Precision Attachment Case Restoration With Implant Abutments: A Review With Case Reports
Passively retained precision attachment partial dentures have been used successfully on natural tooth abutments since the 1920s. However, the dental profession has not advocated their use with implant abutments. When used in the passive manner that has proven successful on natural tooth abutments, precision attachment cases on implant abutments can be an excellent treatment option. This type of case has been used successfully for more than 17 years and offers tremendous advantages over the conventional overdenture approach to removal restorations on implant abutments.Abstract
In his 1982 article in The New York State Dental Journal, “Diagnosing and Prescribing Therapeutic Attachment-Retained Partial Dentures,” Dr Elliot Feinberg presents this case with questionable teeth that was originally made in 1975. This patient is still wearing this case after 35 years, and the questionable posterior abutments are still there! It is not likely that the upper left molar would have survived 35 years with fixed bridgework. Full-mouth X rays taken (Figure 8 shows 28-year X rays taken in 2003) over 3 decades reveal very little change in the periodontal bone. The precision attachment components have not been altered or replaced in 28 years.
The double tilt. Dual path. Anteroposterior tilt 10°–15°. Lateral tilt 10°–15°. Elimination of all locking mechanisms. Free movement of the attachment.
Case I: lower implant attachment case. Figure 4. Three implants with screw-retained abutments were placed in the anterior region of the mandible in 1995. The wax-ups are surveyed to create the double-tilt path of insertion for the boxes that will house the female attachments. Figure 5. The finished case, 1996. Figure 6. Thirteen-year X rays (2009).
Case II: upper precision attachment case. Figure 7. The denture was duplicated using the Lang Denture Duplicator and alginate to create a stent out of clear acrylic to guide implant placement. Figure 8. Three implants were placed and fitted with angled abutments. Figures 9–10. The finished case. The teeth appear longer than the original attachment case because of resorption and remodeling of the bone after the extractions. The vertical dimension has not been altered, and the patient shows the same length of the anterior teeth when she smiles as she did with her denture. Figure 11. Nine-year X rays (2009).
Case III: salvaging a fixed bridgework case with precision attachments; connecting natural teeth and implants with precision attachments. Figures 12–13. This case was made with 4 male-female attachments that connect natural teeth with implants. When the partial is in place, no one can tell she has removable bridgework. Figure 14. Five-year X rays (2009). Figure 15. The implant overdenture vs the implant precision attachment case. (a) Implants were used to retain a full denture. (b) Implants were used to create fixed bridgework in the front and a precision attachment partial denture in the back.
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