M.S.

Ramaiah Dental College and Hospital

Bangalore
Department of Prosthodontics

SEMINAR
ON
MAGNETS IN PROSTHETIC DENTISTRY

Presented by
Dr. P. Roshan Kumar
 Contents

Introducion

History

Classification

Mechanism of action of magnets

Magnetic material

Types of magnetism

Designs

Open field

Closed field

Corrosion

Effects of magnets on tissues and their safety factors

Advantages

Disadvantages

Conclusions

References.

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INTRODUCTION

Magnets have generated great interest in dentistry because of their small size and

strong attractive forces which allow them to be placement within prosthesis without being

obtrusive in the mouth. They are being used as retentive aids for over dentures,

removable partial dentures, implants and in orthodontics for correction of malocclusion

and for treating unerupted teeth. In maxillofacial prosthodontics they have been used for

decades to reconstruct large defects with the help of multiple component prostheses. The

two main areas for their use in prosthetic dentistry are for the retention of overdenture or

a maxillofacial prosthesis

HISTORY

1950- First magnets were used in dentistry. Magnetic repulsion (of like poles) was

used to seat the dentures. Magnetic material was alnico type which is discontinued now

because of the large bulk needed for magnetic strength. The magnets were embedded in the

molar regions in the bases of complete dentures so that the like poles were oriented toward

each other. As the patient closes jaw together, mutual repulsion of the like poles of the

magnets seated the dentures against the alveolar ridges. The constant repelling force

promoted resorption of bone in the alveolar ridges and the seating effect fell dramatically

when the jaws were apart.

Hence, mutually attractive forces of paired magnets were used as retentive aid for

sectional dentures, maxillofacial prosthesis, obturators and complete dentures.

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 Early-1960’s- Magnets in attraction were used .Alnico V was surgically

implanted in the mandible. But they provided inadequate force to aid the retention of the

denture. Later coated and uncoated Co-Pt magnets were introduced by Behrman and

Toto et al. Coated magnets exhibited, no adverse physiologic effects, favorable bone

response; enhanced denture retention and encouraged tissue reaction. Where as

uncoated magnets which were implanted in the mandible moved over a period of time

through the bone and tissues and became exposed in the oral cavity. Even though these

magnets were smaller and stronger, because of their high cost, limited availability and

difficulty in fabrication, they were soon abandoned.

Late1960’s- Rare earth metals were introduced. Cobalt was alloyed with samarium

(Co5Sm). This has twice the magnetic field strength of Co-Pt and the strongest of Alnico

alloys. These magnets could be produced in very small dimensions and approximately one

fifth of Co-Pt magnets and still could provide the same force.

A protoplast (Polytetrafluoroethylene and pyrolytic graphite) coating was given

for protection in vivo. This provided corrosion protection only if there was no faults or

damage to the magnets during surgical placement. Nowadays, the proplast is no longer

used as coating material but the Polytetrafluoroethylene (PTFE) is being used as a

binder in polymer-bonded magnets. But these are not suitable for long-term. usage of

magnets in the body as diffusion of moisture through the polymer results in loss of

corrosion resistance.

Another alloy based on neodymium iron-boron (Nd-Fe-B), became available in

1980s for dental applications.Both Co5Sm and Nd-Fe-B are termed as rare earth magnets

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{RE.} because they are rare from the Standpoint of extraction.Both are excellent for

dental applications because of their small sizes without compromising on the magnetic

force. They also exhibit. High intrinsic coercivity (they do not tend to demagnetize).

However, they are brittle and have low corrosion resistance. In spite of encapsulating

them in stainless steel, titanium or palladium, if these coating materials wear out, they

cause deleterious effects on the tissues and this may be increased in the presence of

bacteria such as Streptococcus sanguinus.

To overcome the above problem, another material, Samarium iron nitride is being

developed for medical and dental applications. It is highly resistant to de-magnetization

and has better resistance to temperature and corrosion than Nd-Fe-B type magnets. This

material is still under development.

These magnets could be incorporated into retained roots with similar units built into

denture. Later developments included the replacement of the root magnet with a soft

material that is magnetized while the denture is in place but returns to a demagnetized state

on removal of the denture.

