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Photoelastic analysis of stress patterns on teeth

and bone with attachment retainers for


removable partial dentures
F. James Kratochvil,
University
of California,
Long Beach, Calif.

D.D.S.,*

Wayne D. Thompson,

School of Dentistry,

Los Angeles,

D. D.S.,**
Calif.,

and Angelo A. Caputo, Ph.D. ***

and Veterans

Administration

Medical

q A
fm#
q IC

he two basic types of direct retainers


used for
extension removable partial dentures are the extracoronal and the intracoronal. The most commonly
used extracoronal
retainer designs have been
reported in previous articles.2. 3 The purpose of this
study was to evaluate attachment retainers. Photoelastic analysis was used to compare forces resulting
on supporting structures by three commonly used
attachment retainers based on different design principles.
LITERATURE

REVIEW

Descriptions and discussions of attachment retainers have been reported in the literature by many.*-*I
Chayes12devised the first internal attachment. It was
basically the same as attachments currently manufactured, such as Stemgold (APM-Stemgold,
San
Mateo, Calif.), McCollum (APM-Stemgold), Ney (J.
M. Ney Co., Bloomfield, Conn.), and Baker (Engelhard Industries, Baker Dental Division, Newark,
NJ.).*-. 13.* In this study, the Stemgold type 7
precision attachment was tested.
Another design is a European concept developed
by Hans Dalla Bona in Switzerland, and n&keted
as the Dalbo attachment (APM-Stemgold).. lo. I. I5
It has been described and classified as an extracoronal stressbreaker by Mensor15 and others.O
Thompson*B described an attachment retainer
which is intracoronal, semiprecision, and has been
Read hefore the Pacific Coast Society of Prosthodontists, Orcas
Island, Wash.
*Professor and Director of Postgraduate Prosthodontics, University of California, School of Dentistry, Los Angeks, Calif.
**Chief, Restorative Section, Veterans Administration
Medical
Center, Long Beach, CaIif.
***Professor and Chairman, Biomaterials Science Section, University of California, School of Dentistry, Los Angeles, Calif.

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Center,

Fig. 1. Plastics used to form test model were type A,


photoelastic plastic for entire tooth; type B, photoelastic
plastic for periodontal ligament; and type C, photoelastic
elastic for bone.

---

Fig. 2. Stemgold attachment


slide attachment.

type

7 is basic H-shaped

described in the literature by many authors.-**


Koper2* stated, The versatility of design, combined
with retention, stressbreaking features, and an effective method of indirect retention make this semiprecision retainer the one of choice for mesial- and

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KRATOCHVIL.

Fig. 3. Dalbo MK attachment showing cross-section of


adjustable female housing (with retention for resin), with
steel coil spring which rests on ball portion of male
attachment.

Fig. 4. Dalbo MK attachment with male portion


dered to distal abutment crown.

sol-

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CAPUTO

Fig. 6. Relation to fulcrum line of receptacle and retention dimple of Thompson dowel. A, Distal view. B,
Occlusal view.

Fig. 7. Bilateral lingual retention dimples of Thompson


dowel are in line with rotation axis established by rest
shelf.

MATERIAL

distal-extension
removable partial dentures. Many
authors through the years have suggested splinting
two abutments for each extension base.8. y. 23 Dykeis used to
ma et a1.24 wrote, . . . if an attachment
retain a partial denture with a free-end extension
base (Class I or II), fixed splinting of the abutment

AND

Fulcrum Line
-__________________________________

teeth is even more important


partial dentures. . .

Fig. 3. Axis of rotation of Thompson dowel attachment


used in study.

THOMPSON,

than for clasp retained

AND METHODS

A photoelastic model of a mandibular


cast was
fabricated to record and study the forces transmitted
to supporting
structures by three types of attachments used with distal-extension
removable partial
dentures. The mandibular
model included the six
anterior teeth and the first premolar
on each side.
Fabrication
of the model duplicated
the procedures
used in previous projects which evaluated extracoronal types of removable
partial dentures.*. 3 The
teeth, including the roots, were formed with one type
of plastic, type A (PLM-lZ,
Photolastic, Inc., Malvern, Penn.). Periodontal
ligaments were formed by
coating the root surfaces with a second plastic, type
B (Solithane,
Thiokol
Chemical
Corp., Trenton,
N.J.). The remainder of the model, which simulates
bone, was of a third plastic, type C (PL-2, Photolas-

