HIS IS A technique for a precision type, bilateral distal extension partial denture that affords a stress-breaking action.

The significant feature of this appliance is that the skeleton is a one-piece casting which includes the male portion of the attachment. This partial denture system was originated by Dr. E. Bruce Clark in 1938, and makes use of the ?ueurohr-Williams Rest Ko. 2. The Neurohr rest or shoe (Fig. 1J) is a thin gauge platinum box cJ]x!rl at the top and one side. There is a recess in the inner portion of the floor, and the side walls are tapered slightly from the top to the bottom. These shoes are soIdered into the abutment castings and are positioned with the aid of the r\Teurohr mandrel (Fig. l,I3). The completed lower denture (Fig. 2) will consist of a lingual bar, i-f, lingual clasps. B, the male portions of the attachments, C. and the saddle portion, I). Pressure at point E causes the denture saddle to depress slightly, rotating alr~rut fulcrum, F.

TECHNIQUE

Survey the study casts carefully to determine the most advantageous path of insertion, the amount of contour to be removed in the preparation of the abutment teeth, and the position of the boxes to be placed in the preparations. Prepare the teeth in the mouth and take one Or more impressions, as necessary, to obtain accurate working dies, and full jaw casts for articulation and for thfa establishment of mesial contact on the abutment castings. lm completing the wax-up of the abutment teeth (which should be threequarter or full crowns) it is necessary to develop the undercuts for the lingual clasp arms needed for retention. The clasp arm must not be in an undercut area. except at the tip end, and, in fact, should not contact the abutment casting at any other point. The wax-up must be contoured in such a way as to result in a. finished casting which meets this specification. At this time, a recess can be placed in the distal portion of the wax-up to accommodate the female portion of the attachment, which is to be soldered into place later. The wax-ups are now sprued and cast, and tried in the mouth. After the castings have been adjusted for mesial and occlusal contacts and marginal fit, a hydrocolloid impression is made over the castings in such a way as to insure meticulous detail of all supporting tissues.
Presented as a clinic before the Academy of Restorative Rereived for publication July 8, 1953. 87 Dentistry, Chicago, Ill., Fell. 4, lS5X

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Fig.

1.--A,

The

Neurohr-Williams

shoe No. 2 with

step.

B, The

corresponding

mandrel.

Fig. 2.- A unilateral view of the skeleton of a lower bilateral distal extension partial denture using the Neurohr shoe as a precision rest. A, Lingual bar. B, Clasp arm. C, Male po&on of the attachment which is cast as part of the skeleton. D, Saddle. E, Point of application of force for saddle movement.

SIMPLICITY

IN

DISTAL

EXTENSION

PART1 AI,

DENTURE

Fig. 3.-A lower cast on a surveyor showing abutment casting. A, Fulcrum line. B, Williams rohr-Williams mandrel holding shoe No. 2 with stem. G, Surveyor.

the positioning of the second shoe in tlte Parallelometer. D, Rubber band. E, Ncustep. F, Crossbar soldered to the mandrel

Labia\

Fig.

4.-Vertical bar

section in the lower incisor to the tissue. A, Lingual bar.

region showing B, Soft tissue.

the relationship C, Lower incisor.

of the lingual

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RYBECK

f anuary,

Pros.