CLASSIFICATION OF MAGNETS

A. Based on Alloys used

 Those containing cobalt

Examples are Ainico, Ainico V, Co-Pt, Co5Sm

 Those not containing cobalt

Examples are Nd-Fe-B, samarium iron nitride

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B. Based on ability to retain magnetic properties (Intrinsic coercivity or

hardness)

• Soft (easy to magnetize or demagnetize) (less permanent )

Examples are: Pd-Co-Ni alloy,

Pd-Co alloy,

Pd-Co-Cr alloy,

Pd, Co-Pt alloy,

Magnetic stainless steels,

Permendur (alloy of Fe-Co),

Cr-Molybdenum alloy.

• Hard (retain magnetism permanently)

Examples are: Ainico alloys

Co-Pt

Co5Sm,

Nd-Fe-B.

C. Based on surface coating (materials may be stainless steel, Titanium or

palladium)

• Coated,

• Uncoated

D. Based on the type of magnetism

• Repulsion,

• Attraction

E. Based on type of magnetic field

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 • Open field,

• Closed field

F. Closed field

• Rectangular closed-field sandwich design,

• Circular closed-field sandwich design,

G- Based on number of magnets in the system

• single.

• paired.

H. Based on the arrangement of the poles

• reversed poles,

• nonreversed poles

HOW DO MAGNETS ACT?

Every atom is a magnet because electrons orbit its nucleus and as moving charges,

produce a magnetic field. However, most of the electrons are paired, and the equal and

opposite fields cancel out. In some atoms such as Fe, Ni, And Co, there are unpaired

electrons that create tiny magnetic field. The atoms, which have the tiny magnetic field

align in small regions called “domains”, when the material is magnetized.

In an unmagnetized state, the orientation of these domains is random and no

magnetization experienced. On the application of magnetic field, the domains align and

there by produce an overall magnetization in the specimen. Soft materials require only

small field to reach saturation and hard materials require large fields to reach saturation.

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When the applied force is removed, if the material retains its magnetization (remenence), it

is called a permanent magnet.

Flux density refers to the magnetic field strengths around the magnet. This flux

density can be measured both in axial direction and lateral direction of a magnet. In an

open field magnet, this can be measured in both directions were as in a closed field magnet,

there is no axial flux as he magnetic field gets cancelled due to the presence of north pole

and south pole arranged in the opposite directions due to the presence of a “keeper” at both

ends. The lateral flux distribution in a closed field system is less than an open field system

by 1/30 to 1/200.

The new rare earth magnets like cobalt-samarium have twice the magnetic field

strength of any known Alnico alloys and they have extremely high magnetic permanence

(Hardness). Coercivity of cobalt-samarium is five times that of Cobalt-Platinum and more

than 10 times that of Alnico alloys. Because of this property they can be made extremely

small and still maintain their high magnetic field strength. They can be made in

dimensions of 2mm or even less, which permits their use in over dentures.

MAGNETIC MATERIALS

Over the last century, significant advances have been made in the development of

magnetic materials. Alnicos-alloys based on aluminum, cobalt, and nickel-were the main

materials in use. In the 1960’s a new type of magnets based on rare-earth elements was

developed. When a transition element such as cobalt or iron was alloyed with an element of

this class, permanent magnets that provided high strength in a small size could be made.

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These include samarium-cobalt(Sm-Co), Neodymium iron boron (Nd-Fe-B) and the most

recent Samarium iron nitride.

TYPES OF MAGNETISM

Magnetic materials may be termed either soft (easy to magnetize and demagnetize)

or hard (able to retain magnetic properties and be made into permanent magnets). Whether

a material is hard or soft depends on whether it retains its magnetic properties after the

removal of an applied magnetic field.

DESIGNS AVAILABLE

An open-field system consists of a cylindrical magnet with open ends It can be

either single or paired. The first devices were of an 'open field' type; in which two

magnets were used one in the jaw and one in the denture.   In this configuration the

magnets were unshielded and hence magnetic fields were experienced in the oral cavity. 