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PHOTOELASTIC

ANALYSIS

OF STRESS PATTERNS

Fig. 8. Occlusal view of Dalbo MK attachment with load


bar in position for testing and gold crowns secured to
abutment teeth with threaded screws.
tic, Inc.) (Fig. 1). The teeth, roots, and tissue
contours of the model were of average size and shape.
The periodontal
ligament was formed to an approximate 0.2 mm thickness..
The coronal portions of both canines and premolars were prepared for complete crowns. The three
attachment
designs tested were the (1) Sterngold
type 7, (2) Dalbo MK, and (3) Thompson
dowel.
Each type tested was attached to the first premolars
bilaterally.
The premolars and the canines were then
splinted
by soldering
and the series of tests
repeated.

Design I-Sterngold

MK attachment (Fig. 3)

Complete gold crowns were waxed and cast for the


first premolars.
The Dalbo attachments
were soldered to the distal portion of the crowns according to
the manufacturers
recommendations
(Fig. 4). A
gold framework
was cast to join the denture bases
bilaterally.
The female portions of the Dalbo attachments were secured with acrylic resin (Duralay,

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FIBER OPTIC LIGHT SOURCE

POLARIZATION

QUARTER

A
M

ANALYZER

WAVE PLATE - CIRCULAR

POLARIZED

LIGHT

- PGLARUER

MODEL - BIREFRINGENT

PLASTIC

Fig. 9. Schematic drawing illustrating


lens, and camera utilized in testing.

position of light,

type i attachment (Fig. 2)

Complete gold crowns were fabricated on the first


premolars with the female portions of the attachments positioned parallel to each other and to the
distal aspect of the abutment
teeth. A gold framework was constructed to which the male portions of
the attachments
were soldered.O The crowns were
finished so that they fitted passively on the prepared
abutment
teeth. The removable
partial
denture
attachments
were adjusted
until they could be
placed and removed smoothly.

Design 2-Dalbo

OF PROSTHETIC

DENTISTRY

Fig. 10. Test apparatus with photoelastic


attachment in position for testing.

model and

Reliance Dental Mfg. Co., Worth, Ill.) to the denture


base in proper relationship
to the male attachments
as recommended
by the manufacturer.

Design 3-Thompson

dowel attachment (Fig. 5)

During fabrication of the complete gold crowns on


the premolar abutment teeth, the receptacle portion
was formed as shown in Fig. 6. Dimples for retentive
retainers were placed into the lingual areas directly
in line with the rotation axis established by the rest
seat floorP (Fig. 7). The removable partial denture

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KRATOCHVIL,

THOMPSON,

AND

CAPUTO

2A

IA

4A

%A

511
Fig. Ilk
Photoelastic stress distribution
with single abutment.
Fig. 1ZA. Photoeleastic stress distribution
with abutments splinted.
Fig. 13A. Photoelastic stress distribution
single abutment.
Fig. 14A. Photoelastic stress distribution
abutments splinted.
Fig. 15A. Photoelastic stress distribution
with single abutment.
Fig. 16A. Photoelastic stress distribution
with abutments splinted.

24

resulting from tests of Sterngold attachment type 7


resulting from tests of Sterngold attachment type 7
resulting from tests of Dalbo MK attachment with
resulting from tests of Dalbo MK attachment with
resulting from tests of Thompson dowel attachment
resulting from tests of Thompson dowel attachment

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PHOTOELASTIC ANALYSIS OF STRESS PATTERNS

.. ...... .... . .. . .._._.................

... .. ...__....._....._._............ .J

118

12B

.......... .

..........................

%..........

....................................
............................................

148

......... i

.......................................

...........................................

15B
Fig. 1lB. Diagrammatic
with single abutment.
Fig. 12B. Diagrammatic
with abutments splinted.
Fig 136. Diagrammatic
single abutment,
Fig. 14B. Diagrammatic
abutments splinted.
Fig. 13B. Diagrammatic
with single abutment.
Fig. 168. Diagrammatic
with abutments splinted.

