Attachments for Removable Partial

Dentures

MARIAM BOKUCHAVA
DMD , PROSTHODONTIST

2019
 The removable partial denture components that engage abutments to resist dislodging
forces are called direct retainers. Strict criteria guiding the design of direct retainers
must be observed.When appropriately designed and constructed, direct retainers
prevent a removable partial denture from being dislodged and limit the transfer of
detrimental stresses to abutments and supporting tissues.
 In general, there are two types of direct retainers: intracoronal and extracoronal
 Intracoronal Attachment Direct Retainers - were introduced in the late nineteenth
century with substantial contributions from Dr Herman E. S. Chayes. Often referred to
as simply “attachments,” intracoronal direct retainers are composed of two closely fitting
components. .The first component,or matrix, is a metal receptacle or keyway.The
matrix is positioned within the normal clinical contours of a cast restoration placed on
the abutment. The second component, or patrix, is attached to the removable partial
denture.
 .When the removable partial denture is placed in the patient’s mouth, the two
components interlock in a sliding joint configuration.This sliding joint resides within the
normal clinical contours of an abutment and functions to retain, support, and stabilize
the removable partial denture .
 Parallelism of multiple attachments must be carefully considered when designing a
removable partial denture.The paths of engagement for the attachments, ie, the long
axes of the attachments .

 The prosthesis can only be removed when force is intentionally applied to the
removable partial denture parallel to the long axes of the attachments.
 Extracoronal Attachment Direct Retainers - are mechanical devices that reside entirely
outside the normal clinical contours of abutments. They serve to retain and stabilize
removable partial dentures when dislodging forces are encountered. Extracoronal direct
retainers may be divided into two categories: extracoronal attachments and retentive
clasp arms. Of these,retentive clasp arms are by far the most common.
 First introduced to dentistry in the early 1900s by Henry P.Boos and later modified by
F.Ewing Roach,an extracoronal attachment provides a rigid, movable, or resilient
connection between an abutment and a removable partial denture. Like its intracoronal
counterpart, the extracoronal attachment is a sliding joint that derives its retentive
characteristics from closely fitting components. Because mechanical connection resides
outside the normal clinical contours of the abutment crown,this attachment is
 considered extracoronal (Figs 21-9 and 21-10). Many of these attachments permit
movement of the prosthesis during occlusal loading.This mechanical accommodation to
functional movement is intended to minimize the transfer of potentially damaging forces
to the abutments.This concept supports the “stress-breaking” philosophy of removable
partial denture design.
 Other Classification Systems - In addition to the aforementioned methods of
classification, attachments may be categorized based on the stiffness of the resulting
joint or geometric form.
 Stiffness of resulting joint - When metal-to-metal contact of the patrix and matrix
restrict relative movement between the abutment and prosthesis during functional
loading of the removable partial denture, the attachment is said to be rigid. On the other
hand,many attachments are designed to permit movement of the denture base during
functional loading.These attachments are considered resilient attachments. Functional
movement of the prosthesis may be restricted to a defined vertical, horizontal, and/or
rotational path or omnidirectional displacement of the prosthesis may be permitted.
 Geometric form Another method of classification is based upon the overall geometric
configuration and design of the attachment system. A wide variety of designs have been
described in this classification method, including key and keyway, ball and socket, bar
and clip (Figs 21-13 and 21-14), bar and sleeve, telescope,hinge,push-
button,latch,interlock,and screw units.
 Advantages and Indications
 Consideration must be given to retention, support, stability, comfort, and esthetics when
designing a removable partial denture. In carefully selected patients, attachments may
offer some advantages. Clasp arm direct retainers placed on canine and premolar
abutments may be esthetically objectionable.The appropriate use of attachments may
eliminate the need for facial clasp arms while providing acceptable
retention,support,and stability to the prosthesis.The result is both improved esthetic
appearance and elevated psychological acceptance of the prosthesis.
 In general, the removable partial denture design philosophy discussed in this textbook
follows the principles of broad stress distribution. That is, stress on the abutments is
minimized by deriving optimal support from the edentulous ridges, developing
harmonious occlusion, providing adequately flexible direct retainers, and constructing a
rigid major connector. By following these concepts during prosthesis design, applied
functional loads may be distributed throughout the dental arch so that no one area
receives excessive stress.
 The most apparent disadvantages of attachment-retained removable partial dentures
are complexity of design, fabrication, and clinical treatment. Abutments must be
crowned in order to incorporate attachment components.
 Intracoronal and extracoronal attachments may be used in the treatment of partially
edentulous patients requiring removable partial dentures. However, the highly
specialized, and often complex,principles and procedures necessary to accomplish
such therapies must be carefully considered.
 Attachments are not a panacea.They are costly,complicated, and require periodic repair
and replacement.The practitioner and patient must be aware of the limitations and
potential problems associated with attachment-retained removable partial dentures and
be willing and able to accommodate these situations. However, by following sound
principles of treatment planning,clinical therapy,and laboratory construction,attachment-
based removable partial dentures can provide an excellent service for partially
edentulous patients.
 Summary
 Intracoronal and extracoronal attachments may be used in the treatment of partially
edentulous patients requiring removable partial dentures. However, the highly
specialized, and often complex,principles and procedures necessary to accomplish
such therapies must be carefully considered. The esthetic advantages of attachments
must be weighed against the difficulties associated with such restorations. Thorough
and insightful treatment planning,a sound knowledge base, practical experience, and
reliable technical support must be available in order to be successful with this
removable partial denture design approach. Attachments are not a panacea.They are
costly,complicated, and require periodic repair and replacement.The practitioner and
patient must be aware of the limitations and potential problems associated with
attachment-retained removable partial dentures and be willing and able to
accommodate these situations. However, by following sound principles of treatment
planning,clinical therapy,and laboratory construction,attachment-based removable
partial dentures can provide an excellent service for partially edentulous patients.