PRECISION ATTACHMENTS

SUBIYA
Introduction

History

Definition and synonyms of attachments

Classification

Indications / Applications of precision attachments

Contraindication

Advantages and Disadvantages

Selection of the abutment teeth

Requirement of the abutment teeth

Selection of the attachment

Intracoronal attachments

Extracoronal attachments

Bar attachments

Stud attachments

Magnets as attachment

Auxillary attachments

Conclusion
 SPECIAL
BAR CLASP
CUSTOM MADE
BAR C CLASP
INTRACORONAL L
STUD EXTRACORONA
ATTACHMENT
EXTERNAL DALBO MANUFACTURED
INTERNAL ATTACHMENT
• It is that component part of removable partial denture that
is used to retain and prevent dislodgement consisting of a
clasp assembly or precision attachment.-GPT Direct retainer
INTRODUCTION
 DEFINITION

PRECISION ATTACHMENT

A retainer consisting of a metal receptacle (matrix) and a closely fitting part (patrix); the
matrix is usually contained within normal or expanded contours of the crown on the
abutment tooth and the patrix is attached to a pontic or the removable partial denture
framework. - (GPT-8)
 INDICATIONS

Movable
Movable joints
joints in
in fixed
fixed movable
movable bridges.
bridges.

As
As stress
stress breaker
breaker in
in free
free end
end saddles
saddles and
and bridges.
bridges.
Intracoronal
Intracoronal attachments
attachments as
as effective
effective direct
direct retainers
retainers for
for
removable
removable partial
partial dentures.
dentures.
As
As a
a connector
connector for
for sectional
sectional dentures.
dentures.
Sections
Sections of
of a
a fixed
fixed prosthesis
prosthesis can
can be
be connected
connected with
with intra
intra coronal
coronal
attachments.
attachments.
To lock a connector joining saddles in the opposite side of
the arch.
As contingency devices for the extension or conversion of
existing dentures.
Where fixed dentures are contraindicated due to
periodontal condition.
In the esthetic zone where extracoronal direct retainer
adversely affects the esthetics.

To retain hybrid dentures.

CONTRAINDICATION

prosthesis with
Senile patients with less attachments must
be inserted along
dexterity one precise path of
insertion

Patients with severe Periodontitis or poor oral

hygiene
Patients with abnormally high caries rate.

Large pulp since it limits the depth of the

receptacle.
Short crowns offer less frictional resistance

Cost factor
Doesnot
permit
Distal extension denture base horizontal
movement
 HISTORICAL BACKGROUND

Designed and used Designed his own

attachment and also a
simple intracoronal paralleling device for
attachment alignment

Alexande
Carr Peeso Parr Morgan Griswald
r
 Original idea was to position the
attachment lingually, but mesiodistal
Late 19th century : position was suggested
Dr.Herman ES Chayes
First attachment to be available in the general market

“T shaped” “H shaped”
Precision Attachment (1906) Chayes Attachment (1912)
 SYNONYMS

Key and
Internal Parallel Frictional
keyway
attachmen attachmen attachmen
attachmen
ts ts ts
ts

Male attachments Female attachments

Patrix Matrix

Flange Slot
Insert Crypt
Key Keyway

Fitting Receptacle
part
CLASSIFICATION OF ATTACHMENTS

1. BASED ON METHOD OF FABRICATION

PREFABRICATED CUSTOM / LAB MADE

2. BASED ON RELATIONSHIP TO ABUTMENT TEETH

Intracoronal Extracoronal
 3. BASED ON STIFFNESS OF JOINT

Rigid attachment Resilient attachment

 4. M.C. Mensor (1973)
Classification according to shape, design and primary area of utilization of
attachment.

Coronal Radicular Accessory

Auxillary

Telescope studs Screw units

Intracoronal • (pressure buttons)
Bar connectors

Bolts
Extracoronal Bar attachment
Stabilizers
• (Bar joints and Bar
units)
Balances

Interlocks
 5. Gerardo Beccera and others (1987)

• Magnetic
Intradental attachments • Frictional

• Bar attachment
Extradental attachments • Cantilever attachment
INTRACORONAL ATTACHMENT
 INTRACORONAL ATTACHMENT

 Matrix and patrix are positioned within the normal contour of the abutment tooth.