A closed field system of magnets consists of paired magnets and an attached

keeper and a detachable keeper. The magnet pairs are arranged with opposite poles

adjacent, and magnet faces abut magnetizable alloy keepers. Keepers can be either oval

or circular disks. The paired magnets may be 2.5 mm in diameter and 1.5 mm high or 3

mm in diameter and 2.5 mm high. The 'keepers' are magnetizable, low-coercivity,

martensitic stainless steel or a Pd-Co-Ni alloy, which join the unlike poles of a magnet.

These 'keepers’ provide a closed field pathway for the magnetic field. In this

configuration the magnetic field lines are shunted through the keeper as it is the path of

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minimum energy and hence there is no magnetic field experienced in the oral cavity. 

Attachments of this type are more efficient as both the north and south poles can be

employed for attachment to the keeper, opposed to the open field systems where only one

pole is used.

CORROSION

A magnet has poor corrosion resistance in the oral fluids, especially the uncoated

ones. Both the rare earth magnets are brittle and are susceptible to corrosion. They

corrode rapidly in saliva and the presence of bacteria enhances corrosion of Nd-Fe-B

magnets. These corrosive products have been found to have cytotoxic effects on the

tissues. Hence, they should be encapsulated prior to placement in the oral cavity.

Stainless steel and titanium have been the most commonly used materials but polymeric

materials also have been used. How ever, continuous wearing of these coating materials

leads to exposure of the magnets. The pitting corrosion of stainless steel also occurs in

the oral environment. To overcome these problems, other coating materials such as

titanium and chromium nitrides have been used to prevent wear.

In polymeric materials diffusion of moisture and ions attack the magnets

through the interface between them. To avoid this problem non-permeable sealing

technique like laser welding are being tried these days. One such system, which uses laser

welding is the open- field system like Dyna, of Netherlands and the other being. the

Steco of Germany.

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 A Recent material, which is being investigated as a new candidate for permanent

magnet applications is samarium iron nitride. It has better corrosion resistance than even

Nd-Fe-B.

EFFECTS OF MAGNETS ON TISSUES AND THEIR SAFETY FACTORS

There are two possible ways by which a. magnet can cause injury to the tissues.

They are

1. Physical effects due to the steady magnetic fields (magnetism) around them.

2. Chemical effects of alloys and their corrosion products.

1. Physical effects

In 1960,Behran studied the physical effects on bone and soft tissues of

450 subjects and concluded that magnetism is completely innocuous to tissues

In 1979, Cerny observed that embedded magnets do not cause adverse

effects in experimental animals.

Effects of the magnetic fields have been studied extensively, with

confiicting results. But for dental applications there is no claim of any

damaging tissue effects. The closed fields system has better tissue

compatibility when compared to a open-field system. The denture-retention

element abuts the keeper in the root and holds the denture with the help of

magnetic attraction. When in position, there is no external field surrounding

the denture or the root.

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 2. Chemical effects

In 1979, Tsutsui and his colleagues stated that cobalt-samarium is not

harmful chemically. Cobalt has been an essential dietary trace element.

Samarium salts are not considered toxic. Another rare salt cerium oxalate

(which also contains samarium) has been recommended as a treatment for sea

sickness in dosages up to 1gm/day.

However, Walmsley suggests that the magnets have to be encapsulated in

any of the materials mentioned earlier. He observed that if the coating wears

out, themagnet would come in contact with saliva, which can corrode the

magnet. Corrosion rate can increase in the presence of bacteria like

Strptococcus sanguinus. Thus life span of the magnet may decrease. Also,

coated magnets have been found to produce no effect on human dental pulp,

gingiva ,osteoblasts or blood flow. Only uncoated magnet has cytotoxic

effects on the cells. Oral mucosal osteoblasts are most sensitive to effects of

these rare earth magnets.

ADVANTAGES OF MAGNETS

1. Small size with strong attractive forces

2. Great capacity of retention

3. Transmit little lateral force to abutments (Dissipate lateral frictional forces)

4. Simple to insert and remove(self seating/automatic reseating)

5. Non diminishing retentive properties compared with mechanical

attachments(Constant retention with many cycles)

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 6. Easy replacement if needed

7. Can be placed within prosthesis

8. Less need for parallel abutments

9. Can be used for implant –supported prosthesis

10. Ease of cleaning

DISADVANTAGES

1. Poor corrosive resistance within oral fluids and therefore require encapsulation

within relatively inert alloy such as stainless steel or titanium.

