In the past, restoration of implant crown, ready-made abutment produced by implant manufacturer could only be used. Using straight, angled abutment, there was a limit in adaptation multiple implants. Recently, with the development of implant and CAD/CAM technology, CAD/CAM customized abutment use has become possible which is different from the past when restoration was possible with only prefabricated abutment. Not only it makes emergence profile possible which is similar to natural teeth, but also it makes insertion path possible on CAD in multiple implant restorations. However, on anterior teeth which dental esthetics is very important, another restorations which are formed with natural colored gingiva area could be required. Titanium-based zirconia prostheses which have titanium connection and zirconia structure from 1mm above fixture platform are alternative. Therefore, the purpose of this review is to analyze the characteristics, advantages and disadvantages of the abutment which is used in multiple implant restorations, and to choose right abutment when clinical trials.
Patients who underwent resection of maxilla due to benign or malignant tumor, or accident will have defect in palatal area. They get retention, support and stability from remaining tissues which are hardly optimal. The advantage of swing-lock attachment design is having multiple contacts on labial and lingual side of the abutment teeth by retentive strut and palatal bracing component. Because the force is distributed equally to abutment teeth, abutment teeth of poor prognosis can be benefited from it. It is also more advantageous to cover soft tissue defects which are hard to reach with conventional prosthesis. A 56-year-old female patient who had undergone a maxillectomy due to malignant melanoma complaining of loose and unstable surgical obturator. Surveyed crowns were placed on #12, 26, and 27. Teeth #11, 21, 22, and 23 had lingual rest seat and #24 had mesial rest seat to improve stability and support of the obturator. This clinical report presents the prosthetic management of a patient treated with obturator on the maxilla using swing-lock attachment to the remaining teeth.
This study was to analyze the displacement and the magnitude and mode of distribution of the stresses in the lower overdenture, the mucous membrane, the abutment teeth and the mandibular supporting bone when various abutment designs were subjected to different loading schemes. For this study, the two-dimensional finite element method was used. The models of overdenture and mandibe with the canine and the second premolar remaining, were fabricated. In the first design, a 1 mm space was prepared between the denture and the dome abutment with the height of 2 mm(OS). In the second design, a contact between the denture and the occlusal third of the dome abutment with the hight of 2 mm was prepared(OC). In the third design, a 0.5 mm space was prepared between the denture and 8 degree tapered cylindrical abutments with the height of 7 mm(TS). In the fourth design, a contact between the denture and the occlusal two thirds of the conical abutments with the height of 7 mm was prepared(TC). In order to represent the same physiological condition as the fixed areas of the mandible under loading schemes, the eight nodes which lie at the mandibular angle, the coronoid process and the mandibular condyle were assumed to be fixed. Each model was loaded with a magnitude of 10 Kgs on the first molar region (P1) and 7 Kgs on the central incisor region (P2) in a vertical direction. The force of 10 Kgs was then applied distributively from the first premolar to the second molar of each motel in a vertical direction (P3). The results were as follows: 1. The vertical load on the central incisor region(P2) produced the higher displacement and stress concentration than that on the posterior region(P1, P3). 2. The case of space between abutment and denture base produced higher displacement than that of contact, and the case of long abutment produced higher displacement than that of short abutment because of low rigidity of denture base. 3. The magnitude of the torque and vertical force to the abutment teeth and the stress distribution to the denture base was higher in the telescope coping than in the overdenture coping. 4. The vertical load on the central incisor region(P2) produced higher equivalent stress in the mandible than that on the posterior region(P1, P3). 5. The case of space between abutment and denture base produced better stress distribution to the farther abutment from the loading point than that of contact. 6. In case of sound abutment teeth, the type of telescope coping can be used, hilt in case of weak abutment, the type of overdenture coping is considered to be favorable generally.
