Running, just in contact with oral mucosa

Soldered additions to the bar scratch

h easily and are difficult to clean
clean. The
appearance of plaque leads to mucosal irritation.

The addition of a metal skirt simply provides

p
additional surface for plaque
accum
mulation

Single sleevve bar joints

Has to run straight J caannot follow the curvature
of the ridge
Using connecting elemen
nt J unfavorable
leverages
Bar could occupy too mu
uch tongue space
Split the bar in the midw
way then solder it, split the
sleeve

An insufficient number of implant abu

utments together with nonnon-axial loading
has contributed to losss of osseointegration.

 The
Th space between
b
the
h sleeve
sl
and
d the
h b
bar will
ill llost
result of resorbtion of thee edentulous ridge J
rebasing.
b i

Multiple sleeve joints

Short sleeves (clips)
Following the ridge cu
urvature
Connection between ab
butment should be rigid
Circular, pearpear-shaped and
a oval cross section

The Gilmore,
Gilmore Ackermann,
Ackermann and derivatiive bars are examples of multiple sleeve
systems.

Multiple slleeve joints

Prevent hinge rotation
Possible distal cantileverred extensions (<
(<77 mm)

The use of cantilevered extensions req

quires at least four implant
p
abutments.
abutments.
Sleeves positioned on the extension will
w prevent any tendency for the distal
part of the maxillaary denture to drop.

Impression surface of an implant rettained overdenture

overdenture. Note the occlusal
stops that havee been provided.

Tags of the rettaining sleeves

At right angle to the bar (resist rotation,
complicate relocatiion)
Parallel with the baar (simpler relocation,
arrangement of teetth)

Clips featuring two designs of reteention tags are now available for the
A k
Ackermann
b
bar. Th
These clips
li can als
l o be
b employed
l d with
i h the
h H
Hader
d b
bar or
other bars with a 1.8 mm diameter.

Retainin
R t i ing sleeves
l
Metal (C.M
M.)
Plastic (H
Hader bar)

The Hader bar incorporates a resin sleeeve that is speedily replaced when it
slackens. Another notable feature is th
hat the sleeve seats directly on the bar
with no intervvening spacer.

Bar attachmen
nts on implants
Implants has no PDL
Implant place usually paalatal to the original root
place J bar should placeed facial to the implant

Maxillary resorption may result in thee implants being placed some 77-10 mm
palatal to the root position

Use of angled abutmeent J non

non--axil loading

Standard abutments can bee employed when implants

are only moderately misaligned.

Technical co
onsiderations
1. Treatment planning
2. Silicon index
x of trial denture

A silicon mask is used to record

d the position of the teeth for a
mandibularr prosthesis.

The artificial teeth can be removed an

nd the metal substructure constructed.
The
Th space available
il bl can b
be checked
h k db
by replacing
l i th
the silicone
ili
mask.
k Th
The
artificial teeth are replaced followin
ng the completion of the substructure.

Technical co
onsiderations
3. Avoid malaliigned abutments

Lingual inclination of the impllants causing tongue cramping,

inserting the overdenture compounds the problem.

A l d abutments
Angled
b
allow
ll the
h superstru
ucture to be
b positioned
ii
d ffacially
i ll and
d an
acceptable removable prostheesis can now be constructed.

Technical co
onsiderations
4. Use smaller spacer
5. Clearance of th
he edge of the sleeve
6. Adjustment
j
of retention

Adjustments for retention must be caarried out with care using the special
instrument when available. The blue devvices slacken the retention of the Dolder
bar and are used prior to initial insertion or if the sleeve has become accidentally
distorted in use. The small keys arre employed to increase retention.

L bP
Lab
Pro
ocedures
d

Determine the path of insertion and che

check
ck the parallelism of the root canal posts

Prior to waxing the root caps, determin

ne the occlusal thickness of the wax and
model the root caps at right angles to th
he path of insertion using the wax knife.

After casting and fitting the root caps,

determine the final occlusal thickness
and mill the root caps at right angles to
the path of insertion.

Position the bar in the correct relation

to the roots and edentulous ridge.
ridge
Then align it with the path of insertion
using the special connector for the
surveyor.

Invest with soldering

g investment,
leaving the soldering area free to give
good access for the flame.

Prior to soldering
g be sure that the
liquidus of the solder corresponds
with that of the casting alloy, then
apply flux to the root caps.

The bar is rounded off at the ends and

carefully polished.

Fit on the sleeve according to the space

available.

The space under the bar has been blocked out

o prior to the impression. This blocking
out p
procedure is also employed
p y when a sleeeve is to be relocated in the mouth. It is
essential to ensure that no selfself-polym
merising resin can flow under the bar.

Complications with
w bar retainers
Misguided imp
plant placement

An example of poor treatment plannin

ng that complicates plaque control and
provides inadequate sp
pace for an anterior clip.

A significant strain induced

i
within a bar
during screw
w tightening

Insert the screw at one end of the barr and check for any movement at the
other as it is tightened, the screw is then
n removed and the procedure reversed.

G z for
Gauze
f cleaning
l nin th
the b
bar.

I
Interdental
d
lb
brush
h ffor cleaning
l
i
the approximal sites.