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A Technique for Retrofitting a Metal Ceramic Crown

to an Attachment-Retained Removable Partial Denture:


A Clinical Report
Bulent Uludag, DDS, PhD, Fehmi Gonuldas, Emre Tokar, DDS, & Volkan Sahin, DDS, PhD
Department of Prosthodontics, Faculty of Dentistry, University of Ankara, Ankara, Turkey
The article is associated with the American College of Prosthodontists journal-based continuing education program. It is accompanied
by an online continuing education activity worth 1 credit. Please visit www.wileyhealthlearning.com/jopr to complete the activity and
earn credit.

Keywords
Precision attachment; attachment-retained
dentures.
Correspondence
Bulent Uludag, Department of
Prosthodontics, Faculty of Dentistry,
University of Ankara, Besevler Ankara 06500,
Turkey. E-mail: bculudag@gmail.com
The authors deny any conflicts of interest.
Accepted March 7, 2014

Abstract
In dental applications, precision attachments have been used to retain removable partial
dentures (RPDs) for several decades. Various types of extracoronal attachments are
commonly used in combination with fixed partial dentures and RPDs to achieve
retention and stability. Fracture of the framework, fracture of the roots or teeth, and
irretrievable decrease of retention are common reasons for a failed attachment-retained
RPD. Another complication of metal ceramic crowns with precision attachment is
decementation of the crowns. When fixed components of the attachment-retained
RPD fail, the traditional treatment approach requires remaking both the fixed and
removable components of the attachment-retained RPD. This technique describes
retrofitting of a metal ceramic crown to a resilient attachment-retained RPD.

doi: 10.1111/jopr.12204

In dental applications, precision attachments have been used to


retain removable partial dentures (RPDs) for several decades.1,2
Generally, clasps, adhesive attachments, crowns, and fixed partial dentures (FPDs) with intra- or extracoronal attachments,
telescopes, root caps, and/or prefabricated interradicular retainers provide that retention for combinations of FPDs and
RPDs.3,4 Various types of extracoronal attachments are commonly used in combination FPDs and RPDs to achieve retention
and stability.2 Framework fracture, fracture of the roots or teeth,
and irretrievable decrease of retention are common reasons
for a failed attachment-retained RPD. Another complication of
metal ceramic crowns with precision attachment is the decementation of the crowns.3,5,6 Although retrofitting of crowns
to existing RPDs has been well documented, including fabrication of direct resin copings on the abutment teeth, making
resin replicas of the clasp assemblies,7-20 or using CAD/CAM
technology,21,22 no information regarding retrofitting of crowns
to existing attachment-retained RPDs has been documented.
Common clinical protocol requires remaking both fixed and
removable components of an attachment-retained RPD. This
article describes a method whereby a metal ceramic crown can
be retrofitted to a resilient attachment-retained RPD.

Clinical report
A 70-year-old man was referred to the Department of
Prosthodontics, Faculty of Dentistry, University of Ankara
164

(Ankara, Turkey) for evaluation. In the initial clinical examination, attachment-retained distal extension RPDs were noted
for both dental arches. The mandibular RPD was supported by
mandibular left and right canines. The metal ceramic crown
of the mandibular right canine was missing. The patient stated
that the RPD had been in service for 2 years without any
complaints. The patient had not experienced any previous
decementation of the metal ceramic crown on the mandibular
right canine, which was noted to be sound with no clinically
detectable mobility. The RPDs were observed to have acceptable occlusion and esthetics. No periodontal or periapical
lesions were present in the radiographic examination. Previous
dental records were obtained from the previous dental office
where the existing RPDs were fabricated. These records
indicated that the attachment system used to retain the RPD
was the resilient rk-1 attachment system (rk-1; Karg Saglk,
Bursa, Turkey; Fig 1). Castable extracoronal rk-1 attachments
are resilient and permit a hinging movement limited to 17
of the distal extension RPD. These attachments have plastic
patrices and matrices. The castable patrix is attached to the
crown pattern with a paralleling mandrel, and the matrix is
incorporated into the cast framework using inserting tools.
Because current clinical knowledge requires splinting of
at least two terminal abutment teeth to retain an extensionbase, attachment-retained RPD,23 the patient was offered a
new treatment plan including remaking of a new attachmentretained mandibular RPD after tooth preparation of the

C 2014 by the American College of Prosthodontists


Journal of Prosthodontics 24 (2015) 164167 

Uludag et al

A Technique for Retrofitting a Metal Ceramic Crown

Figure 3 Mandibular prosthesis impression.