Distal-extension removable partial dentures have long been implicated in the increase in mobility and the destruction of the supporting structures of the primary abutment teeth. Various clasping systems have traditionally been used to retain distal extension removable partial dentures, and other designs have been proposed to minimize torquing forces on the abutment teeth. Most recent studies investigating the effects of removable partial dentures on abutment teeth have been performed in it laboratory setting. Results obtained from in vitro research have given dentists insight into removable partial denture design, but laboratory test model cannot be constructed that simulates actual functional or parafunctiona1 movements and forces. The purpose of this study was to clinically evaluate the degree of tooth mobility produced by two clasping systems (suprabulge type and infrabulge type) used for distal extension removable partial dentures. Akers clasp and R.P.I. system were selected for the evaluation, and four patients required a distal extension removable partial denture on the mandibular arch were selected for participation in the study. Two partial dentures were constructed in the same condition expect the design of clasp. All abutments in the study were mandibular first or second premolars. Measurements of mobility were made with a research tool designed by $M\"{u}hlemann$. This instrument, periodontometer, measures tooth mobility in the mouth by means of a dial gauge accurated to 0.01mm when the tooth is stressed with a force meter. Lingual and buccal deflection of abutment tooth was measured using buccal and lingual pressure. The amount of force applied was 500gm. Tooth mobility tests were made at four key stages; 1. Before insertion of the first removable partial denture, baseline mobility was establsihed. 2. After wearing of the first prosthesis, measurement was made at weekly intervals for 4 weeks. 3. The removable partial denture was then taken from the patient, and tooth mobility was measured again at weekly intervals until the patient's established baseline mobility had returned. 4. The second prosthesis of different clasp design was worn for a month and evaluated in the same manner as the first. The sequence of placement of clasping system was alternated between patients. The following results were obtained from this study; 1. The mobility of abutment tooth increased during the initial stage of wear and returned to baseline mobility after removal of removable partial dentures. 2. The mobility of abutment tooth showed no difference between Akers clasp and I-bar clasp during the 4-week test period. 3. All teeth tested showed greater mobility toward the buccal than the lingual direction.
The purpose of this study was to analyze the magnitude and distribution of stress using a photoelastic model from a unilateral distal extention removable partial dentures with five kinds of the direct retainers, that is, the bilaterally designed bar clasp of the cross-arch lingual bar and the unilaterally designed bar clasp, circumferential clasp, mini-Dalbo attachment, and telescope retainer. A photoelastic model for mandible was made of the epoxy resin(PL-1) and hardner (PLH-1) with the acrylic resin teeth used and was coated with plastic cement-1 at the lingual surface of the model, and then five kinds of removable partial dentures were set, A unilateral vertical load of about 16Kg was applied on the first molar and the stress pattern of the photoelastic model under each condition was analyzed by the reflective circular polariscope. The following results were obtained: 1. The conventional removable partial denture with the bilaterally cross arch lingual bar produced the most favorable stress distribution on the residual ridge and supporting structure of abutment teeth than the unilaterally designed removable partial dentures. 2. The unilaterally designed removable partial denture with the bar clasp produced the stress distribution on the residual ridge, except sligtly higher stress concentration on the supporting structure of the abutment teeth, similar to the conventional removable partial denture with the bilaterally designed cross arch lingual bar. 3. On the unilaterally designed removable partial dentures, the bar clasp produced greater stress distribution on the residual ridge and supporting structure of the abutment teeth than the circumferential clasp. 4. On the unilaterally designed removable partial dentures, the mimi-Dalbo attachment produced relatively higher stress concentration on the residual ridge, but produced lesser stress concentration on the supporting structure of the abutment teeth than the other direct retainers. 5. On the unilaterally designed removable partial dentures, the telescope retainer produced uniform stress distribution on the residual ridge, but produced higher stress concentration at the root apex of the terminal abutment tooth than the other direct retainers. 6. On the unilaterally designed removable partial dentures the circumferential clasp and telescope retainer produced slightly higher stress concentration on the residual ridge and supporting structure of the abutment teeth than the bar clasp and mini- Dalbo attachment.
Statement of problem: In distal extension removable partial denture, the preservation of health of abutment teeth are very important, but they are always subjected to unfavorable stress. Purpose: The purpose of this study was performed to investigate the effects of abutment splinting and design of direct retainer on the stress distribution of abutments in unilateral distal extension removable partial dentures. Material and method: Abutments were splinted by different method. In group 1, autment teeth were not splinted, in group 2, canine and 1st premolar were splinted, and in group 3, canine, 1st and 2nd premolars were all splinted. Three different types of direct retainer such as Akers clasp, RPI clasp, and wrought wire clasp were designed. Strain was measured with Switch & Balance Unit(SB-10, Measurement Group Instruments Division, Raleigh USA) and Strain Indicator(P-3500, Measurement Group Instruments Division, Raleigh, USA) 15kg of vertical and oblique loads was applied at central fossa of missing 2nd molar area. Results : The strain on lingual side of 2nd premolar was the greatest, and abutment splinting induced decrease of strain on buccolingual side of 2nd premolar. The strain of loaded area was decreased by abutment splinting and there was no statistical difference of strain between Group2 and Group 3, and strain on 2nd premolar in wrought wire clasp was the least. Conclusion: Within the limitations of this study, splinting of two distal abutment teeth is enough for stress distribution widely, and wrought wire clasp was more benefitable than others.