 The two parts of an intracoronal attachment consist of a flange and a slot. The flange is
joined to one section of the prosthesis and the slot unit embedded in a restoration forming
part of another section of the prosthesis.

 Provides rigid connection between the two prosthesis

 BASED ON MECHANISM OF RETENTION

Retention is augmented by a mechanical

Retention is entirely frictional
lock.

Schatzmann unit
McCollum intra Additional retention is provided by
coronal unit. a spring loaded plunger
Depends on the height of the

“Clinical crown”
Most important for
retention and stability ht
Heig
of
ro wn
c

Cross
length SA
section Surface
area of
patrix

Retention

Cross section is limited since its

necessary to limit the matrix
within the circumference of tooth
 BASED ON MECHANICS OF RETENTION

Frictional : Preiskel group I

Mechanical : Preiskel group II
 Retention – Surface area contact
Auxillary mechanical retentive
 Function of the length
features
 – Controlled by height of clinical crown
Ex. Spring loaded plunger / clips
 – Intermaxillary space available

 Function of cross sectional dimensions

BASED ON CROSS SECTION OF INTRA CORONAL ATTACHMENTS

Attachments with a
H-Shaped flanges T-shaped flanges circular cross
section.
• The external • Less SA hence less • They are suitable
frictional flange retention only for joining two
doubles the SA and sections of a fixed
strengthens the prosthesis.
attachment, without
increasing the size of
the matrix.
 Ney’s Crismani McCollum Beyeler Omega
Active attachment Passive attachment
Locked precision
attachment With adjustment Without adjustment
potential potential
DEPENDING ON ARTICULAR RETENTION
 PASSIVE ATTACHMENT

 Lack of adjustment potential renders this type of unit unsuitable for

removable prostheses,
 As repeated insertion and removal causes wear

Omega
 Useful for joining series of crowns without common path of insertion

 Round profile (OMEGA) used when connecting anterior crowns

 BEYELER has more contact surface area hence used for posterior

Beyeler
 ACTIVE ATTACHMENT

 Constant insertion and removal causes wear hence some form of adjustment is
desirable.

 Chayes unit can be adjusted by simply opening the two halves with a blade or
scalpel

 Whereas, complicated ones require manufacturer’s instructions

 In the past, patrix was manufactured in two parts and soldered later but the
soldered junction becomes weak hence avoided
 Mc Collum attachment

 Among the most robust

 Can be bonded from gold to porcelain to combinations

 Frictional fit with adjustment potential

 Retention is by expanding the adjustment slot

 Adjustment split runs part way through attachment from one side
 Since split should face laterally, it’s necessary to produce separate left and right
attachments

 Manufactures have selected lower denture for terminology

 Hence, for upper left side, the right side unit should be placed and vice versa
 Crismani series

 Available as 2 basic configuration :

 Narrower version 2.8 mm has adjustable central groove
 Redefined over the yrs, now has chamfer & tapered gingival patrix to facilitate
insertion

 Unit is 7mm but can be shortened to 2mm

 Schatzmann attachment

 Mechanical retention
 (spring loaded plunger & coil spring)

 Application limited due to their bulk

 Stern gingival latch attachment

 Novel method of additional retention

 Opening the base with special instrument

 Base of patrix is split and formed in the shape of door latch

 To provide a lock when patrix is engaged

 2 size
 Standard unit, the split is 2.5mm high
 Can be shortened to 3.6mm
 Miniature unit, the split is 1.5 mm high
 Can be shortened to 2.62mm
Operators are cautioned to think twice
before reducing any intracoronal
attachment below 4mm, if
unacceptable movement is to be
avoided at a later date.
 Ney’s attachment

Conventional Latch retained Ney loc split

H shaped lingual
 SEMIPRECISION

 While prefabricated attachments are called as precision attachments, those fabricated

in laboratory are called as semiprecision attachments.

 “Laboratory fabricated rigid metalic extension (patrix) of a fixed or removable dental

prosthesis that fits into a slot type key way (matrix) in a cast restoration allowing
some movement between the component”. -GPT8
 Precision attachment is made of precious metal and fit of two working
elements is machined to very close tolerances, hence is more precise than
laboratory fabricated attachment.

