Using Attachments in Dental Treatment Planning

By George Bambara, DMD, MS, FACD, FICD

Before I discuss how using dental attachments allowed me to enhance my treatment planning skills, I would like to give credit to one of my dental school professors who recently passed away, Dr William Cinotti; a man and a friend who knew no boundaries and who contributed greatly to my professional development.

Using attachments in dental treatment planning simply requires a knowledge of how attachments are designed to allow the prostheses to move in certain directions, if not all directions. Using attachments does not change how we fabricate our crown and bridge, partial dentures, overdenture and segmented fixed bridgework. We continue to follow all the steps that lead us to creating a successful prosthesis except that attachments are used in the process.

Attachments are rigid or resilient connectors that redirect the forces of occlusion. By being rigid, occlusal forces can be redirected to tooth or implant bearing areas and away from maxillary or mandibular ridges as in the case of partial dentures or overdentures. By using resilient attachments, those same occlusal forces can be redirected to the maxillaiary or mandibular ridges for support since the tooth or implant bearing areas may not be suitable to bear most of the chewing forces.

Segmenting fixed bridges simply means to fabricate a long span fixed bridge into two or more components utilizing a rigid or resilient attachment between the segments. Using attachments in this fashion creates shorter spanning bridgework that is easier to cast and seat while creating a rigid or resilient unit. A resilient unit acts as a stress releaser or stress breaker, depending on the attachment used while a rigid unit can function exactly as a cast fixed bridge with the ability for easier retrieval.

When using attachments, the first things that must be considered is how this newly designed prosthesis will function. Will it be rigid or resilient? Will it be tooth or implant supported or tissue supported? Evaluation of the remaining teeth or implants in terms of number, position and periodontal condition has to considered to determine exactly how much load the teeth, implants or ridges can bear. We need to determine our philosophy on loading teeth, implants and tissue and examine carefully what is on the opposite arch. Then, select the attachment that will suit our treatment planning purposes. Maxillary arches are usually bound down areas with much surface area and firm supportive areas  Here, in many cases, rigid attachments can be used. The mandible, which has less surface area and less supportive areas can benefit from either rigid or resilient attachments depending on the type of prosthesis designed as well as the existing or planned prosthesis for the opposing arch integration.

In consideration of all these factors, attachment dentistry can provide the opportunity to create long lasting prostheses and many happy and satisfied patients.

 

DrGeorgeEBambara-863kbDr. Bambara is on faculty at the Rutgers School of Dental Medicine and holds Fellowships in the American College of Dentists, the International College of Dentists, and the International Academy of Dento-Facial Esthetics. He is an Adjunct Assistant Professor at the College of Staten Island and lectures nationally and internationally on attachment prosthetics.  He has been selected as one of Dentistry Today’s Leaders in Continuing Education for the past seven years. Dr Bambara has published articles on attachment dentistry and has authored a chapter on Precision and Semi-Precision Attachments in the recently published textbook Contemporary Esthetic Dentistry.

 

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