Year : 2021 Month : April Volume : 10 Issue : 17 Page : 1265-1268

A Distinct Parallel Attachment System for the Rehabilitation of Kennedy s Class 2 Partially Edentulous Arch - A Case Report

Meekha Peter1, Mahantesh Bembalagi2, Hema Kanathila3

1, 2, 3 Department of Prosthodontics, KAHER S KLE VK Institute of Dental Sciences, Belgaum, Karnataka, India.

CORRESPONDING AUTHOR

Dr. Meekha Peter, KAHER S KLE V K Institute of Dental Sciences, Belgaum, Karnataka, India.
Email : meekhapeter@gmail.com

INTRODUCTION

Among the numerous techniques of oral rehabilitation, precision attachments are considered as a good treatment option in removable (RPD) as well as fixed partial dentures (FPD). Precision attachments enhance patient’s self-confidence and self-image as they help in facilitating aesthetic, functional and retentive replacement of teeth that are missing in the oral cavity. They can improve the aesthetics by eliminating the clasp assembly in cast partial dentures (CPD). This particular case report explains the treatment sequence and approach for the utilisation of attachments in a Kennedy Class 2 situation.

A successful removable partial denture includes a precise diagnosis with meticulous treatment planning. However, re-establishment of partially edentulous arch is particularly challenging in distal extension situations classified as Kennedy’s class 1 or 2 conditions.1 In such clinical cases, where a fixed prosthesis cannot be fabricated, a prosthodontist often suggests an implant retained prosthesis that is not routinely possible because of the insufficient available bone width and height.2 Thus to ensure functional and aesthetic substitution of lost teeth, an attachment secured RPD can be considered as a good treatment option in such cases.

Attachments are constructed in a ready to place form (pre-fabricated) known as precision attachments. Another one is semi precision attachment where the segments have to be constructed by dentists or dental technicians because it requires casting for incorporating into fixed unit of restoration.3 Hence precision attachments are considered as possible alternatives when patients demand for a fixed restoration in distal extension cases.

Various extra coronal attachments are available and used in distal extension cases. Preci-Sagix is considered as an ideal extra coronal attachment for removable partial dentures and also in over denture cases. It is accessible in two sizes, 1.7 mm mini or 2.2 mm standard and is selected according to the permitted space. The male component is available in three varieties, a plastic castable pattern (any hard alloy), cast to no prax (only non-precious alloy) and a threaded male and base ring (2.2 mm size only).4 These attachments produce vertical, horizontal and rotational movements during its function which supports the prosthesis by transferring harmful forces from the abutments to the supporting structures by its passive movement, which helps in the rehabilitation of distal extension cases.5

This case report explains restoration of partially edentulous arch by incorporating a Preci Sagix attachment in mandibular cast partial denture retained by a six-unit FPD and a maxillary conventional cast partial denture.

PRESENTATION OF CASE

A 56-year-old female patient reported to the Department of Prosthodontics (KAHER’S KLE VK Institute of Dental Sciences, Belgaum, Karnataka) with a chief complaint of missing teeth in right and left lower posterior region of the jaw. Patient complained of difficulty in eating food properly due to compromised chewing efficiency, thus patient was demanding a fixed prosthesis. Patient’s medical history was evaluated and was found to be irrelevant.

On examination, patient presented with a collapsed bite (Figure 1) and the missing teeth were 13, 15, 16, 23, 24, 26, 34, 35, 36, 37, 44, 45, 46 (Figure 2 and 3). Remaining existing teeth in the patient’s oral cavity were periodontally stable. Hence, to replace the lost teeth a semi-fixed prosthesis was considered which included splinted lower anterior crowns combined with an extra coronal attachment and a cast partial framework.

 

 

 

 

 

 Clinical Procedures

Treatment was commenced by making diagnostic impressions of maxillo-mandibular arches with alginate (Tropicalgin, Zhermack, Italy). Following which a tentative jaw relation was recorded and transferred to the semi adjustable articulator (Hanau Wide-Vue) using the face bow as an adjunct. Subsequently diagnostic wax up was done wherein the vertical dimension of occlusion was increased by 2 mm in the articulator in order to regain patient’s lost vertical dimension and a provisional removable prosthesis was provided to the patient to get accustomed to the new vertical dimension. Preci-sagix attachment system was decided depending upon the available space. Tooth preparation was performed with lower anteriors after intentional root canal treatment, i.e., 31, 32, 33, 41, 42, 43 to receive porcelain-fused-to-metal crowns and a rest seat was prepared in 47 mesially. Final impressions were made after adequate gingival retraction was achieved. Provisional prosthesis (Temp‑Bond, Kerr Corporation, Romulus) was fabricated in accordance with the diagnostic wax up and luted with temporary cement.

 


Laboratory Procedures

The final impressions were poured in die stone and wax patterns were made to full contour. Thereafter a box was created in the wax up to house matrices of extra coronal attachment to axial surfaces of the abutment using a surveyor, which ensures that bulk of matrices does not interfere with aesthetics of restoring denture tooth (i.e., 43 & 33) (Figure 4).

DISCUSSION OF MANAGEMENT

Treatment Procedure

Proposed treatment plan for the patient was a combined prosthesis with an extra coronal precision attachment for mandibular unilateral distal extension arch and cast partial denture for maxillary arch.

 

Clinical Procedures

Treatment was commenced by making diagnostic impressions of maxillo-mandibular arches with alginate (Tropicalgin, Zhermack, Italy). Following which a tentative jaw relation was recorded and transferred to the semi adjustable articulator (Hanau Wide-Vue) using the face bow as an adjunct. Subsequently diagnostic wax up was done wherein the vertical dimension of occlusion was increased by 2 mm in the articulator in order to regain patient’s lost vertical dimension and a provisional removable prosthesis was provided to the patient to get accustomed to the new vertical dimension. Preci-sagix attachment system was decided depending upon the available space. Tooth preparation was performed with lower anteriors after intentional root canal treatment, i.e., 31, 32, 33, 41, 42, 43 to receive porcelain-fused-to-metal crowns and a rest seat was prepared in 47 mesially. Final impressions were made after adequate gingival retraction was achieved. Provisional prosthesis (Temp‑Bond, Kerr Corporation, Romulus) was fabricated in accordance with the diagnostic wax up and luted with temporary cement.

 

 

Laboratory Procedures

The final impressions were poured in die stone and wax patterns were made to full contour. Thereafter a box was created in the wax up to house matrices of extra coronal attachment to axial surfaces of the abutment using a surveyor, which ensures that bulk of matrices does not interfere with aesthetics of restoring denture tooth (i.e., 43 & 33) (Figure 4).