 Semiprecision attachments are usually fabricated in base metal alloys.

 Louis blatter fein (1969) : Aspects of rest seat preparation
Occlusal form / outline form – controls amount of rotation

Circular Dove tail Rectangular Mortice

(Non-locking type)
Proximal form / side walls – lateral force control

Parallel outline Tapering outline

Gingival floor form : serves the function of reciprocation

Added
reciprocation

Flat Inclined Channeled

Mortice occlusal Rectangular
form occlusal form
 Advantages

• Versatility for clinical situations – employing various rest seat outline forms.
• Variation in tooth size and shapes are easily accommodated.
• Better crown contour compared to prefabricated type

.
 Disadvantages

 Long term wear is more

 No standardization of sizing
 Greater degree of laboratory skill and attention in detail
EXTRACORONAL ATTACHMENT
 EXTRACORONAL ATTACHMENTS
Introduced by Henry R. Boos (1900)
Modified by F Ewing Roach (1908)

Any prefabricated attachment for support and retention of an RDP in which the
“matrix” and “patrix”components are positioned outside the normal contour of the
abutment tooth

Rigid attachments

Boitel (1978)
Resilient
attachments
Bar attachments
 Rigid attachments

Hinged attachments (Stress

breaking action)

ERA
Resilient attachments
O-ring

 Careful judgment is needed in deciding when to use such attachments

 (e.g., ERA, Ceka, Dalbo or Dawson)
 because they place unfavorable stresses on the abutment teeth, similar to the stresses exerted
by a cantilever.
 In addition, they make oral hygiene more difficult. In some instances

 In some instances, however, extracoronal attachments offer esthetic advantages that may
outweigh their biologic and mechanical disadvantages
 RIGID EXTRACORONAL
ATTACHMENTS

Roach attachment Pin and tube attachment

(ball and tube attachment) • The simplest
• Oldest attachment • Patrix - pin
• Patrix – round ball • Matrix – tube
• Matrix - tube
 Conex attachment

Stabilex attachment
• Two retention pins
• Disadvantage is increased length
 HINGED ATTACHMENT
STRESS BREAKER DESIGNS

ASC-52 attachment
 Neys distal extension stress
breaker

Crismani resilient attachment

Hinge stress breaker

Stern stress breaker Anchorvis attachment
 RESILIENT EXTRA CORONAL
ATTACHMENT

1. Dalbo / Dallabona attachment

This attachment provides some movement between the patrix and matrix
component

a) Patrix
Assembled
b) Matrix
2. ERA EXTRACORNAL RESILIENT ATTACHMENT
 Colour coded retention caps

Most flexible White > Orange > Blue > Gray Least
 3. O-ring attachment

Patrix - post with the groove or undercut.

Matrix – O-ring synthetic polymer + encapsulator

O-ring are made up of

• Silicone
• Nitrile
• Fluorocarbon
• Ethylene propylene
 Advantages of O-ring

• Ease in changing the attachment

• Wide range of movement

• Low cost

• Different degrees of retention

 3. THE CEKA

• Developed by karl (1951)

Matrix Patrix Attachment pin 1. Female component; 2.Male

component; 3.Spacer; 4.male
(metal ring retainer) partial RDP connector;
(split metal post) 5.Positioning mandrel;
6.Adjustment tool
 CEKA ATTACHMENT CEKA REVAX

Patrix – metal ring

Matrix – attachment pin (split metal post)

Extra Intra radicular

Radicular
 THE DAWSON

1. Female component; 2.Male component –

which has a built in plunger for retention; 3.
The 2.7 Dawson attachment assembled
 STUD ATTACHMENT

 “Anchor the roots”

 Simplest of all the attachment

 Patrix – dowel / post retained restoration

 Matrix – denture base of the prosthesis

 Classified as :
 Extraradicular units
 Intraradicular units
 ERA Stud attachment

 Available in different colors coded

retention

 Stern root anchor

 Intraradicular ball and socket joint

 The nylon male unit is processed in the
denture acrylic
 Titanium female unit is cemented
directly into the prepared root
 Dalla bona spherical

 Gold alloy stud with adjustable frictional

resistance
 BAR ATTACHMENT

 Gilmore clip system (1913) - metal bar with retaining sleeve / clip.

