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Although added preparations and skill are required to provide precision attachment removable partial dentures, more favorable esthetics and load distribution may outweigh the disadvantages. Basic design principles, categories (intracoronal, extracoronal, stud, bar and plunger) and selection of precision attachments are reviewed.
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Patients provided with 53 distal extension-base removable partial dentures retained using rigid intracoronal slide attachments were followed up to 25 years. The initial treatment consisted of fixed partial dentures involving all remaining teeth in the treated arches and removable partial dentures having a cast cobalt-chromium framework. The removable dentures showed few complications and little need for relining. The failures primarily involved the fixed partial dentures. Seven arches required complete dentures as a result of technical complications in five patients. Cement failures, root fractures, and fractures of the fixed prostheses were most problematic. The survival rate was about 65% up to 15 years, and a survival time of 50% was extrapolated to 20 years.
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Limited space for extracoronal attachments is a serious complication in the design and fabrication of a precision attachment removable partial denture. A custom metal-ceramic housing joined to the partial framework with laser welding offers strength and improved esthetics while requiring minimal space. This article presents the technical aspects of custom housing construction.
A technique has been outlined for construction of a metal base precision attachment. The technique emphasizes the need for an accurate impression of the edentulous ridge and construction of a metal base. The metal base is related intraorally to the abutment restorations and fixed via a strut with autopolymerizing acrylic resin. When the relationship has been determined the replacement dentition is added to the base.
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