Den. 1954

The castings are then removed from the mouth and dried. A thin layer of a separating material, such as whiting in the form of a paste, is placed inside the castings and then dried out over a low flame. The castings are now seated back into the hydrocolloid impression. Lowfusing metal is poured into the castings, and a small-sized screw eyelet is placed into the still molten metal in such a way that the screw portion is embedded in the metal and the ring portion extends above it. The stone, which is now poured into the remaining impression, will embed the eyelet and retain the metal die Then the cast containing the castings is placed in a secure and accurate position. on a surveyor in its originally surveyed position (Fig. 3). The fulcrum, A, is on an axis formed by a line between the two attachments so, whether the denture is symmetrical or not, we must make reference to this line when placing the attachments into the castings. A Williams Parallelometer, B, is now placed so that the main shaft is parallel to a line drawn between the two attachments, with the indicating prongs, C, pointing distally. This can be attached with wax or held in place by a rubber band, D. A Neurohr shoe is placed on one Neurohr Mandrel, E, (which contains a guiding rod, F, soldered on its shaft so positioned as to be parallel to the sidewalls The mandrel is now placed on the surveyor, G, and the of the attachment). shoe is seated in such a way as to be as close as possible to the center of the tooth, and so the guide rod on the mandrel is lined up with the prongs on the parallelometer. The shoe is waxed into place, and the surveyor is removed from the mandrel which remains in position in the shoe. Another mandrel, with a shoe attached, is similarly placed in the surveyor and into the other casting. After lining up the attachment by eye, a measuring gauge is used to check the distance between the ends of the guiding rods on the mandrel so as to accurately establish their parallelism. The second shoe is now waxed in place, and both mandrels may be withdrawn from the shoes. The castings are now removed from the surveyor and placed in a soldering investment along with the waxed-in shoes. After the wax has been eliminated, the shoes are soldered to the castings. The investment is removed, the excess portion of the shoes are cut off, and the castings are finished, at least to the rough polish stage. A sandpaper disk is used to make a slightly flattened surface which encircles the attachments on the distal portion of the casting. The castings are now placed back on the dies, and the necessary relief for duplication is placed on the cast. The lower cast is relieved in such a way that the top of the lingual bar, A, is in contact with the tissues, but from this point downward, increasing relief is incorporated depending upon the relation of the path of insertion to the slope and the thickness of the tissue beneath the lingual bar (Fig. 4). The cast is then duplicated. Care is taken to duplicate the female portion of the attachments and the castings accurately as well as the soft tissue surfaces. The pattern of the casting is waxed so all connectors are as rigid as is practical. The metal skeleton is cast and polished.

The castings are placed into the teeth anti, ii desired, can be cemented M this tiilie. Over the saddle portion of the skeleton, a shellac baseplate is adaptcti and tightly secured. The baseplate must cover all the supporting tissue; ;3j the saddle.

Fig.

5.-Occlusal

views

of the completed

upper

and lower

tienture$

An easy-flowing zinc-oxide paste is placed on the tissue surface of the shellac baseplate attached to the casting, and the metal casting is seated in place in the mouth. Pressure is applied in seating only on the attachment portion of the skeleton, and not on either the palatal or lingual bar, or on the saddles. When a mucostatic impression has been obtained, an occlusion rim of modeling compound is built on the baseplate in such a way that it occludes with the opposing cusp tips. The occlusal surface of the occlusion rim is now seared to a very fluid consistency. The skeleton is immediately replaced in the mouth, and a hinge position closure is made that registers depressions of l.he opposing cusps. KOW, depending upon the type of mounting used, checkbites of wax or any satisfactory material are made. A hydrocolloid impression is then made over the compound oc--inclusion rims and the skeleton. The impression is removed, and the SkektcJn--

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J. Pros. January,

Den. 1954

eluding the occlusion rims-is seated in it. A stone cast is poured and separated. These procedures have produced a cast which includes the skeleton and occlusion rims. The casts are mounted on an articulator and the missing teeth are waxed into place and the denture is processed. An example of the completed restorations is shown in Fig. 5.
CONCLUSION

Several features in the construction of this partial denture appliance should be re-emphasized. The sidewalls of the attachments must be parallel with each other, and at the same time be perpendicular to the axis of rotation. This is represented by the fulcrum line drawn between the two attachments. The design and placement of the lingual clasp arm must be such that the body of the clasp is above the undercut, and the tip end of the clasp is dropped into the mesiolingual undercut that has been created. The clasp arm should contact the abutment casting only at the ends, and then only passively, except when the denture is in function.
303
LACONIA BLDG. WHEELING,

W.

VA.