Overdenture attachments

* The need for attachment:

Not all cases of overdenture need attachment,
sometimes attachment just to increase the
confidence of the patient, but in some cases,
attachments are mandatory otherwise failure
will be the result of the treatment.
 * When is it mandatory to put
attachment?
1. When additional retention is needed, as in the
case of reduced labial flange.
As we know, In overdenture we don’t extract the
tooth; we just prepare it to preserve the bone “So no
bone resorption will occur as in the case of
extraction”. And also we know that the denture
replace both, missing teeth and supporting tissues, so
if there’s no resorption, the flange of the Overdenture
will make bulkiness and the patient can’t tolerate it,
and also it’s of poor aesthetics.
In such cases, the dentist needs to reduce the labial
flange, breaking the seal that gives retention in
cases of complete denture.
The reduction of labial flange might lead to
flangeless denture, in this case and to compensate
for retention, it’s a must to use attachments.
2. Reduced palatal coverage, in cases of torus
palatinus or if the patient can’t tolerate the palatal
coverage. The same point, we lose retention and we
need to compensate by attachments.
In cases of reduced palatal coverage and we have
abutments “Overdenture”, we use attachment. But
if we don’t have abutments, we put implants with
attachment “if the patient is well enough to pay”.
3. Splinting: if we have questionable abutments,
we use attachments to gain retention and
to splint abutments to distribute the load and
protect the abutments. Bar attachment is
used to achieve splinting.
* Types of overdentureOverdenture
attachments:
Three main types:
1. Stud attachment:
a. Zest anchor attachment: a metal part is
inserted and cemented in the root of the
abutment, and a nylon part will be fixed in the
denture.
Dimensions: width of 4 mm, and length of 6 mm.
Mini Zest attachments are also available. They’re
smaller than the Zest attachment, and used for
smaller teeth or teeth that aren’t covered by
bone.
Clinical procedures: primary impression, mouth
preparation, final impression –just like making a
Co\Cr partial denture-. On the insertion step, we
prepare for the post cavity that will contain the metal
part of the Zest anchor attachment.
The attachment kit contains bur that has the same
size and shape of the metal part, this bur is used for
the preparation.
Then the metal part is cemented in the root of the
abutment, usually it’s cemented with GI cement due
to Fluoride leaching abilities.
One more thing is to do a pick up impression for the
nylon part. Blue collar of 1 mm of height is used as a
stopper to prevent the over insertion of the nylon
part during the impression. As we applying pressure
during impression making, if the nylon part is under
high pressure and there’s no collar, it will be over
inserted, and relapse will result each time the patient
tries to put on the denture, so we use the blue collar
to prevent this.
After taking the impression, we remove the blue
collar, and the space “1 mm” that was made
between the denture and the metal part will
increase the resilience and perform a stress
breaking action.
The pickup impression is taken using cold cure
acrylic.
Advantages of Zest attachment:
I. Eliminate the need for metal coping of the
overdenture over the abutments.
II. Temporary fixation for transitional Overdenture.
III. Chair - side procedure.
 Disadvantages of Zest attachment:
1- Require meticulous cleaning and caring. They’re
supplied with cover, but it’s usually lost, so the
denture needs continuous cleaning that will affect the
size and shape of the nylon part.
2- The need for changing the nylon part frequently
“every three to six months”. Keep in mind, patients
reached this stage of poor dentition, won’t clean
sufficiently, but we just give a chance to patients that
will clean.
Failure of Overdenture and extraction of abutments
will be the result if the patient didn’t clean enough.
-ring attachment: two parts as all attachments,
one to be fixed to the denture and the other one to
the abutment.
The ball is cemented to the abutment then pick up
impression is made. Tin foil is put on the abutment to
prevent the acryl from going into the undercuts. Cold
cure acrylic is used in the impression.
The ring part –usually made of nylon- is fixed to the
denture and the ball-like part is attached to the
abutment.
Also called ball and socket, the socket here
indicates the ring.
Meticulous cleaning is also needed in this type.
Rothermann attachment
Rothermann attachment: two parts, one to be fixed
on the denture and one on the abutments.
Two sizes, the mini size is smaller in height “only 3.5
mm” and it’s used for patients with limited inter-arch
space.
It looks like C-clasps, and gives retention as the clasp.
It could be made chair side or in the lab, but it’s very
difficult on the chair side, because the C-shape could
move in any direction during the pickup impression.
The bulkiness from the lingual side causes annoying
feeling to the patient, and this is one of the
drawbacks of this type of attachments.
 Advantages of the Rothermann attachment:
1- Low in height.
2- Adequate retention similar to the clasp. Two arms
provide enough retention.
3- Female clip is well retained in the resin due to the
presence of holes.
Disadvantages of the Rothemann attachment:
1- Sufficient bulkiness should be available lingually to
secure the female lug.
2- Chair side insertion is very difficult.
2. Bar attachment:
Two main types: rigid or flexible
Doldar bar is the most popular example that can be
rigid or flexible. Also it could be Doldar bar unit
“rigid” or Doldar bar joint “flexible”.
The unit type provides retention by friction as there’s
no space available provided that there’s no
movements in this type “rigid”. In the joint type,
space is available both horizontally and vertically
which allows for certain movements bucco-lingually
and in the vertical direction, and retention is gained
by the engagement of the saddle to the undercuts
of the bar.
3. Magnet attachment: Cobalt Samarium
magnets “also called rare earth magnet” is a