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sketch of forces resulting from tests of Sterngold attachment type 7


sketch of forces resulting from tests of Sterngold attachment type 7
sketch of forces resulting from tests of Dalbo MK attachment with
sketch of forces resulting from tests of Dalbo MK attachment with
sketch of forces resulting from tests of Thompson dowel attachment
sketch of forces resulting from tests of Thompson dowel attachment

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KRATOCHVIL,

framework
receptacles
torquing.

was cast and adjusted to the abutment


allowing free rotation without binding or

Assembly procedures
The gold crowns were secured to their respective
abutment teeth with threaded screws (Fig. 8). This
arrangement
allowed for ease of placement
and
removal of the crowns when testing the three types of
removable
partial
denture
attachment
retainers,
while assuring fixation
comparable
to a crown
cemented in place clinically.
Acrylic resin denture
bases were attached to each prosthesis. A uniform
thickness of 2 mm silicone material
(Sir, Stern
Dental
Co., Mt. Vernon,
N.Y.) was positioned
between the denture base and the model. This
resilient silicone layer simulated oral mucosa.
A metal bar was positioned between the right and
left denture bases at the level of the occlusal plane in
the region of the mesial cusp of the first molars (Fig.
8). A matrix was used to duplicate the bar position
on all frameworks. The load was directed against the
center of this bar. The removable partial denture on
the photoelastic model was positioned in the center
of a straining frame. The frame could be turned to
present all parts of the model to a fixed camera (Fig.
9). A fiber optic light source was positioned at the
rotational center of the photoelastic model, in a fixed
relation to the camera. Results were recorded photographically.
The load cell was positioned over the
center of the bar between the right and left edentulous regions. A vertical
force of 33 pounds was
applied
and
monitored
by an XY recorder
(Fig. 10).
The first premolar abutments were then splinted
to the canines with solder to form a double abutment. The entire sequence of testing was repeated to
evaluate differences between single and double abutments.

RESULTS
Examination
of the model before and after the
placement of the removable partial denture frameworks on the photoelastic model revealed no significant stresses. Similar responses to the applied force
were observed on both sides of the arch. Therefore, to
simplify
data presentation,
only results from the
right side will be analyzed. To facilitate presentation
and interpretation
of the photoelastic data, schematic representations
of stress intensity were prepared.
Areas of darker shading represent higher stress. It is

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THOMPSON,

to be emphasized that these diagrams


actual isochromatic
fringe lines.

Design I-Sterngold

AND

CAPUTO

do not include

type 7 attachment

Single abutment (Fig. 11). The applied load


produced a pronounced
tendency to bend the premolar distally, as revealed by the pattern within the
root. Pressure was observed at the alveolar crest
distal to the premolar and progressed in an apical
direction along the distal aspect of the root. Apical
stresses developed in the structures supporting
the
premolar; interaction
of these stresses with the canine apex were noted.
Double abutment (Fig. 12). When the premolar
and canine were splinted, a substantial modification
of the response to the load was observed. The roots of
both the premolar
and canine were uniformly
stressed, indicating
that the direction of force was
along the vertical axis of the teeth. Some pressure
occurred at the alveolar crest distal to the premolar
and along the distal aspect of the root; this was of a
smaller magnitude when compared to the unsplinted
crowns. There was a reduction in apical stresses in
the premolar
region compared
to the unsplinted
crowns. An increase in apical stresses at the canine
was observed. The improvement
of the stress distribution over the unsplinted crowns was accompanied
by an increased sharing of the applied force with the
posterior edentulous region.
Design 2-Dalbo

MK attachment

Single abutment (Fig. 13). The stresses within the


premolar were uniform and of a low intensity. Some
pressure resulted at the distal crest of the premolar
and along its distal root. Low level stresses were
observed at the apex of the premolar, which interacted with the root of the canine.
Double abutment (Fig. 14). The stress within both
the premolar and canine was uniform and of a low
intensity when compared to the unsphnted crowns.
Reduced pressure was observed at the distal crest of
the premolar and along its distal root. Lower apical
stresses were observed in the premolar region, while
increased apical stresses occurred at the canine.
More force transfer to the edentulous region was
observed than with the unsplinted crowns.
Design d--Thompson

dowel attachment

Single abutment (Fig. 15). Evidence of distal


bending of the premolar was present. Considerable
pressure was observed at the alveolar crest distal to

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PHOTOELASTIC ANALYSIS OF STRESS PATTERNS

the premolar and along the distal aspect of the root.


Apical stress developed which interacted
with the
distal pressure and with the canine apex.
Double abutment (Fig. 16). Splinting produced a
pronounced change in the stresses within the premolar root. A uniform state of stress was noted in both
the premolar and the canine. Pressure was reduced
at the distal alveolar crest of the premolar and along
the root in comparison
to the unsplinted
crowns.
Stresses were also reduced at the apex of the premolar which interacted with the canine apex. Very low
stresses were noted at the apex of the canine. Greater
stress on the edentulous region was observed than
with the unsplinted situation.