Journal of Dental Rehabilitation and Applied Science
/
v.30
no.1
/
pp.45-52
/
2014
Diagnosis and treatment planning is initial step to fabricate removable partial denture, and one of most important factor influencing the prognosis. Partial edentulous patients have various condition of remaining teeth and oral mucosa. Therefore, for the proper diagnosis and treatment planning for each patient, getting many informations from patients during initial examination and fabricating accurate diagnostic cast are required. Especially, because the use of various diagnostic tools and surveying of diagnostic cast will be a guide for the abutment teeth selection, oral preparation and design of partial denture, dentist should understand and be able to apply this procedure during diagnosis.
Lower right first and second molar missings were restored by unilaterally designed removable partial denture, not to disturb the phonetic function. Terminal abutment teeth were splinted and ASC52 attachment aws used as a direct retainer. After that, oral examination and Roentgenographic examination were done periodically for 2 years. There were no remarkable changes on the abutment teeth and its surrounding structures. Also, there no phonetic disturbances by the appliance.
PURPOSE. This study aimed to evaluate the accuracy of digitizing dental impressions of abutment teeth using a white light scanner and to compare the findings among teeth types. MATERIALS AND METHODS. To assess precision, impressions of the canine, premolar, and molar prepared to receive all-ceramic crowns were repeatedly scanned to obtain five sets of 3-D data (STL files). Point clouds were compared and error sizes were measured (n=10 per type). Next, to evaluate trueness, impressions of teeth were rotated by $10^{\circ}-20^{\circ}$ and scanned. The obtained data were compared with the first set of data for precision assessment, and the error sizes were measured (n=5 per type). The Kruskal-Wallis test was performed to evaluate precision and trueness among three teeth types, and post-hoc comparisons were performed using the Mann-Whitney U test with Bonferroni correction (${\alpha}=.05$). RESULTS. Precision discrepancies for the canine, premolar, and molar were $3.7{\mu}m$, $3.2{\mu}m$, and $7.3{\mu}m$, respectively, indicating the poorest precision for the molar (P<.001). Trueness discrepancies for teeth types were $6.2{\mu}m$, $11.2{\mu}m$, and $21.8{\mu}m$, respectively, indicating the poorest trueness for the molar (P=.007). CONCLUSION. In respect to accuracy the molar showed the largest discrepancies compared with the canine and premolar. Digitizing of dental impressions of abutment teeth using a white light scanner was assessed to be a highly accurate method and provided discrepancy values in a clinically acceptable range. Further study is needed to improve digitizing performance of white light scanning in axial wall.
PURPOSE. We assessed the repeatability and reproducibility of abutment teeth dental impressions, digitized with a blue light scanner, by comparing the discrepancies in repeatability and reproducibility values for different types of abutment teeth. MATERIALS AND METHODS. To evaluate repeatability, impressions of the canine, first premolar, and first molar, prepared for ceramic crowns, were repeatedly scanned to acquire 5 sets of 3-dimensional data via stereolithography (STL) files. Point clouds were compared and the error sizes were measured (n=10, per type). To evaluate reproducibility, the impressions were rotated by $10-20^{\circ}$ on the table and scanned. These data were compared to the first STL data and the error sizes were measured (n=5, per type). One-way analysis of variance was used to assess the repeatability and reproducibility of the 3 types of teeth, and Tukey honest significant differences (HSD) multiple comparison test was used for post hoc comparisons (${\alpha}=.05$). RESULTS. The differences with regard to repeatability were 4.5, 2.7, and $3.1{\mu}m$ for the canine, premolar, and molar, indicating the poorest repeatability for the canine (P<.001). For reproducibility, the differences were 6.6, 5.8, and $11.0{\mu}m$ indicating the poorest reproducibility for the molar (P=.007). CONCLUSION. Our results indicated that impressions of individual abutment teeth, digitized with a blue light scanner, had good repeatability and reproducibility.
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