 Bar can be attached to the :

 Coping or crowns over the vital teeth
 Post coping on endodontically treated teeth
 Screwed down into the coping (implant system)
Two groups of bar attachments :
1) Bar units - rigid
2) Bar joints – permits rotation
BAR JOINTS

Single sleeve bar joints Multiple sleeve bar joints

Depending on cross section

Round / circular Oval / egg shaped ‘U’ shaped / parallel sided bars
 Types of bar attachments :

 Customised bar
 Dolder bar
 Ackermann’s bar
 Hader bar
 Andrews bar
 Hader bar
Helmut Hader in 1960
 Available as a prefabricated plastic pattern

 Plastic bar incorporated into fixed prostheses before casting

 Varying retention Color coded nylon clips incorporated into Clips with metal encapsulator
the denture.

Advantage

 Prefabricated plastic pattern – no need for soldering.

 Precise fit, simplicity, versatility

 DOLDER BAR
 Gold alloy bar

 Rigid, Resilient, Hinging configurations

 Egg shaped bar in cross section

 Open sided sleeve

 Spacer – degree of movement

 MOVEMENTS SEEN IN DOLDER BAR
Rest position Vertical translation Sagittal rotation

Implant supported over denture

 ACKERMANN BAR

 Available in different cross section

 Circular cross section – can be bent in all
planes
Advantages of bar attachments :
• Rigidly splint the teeth
• Provides good retention, stability and support
• Provides cross arch stabilization
• Positioned close to the alveolar bone (exhibit less leverage)

Disadvantages :
• Bulk of bar
• Plaque accumulation
• Wearing
• Soldering procedure
• Manual dexterity
 ADVANTAGES

1. The labial or buccal clasp arms can be eliminated altogether. This makes
spectacular improvement in the esthetic excellence of a denture especially in the
maxillary arch.

2. Precision attachments are less stressful to the abutment teeth than conventional
clasps.
 DISADVANTAGES

1. The restorative service and often necessitate remaking the fixed retainers when the
attachments wear out.
 In one study, only 22 of 57 prostheses were free of complications during the first 2
years.12 When used with distal extensions, attachments lead to higher stresses in the
abutment teeth.13 Nevertheless, their use can be justified, particularly to enhance
appearance.

2. The tooth may have to be extensively prepared to provide required space to

accommodate intracoronal attachment.

3. The attachment is subject to wear as a result of friction between metal parts. As

wear occurs, male portion fits more loosely thus permitting excessive movement
4. The extra coronal type of retainer extends out from the tooth near
the gingival border, so there may be gingival irritation followed by
usual inflammatory sequel.

5. The extracoronal type of attachment must occupy the space

immediately adjacent to abutment tooth, which is precisely where
a replacement tooth should ideally be positioned.
 CONCLUSION

The decision to use Precision Attachments in removable partial design should be carefully
considered. Clasp type removable partial denture’s should be used whenever practical
because of Lower cost, Ease of fabrication , Maintenance and Predictability of results.

Precision Attachment removable partial denture is the treatment of choice because of

esthetics, abutments alignment or the need for greater cross arch bracing
It must be used with a thorough knowledge and understanding of prosthodontics
principles and attachment use as well as an awareness of the intricacies and special
problems associated with the Precision Attachments.
 REFERENCES

1. Precision attachments in prosthodontics vol 1 – Harold W Preiskel

2. Contemporary fixed prosthodontics. Rosensteil, fourth edition
3. Precision Attachment: Retained Overdenture K. Jayasree, M. Bharathi, V. Dileep
Nag, B. Vinod, J Indian Prosthodont Soc (Jan-Mar 2012) 12(1):59–62

4. Precision Attachments- An Overview Anupama Nigam, Ajay Singh, Abhinav

Shekhar, Himanshu Gupta journalofdentofacialsciences 2013; 2(4): 41-44).
5. Precision Attachments for Aesthetics and Function: A Case Report, Nitin
Bhaskar Shetty, Sanyuktha Shetty, Nagaraj E, Omkar Shetty, Raina
D’souza, Journal of Clinical and Diagnostic Research. 2014 Jan, Vol-8(1):
268-270
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