Overdentures in general dental practice. Part 5--the use of copings and attachments.
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A technique has been described that allows the dentist to correct the relation of the implant abutment to the alveolar ridge of the mandibular staple bone implant postoperatively. This correction is often necessary to provide room within the denture space. In addition, heat-cured acrylic resin bases are united to O-ring attachments intraorally. This technique improves predictability for success.
The abutment consideration is but one step in the fabrication of a stable base appliance. This step, however, is a vitally important one. If carried out poorly, the casting can be lost and the tooth and periodontal tissues severely damaged or destroyed. All the steps considered in the fabrication of a case are like links of a chain. If one link fails the entire chain (or case) is broken or impaired. When the conditions of proper room for the attachment, crown contour, retention, and criteria of good preparation techniques and design are met, sound abutment considerations will be a strong link in the success of the attachment.
The background, rationale, and technique for fabricating the remodified Hart-Dunn attachment system have been presented. This subpontic attachment is a product of clinical experience in managing the unilateral distal extension removable partial denture patient. Minimal retention, reduced torque throughout the arch during function, and distribution of force according to sound mechanical principles make this remodified subpontic attachment the preferred method of treating most unilateral distal extension removable partial denture patients.
Refitting clip-retained complete dentures for patients with osseointegrated implants as abutments presents problems in maintaining occlusion and protecting the clip during processing. This article describes a technique for functionally relining osseointegrated prostheses containing anterior clip-bar attachments.
Where conventional clasping will result in poor esthetics, a simple alternative means of retention is available in the form of an attachment with a spring-loaded plunger. Careful placement of the attachment is important to provide effective retention and to prevent tooth movement.
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Part 2 follows the initial review of attachment partial dentures presented in Part 1 and considers the analysis of specific treatment requirements to provide a rationale for appropriate attachment selection. The tooth/tissue-supported removable partial denture is carefully reviewed and several treatment philosophies for attachment use in this situation are discussed.
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It has been amply demonstrated during the last decade that there are significant advantages to implant-supported overdentures beyond conventional complete dentures. Several attachment systems exist for connecting the overdenture to the implants, and practically all of them present notable benefits to the patients. This article discusses the use of the Zest Anchor Advanced Generation (ZAAG). This system, an outgrowth from the original Zest attachment, uses both individual implant attachments and bar attachments, and is compatible with all major implant systems. In addition to the retention, stability, and resiliency the ZAAG implant attachment system provides, it has the advantage of placing the resistance force of the attachment close to the implant body.
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A resin-bonded retainer with a custom-made attachment is an acceptable alternative for patients who have narrow anterior alveolar ridge defects. This restoration facilitates hygiene and satisfies the requirements of form, fit, function, and esthetics.