common example.
 Properties of Cobalt Samarium
magnets:
a. It has a high magnetic field strength that holds the
denture in its place in the patient’s mouth.
b. They possess a high intrinsic coercivity “resistance to
demagnetization”.
The old types of magnets were affected by the saliva and
the oral environment and showed a decrease in the
effectiveness with time, but the Cobalt Samarium “rare
earth” magnet showed a continuous effectiveness
and was not affected by the oral environment.
c. Magnetic retention is self limiting: retentive forces
within the range 155-980 g have been reported.
The magnetic field is self limited, which means, if the
patient is eating or talking, the denture will be stable
in the mouth. And when the patient tries to remove
the denture from its place, it will be easily removed,
and this is very important, because if the magnet
provides very strong field, each time the patient tries
to remove the denture, the abutments will be
affected.
A study showed a range of 155-980 gram of resistance
force to the removal forces.
One part of the magnet will be on the abutment,
the other part will be in the denture.
The smoothness of the magnet makes it easier to be
cleaned than other types of attachments.
 Advantages of magnet attachment:
1. Simple to use, once the patient inserts the denture,
the magnets will move it to the proper place. Other
types need to be aligned in a special way to be inserted
in the patient’s mouth, which is harder for the patient.
2. Economically, it’s cheaper and doesn’t require a
frequent change as it’s easier to be used and easier to be
cleaned.
3. Reduce the forces transmitted to the abutments “as
we said about the self limited magnetic field”.
4. Require little maintenance.
* Drawbacks of Overdenture attachments:
1. Increase the cost of treatment.
2. Maintenance is mostly more complicated, as it needs
more care from the patient.
3. Increase the bulkiness might lead to denture
fracture, whether the bulk was lingually as in the case of
Rothermann attachment or in the vertical dimension as
in other attachments. Increase in the bulkiness might
lead to unwanted forces on the denture and results in
fracture of the denture.
4. Plaque control is more difficult. As we said before,
the shape of attachments increases the liability to
plaque accumulation.
5. Higher loads transmitted to abutments, as the
attachment is directly inside the abutment itself, which
increase the load on the abutment.
 Precision attachments
It’s defined as a mechanical device other than clasp that
functions as a direct retainer. This is used for partial
dentures and not Overdenture.
Again, attachments are the same wither for Overdenture
or partial denture, they’re composed of two parts, one to
be cemented on the abutment “wither the abutment is a
crown or amputated crown”, and the other part will be
fixed to the denture “wither it’s a Co\Cr partial denture or
a complete Overdenture”. Though attachments come in
different shapes, they follow the same principles, they
attach the denture to the abutment to provide retention,
and they could be rigid “retention is gained by friction” or
flexible “flexibility is gained by the shape of the
attachment itself”.
* Classification of attachments:
1. According to fabrication:
i. Precision- prefabricated, machined component.
It’s more precise.
ii. Semi precision – less precise tolerance,
manufactured, hand made
2. According to the rigidity:
i. Rigid type that takes retention from friction
ii. Resilient type that gives stress breaking action for
the attachment
3. According to the design:
i. Key and key hole.
ii. Ball and socket.
iii. Bar attachment.
4. According to the relation to the abutment
i. Intra coronal, inside the crown.
Consist of two parts:
A flange joined to a prosthesis.
A slot impeded in the restoration.
• Provide rigid connection.
• Frictional retention.
ii. Extra coronal, outside the crown.
iii. All or part of there mechanism laying outside the
contour of abutment tooth.
iv. Loads are applied outside the long axis of
abutment tooth.
v. Usually resilient.
5. According to Preiscel classification:
i. Intra coronal attachment
ii. Extra coronal attachment
iii. Stud attachment
iv. Bar attachment
Preiscel mixed all type of attachments and there’s
no specific rule for him.
Extra coronal attachments should always be
resilient.
A clinical case for a patient with severe bone loss, and as
we know, fixed prosthesis don’t provide supporting
tissues, we decided that we want to replace the missing
tissues so we have chosen a removable partial denture
with two attachments. The attachments were inside the
crown “intra coronal”. Increase the friction area will
result in increase in the retention.
* Negative aspects on attachment use:
1- Additional expenses.
2- Poor dental motivation.
3- Manual dexterity. Very old patients won’t be able to
use attachments.
4- Repair.
* Contra-indications of attachment use:

1- Short clinical crown. Minimal accepted length of

crown is 6 mm.
2- Minimum 4mm of vertical space for attachment
3- Short bucco-lingual width.
4- Inadequate space between the pulp and the
normal contour. Severe preparation is performed
and we don’t want to do pulp exposure.
Kennedy class I and II requires extra coronal
resilient attachments
Advantages and disadvantages:
Advantages of Precision attachments
• It provide retention without metal display.
• It provide some horizontal stabilization.
• It has been claimed that stimulation to the
underlying structure is greater.
Disadvantages of Precision attachments
• They must never be used in distal extension condition
without stress breaker
• Full cast crown must be prepared on abutment.
• They cant be used in short clinical crowns
• They cant be used when the pulp is large.
• They are not appropriate for patient who lack
muscular coordination.
• Both clinical and laboratory procedures require
special skill.
• They are difficult to repair.
• Very expensive.
 Conclusion:
Clasp – type RPD
o Low cost
o Ease of fabrication and maintenance
o Predictability of results
 Attachment RPD
o More esthetic
o Need for abutment alignment
o Need for cross-arch bracing
thanks