Comparing

the attachments

proSingle abutment. The Dalbo attachment


duced the lowest and most uniformly
distributed
stresses of all the designs tested. The Thompson
dowel and Sterngold attachment
presented similar
stress intensities and distributions;
both caused a
pronounced distal bending of the premolar.
Double abutment. Splinting improved the stress
distributions
for all the designs. The Dalbo attachment produced the least stress to the abutments and
the most stress to the edentulous
region. The
Thompson
dowel produced less stress to the abutment teeth than did the Sterngold
attachment,
especially with respect to the pressure developed at
the distal crest of the premolar.
DISCUSSION
These experiments indicate that fixed splinting of
adjacent abutment teeth is an important factor when
attachment
retainers
are used for an extension
removable partial denture. When individual
abutment teeth are used, undesirable
horizontal
forces
are much greater than with splinted abutments.
The Dalbo philosophy
basically advocates tissue
support, with the attachment acting as a positioning
control and the teeth providing
only minimal support. The validity of this philosophy was verified by
the results of this study. The Thompson dowel with
splinted abutments appears to be a good example of
the principles of broad distribution
of stresses in that
it utilizes both the teeth and edentulous
regions.
However, the distal rest rotation point on a single
abutment
tooth generates unfavorable
distal forces
according to these tests. The rigid Sterngold attachment produced the greatest forces to the supporting
structures with both splinted and unsplinted
abut-

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ments. It is important
to note that the forces evaluated were direct vertical forces. If lateral forces had
been incorporated
in the experiment,
different stress
patterns could have been demonstrated.
Further
investigation
in this area is indicated.

SUMMARY
This investigation
was designed to evaluate the
forces developed in supporting structures by removable partial dentures with attachment retainers. The
attachments tested were the (1) Sterngold type 7, (2)
Dalbo MK, and (3) Thompson
dowel. The study
utilized a photoelastic model with stress areas recorded photographically.
The results showed that:
1. Splinted abutments are indicated when using
the tested attachment
retainers.
2. With single abutments, the attachment
retainers induced distal force on the teeth which resulted in
unfavorable
horizontal
bone forces.
3. The Dalbo MK attachments
produced
the
most force on the edentulous regions and the least
force on the abutment teeth.
4. The Thompson
dowel and Sterngold type 7
attachment
retainers induced similar stress patterns
on single abutments and both produced distal abutment forces.
5. The Thompson dowel induced more favorable
stress patterns when the abutments were splinted.
We would like to thank APM-Sterngold
project.

for their support of this

REFERENCES
1. The Academy of Denture Prosthetics: Principles, Concepts,
and Practices in Prosthodontics-1976. J PROSTHETDENT
373211, 1977.
2. Kratochvil, F. J., and Caputo, A. A.: Photoelastic analysis of
pressure on teeth and bone supporting removable partial
dentures. J PROSTHETDENT 32:52, 1974.
3. Thompson, W. D., Kratochvil, F. J., and Caputo, A. A.:
Evaluation of photoelastic stress patterns produced by various designs of bilateral distal-extension removable partial
dentures. J PROSTHETDENT 38~261, 1977.
4. Cutiingham,
D. M.: Indications and contraindications for
precision attachments. Dent Clin North Am 14:595, 1970.
5. Preiskel, H. W.: Precision Attachments in Dentistry, ed 2. St.
Louis, 1973, The C. V. Mosby Co.
6. Prciskel, H. W.: Intracoronal attachments. Dent Clin North
Am 17:691, 1979.
7. Miller, E. L.: Removable Partial Prosthodontics. Baltimore,
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8. Henderson, D., and Steffel, V. L.: McCrackens Removable
Partial Prosthodontics, ed 5. St. Louis, 1977, The C. V.
Mosby Co.

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KRATOCHVIL,

9.

Appelate,

0. C.: Essentials

of Removable

Partial

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dowel semiprecision
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Denture

Prosthesis, ed 3. Philadelphia,
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S. D., and Malone, W. F. P.: Tylmans
Theory and
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M. C.: Resilient
hinge-action
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21.

22.

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THOMPSON,

AND CAPUTO

intracoronal

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Becker, C. M., Campbell,


H. C., and Williams,
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for chrome-cobalt
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L. A.: Atlas of Removable
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Reprint requeststo:
DR. F. JAMES KRATOCHVIL
UNIVERSITY OF CALIFORNIA
SCHOOL OF DENTISTRY
Los ANGELES, CA 90024

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