2. Cytotoxic effects

3. High cost

4. Short track record.

PROCEDURES FOR ATTACHING MAGNETS IN OVERDENTURE

The magnetic retention element consists of paired magnets and attached keeper.

To fix the keeper element, three different procedures have been used to fix the keeper

element (detachable keeper) to the toot root.

Keeper Types

Basically of three types

1. The cement in keeper

2. The preformed keeper

3. The cast root cap and dowel keeper

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1. The Cement in keeper

The magnetic retention element of magnetic retention unit consists of paired magnets,

attached keeper and thin end plates covering magnet faces of paired magnets. The keeper

element is cemented into an oval cavity prepared on the root face. The cemented in keeper

is a preformed disk 5mm long, 3.2mm wide and 1.2mm thick, with parallel sides of

magnetizable stainless steel. It has one flat face, which mates with the flat faces of the

protective stainless steel end plates of the retention element. The other face is slightly

curved and this face is inserted into the prepared cavity.

Procedure

Adequate anesthesia and isolation. Root canal therapy is carried out. If the tooth is

vital RCT is finished in one appointment.

For preparing the keeper element cavity, trim the root face so that it is flat and level

with the gingiva. Periodontal health should be assessed and treatment done if needed. The

root face is trimmed with an end cutting diamond or abrasive stone.

Small round bur is used to penetrate the root canal to depth of 3mm. Cavity is then

enlarged using round burs and trial fit of the keeper is checked

The keeper is then cemented & the keeper and root face is flattened with an end

cutting diamond bur

2. The Screwed on Keeper

It was developed for those cases where root face is too small to accommodate a

cemented in keeper. It is preformed chamfered, oval disk and has two counter sink cone

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shaped holes. Because holes for the pins are cone shaped, pins a can adopt positions up to

15 degrees from right angle. The underside or base of the keeper measures 6mm by 4mm

and 1.2mm thick.

Procedure

Adequate anesthesia and isolation. Root canal therapy is carried out. If the tooth is

vital RCT is finished in one appointment.

For preparing the keeper element cavity, trim the root face so that it is flat and level

with the gingiva. The root face must be flat to accommodate the flat base of the keeper.

Trial fit of the keeper is checked. The keeper is then attached with the help of self threading

pins.

3. The cast root cap and dowel keeper

It is indicated in cases where complete coverage of root face is considered

necessary.The casting must be magnetizable and should provide a flat root cap surface that

measures at least 5mm by 3.2mm.

Root face and wax pattern preparation are conventional. Pd-CO-Ni & Stainless steel

are the alloys that are used for casting. The root canal preparation can be made shorter than

normal because of low dislodging forces

The part of the casting that abuts the magnetic retention unit must be:

For Pd-Co-Ni -2mm (it is less magnetizable than stainless steel, extra thickness is

needed).

For Stainless steel -1.2mm thick

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Amount of retention provided by different systems.

Regular Magnet with Regular Keeper = 1.5lbs retention

Mini Magnet with Mini Keeper = 1.0lbs retention

Combination of Regular/Mini components = 1.25lbs retention

CONCLUSION

Magnetic retention systems can be used as an aid to overdenture retention. Since

its introduction in 1977, good clinical results and excellent patient acceptance are

achieved. This system has also been used in a limited number of partial overdentures,

sectional dentures, and sectional bridges with good results. The system is not advocated

as a replacement for conventional precision retainers but rather supplement to them, for

uses in cases where, for reasons of cost, convenience, or patient motivation, conventional

retainers are unsuitable.

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References

1. Magnets in prosthetic dentistry-J.P.D 2001;86:137-42

2. Magnetic retention for overdentures-J.P.D.1981;45484-490

3. Magnetic retention for overdentures-J.P.D1983;49:607-617

4. The direct and indirect technique of making magnetically retained

overdentures-J.P.D 1991;55:112-117

5. Investigations into failures of Dental Magnets In J Prosthodont 1999;12:249-

254

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