Figure 1 View of the patrix and matrix of the rk-1 castable attachment.

Figure 2 Intraoral view of the denture in the mouth.

remaining mandibular arch. The patient rejected the treatment


plan because of the prolonged treatment period and asked about
the possibility of retrofitting of the lost metal ceramic crown
to the existing RPD. A new treatment plan, including fabrication of a resin pattern and castable attachment patrix assembly
to form the substructure of the metal ceramic crown on the
definitive cast, was developed and accepted by the patient.
Impression of the maxillary arch was made with irreversible hydrocolloid (CA37; Cavex Holland B, Haarlem, The
Netherlands) using a stock tray (Teknik Dis Deposu, Istanbul,
Turkey). Low-viscosity poly(vinyl siloxane) impression material (Mucosa Xantopren; Kulzer, Hanau, Germany) was applied
to the intaglio surfaces of the mandibular RPD, which was
placed intraorally. The final seat of the mandibular RPD was
verified by visually inspecting the position of the left reciprocating arm of the RPD with the milled lingual surface of the same
attachment-retained metal ceramic crown on the mandibular left
canine (Fig 2). The patient was instructed to apply slight occluding force in maximum intercuspal position. Low-viscosity
elastomeric impression material (Speedex; Coltene/Whaledent
Inc, Cuyahoga Falls, OH) was injected around the mandibular right canine, and a pick-up impression of the mandibular
RPD was made in a rigid stock tray with heavy-body elastomeric impression material (Speedex; Fig 3). Type IV stone
(BEGO, Bremen, Germany) was poured into the impression.

Figure 4 Resin pattern and castable attachment patrix assembly on the


master model.

Figure 5 View of attachment matrix in the mandibular RPD.

After forming a resin pattern to fabricate the substructure of


the metal-ceramic crown (Fig 4), a castable attachment patrix
was incorporated with the matrix on the RPD framework (Figs
5 and 6). The castable attachment patrix was incorporated in
the resin pattern with sticky wax (Keystone Industries GmbH,
Singen, Germany). The resin pattern and castable attachment
patrix assembly was cast with a chrome-cobalt alloy (Biosil F;
Degudent, Hanau, Germany; Fig 7) and was verified intraorally

C 2014 by the American College of Prosthodontists


Journal of Prosthodontics 24 (2015) 164167 

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A Technique for Retrofitting a Metal Ceramic Crown

Uludag et al

Figure 6 Resin pattern and castable attachment patrix assembly attached to the matrix.

Figure 9 Intraoral view of the metal ceramic crown.

Figure 7 Cast metal substructure of attachment-retained crown.


Figure 10 Intraoral view of the attachment-retained crowns.

Figure 8 Intraoral view of the cast metal substructure.

(Fig 8). Veneering porcelain was applied with conventional


techniques and evaluated intraorally. The metal ceramic crown
with rk-1 attachment was finished according to manufacturers
recommendations (Figs 911).

Discussion
Attachment-retained RPDs may fail due to decementation of
the fixed components, which may be associated with geometry of the tooth preparations as well as the geometry of the
166

Figure 11 Intraoral view of the mandibular RPD.

restorations and improper cementation techniques. When the


fixed components of an attachment-retained RPD fail, the traditional treatment approach requires remaking of both fixed and
removable components of the attachment-retained RPD.6 This
clinical report describes retrofitting of a metal ceramic crown to
a resilient attachment-retained RPD by using a resin pattern and
castable attachment patrix assembly to form the substructure of

C 2014 by the American College of Prosthodontists


Journal of Prosthodontics 24 (2015) 164167 

Uludag et al

the metal ceramic crown. Advantages of this technique include


decreased chair time and treatment cost, as well as increased
patient satisfaction compared to remaking of both fixed and
removable components of the attachment-retained RPD. The
increased technical sensitivity is a disadvantage of this technique. Proper impression techniques and the careful incorporation of the patrix assemblies are the key factors determining
the outcome of the described technique. Well-documented clinical studies are required to determine long-term results of this
technique.

Summary
Several reasons for failure of combination FPDs and RPDs
include fracture of the framework, fracture of the roots or
teeth, irretrievable decrease of retention, and decementation
of the fixed components, which may eventually be lost. Although retrofitting of crowns to existing RPDs has been well
documented, no information regarding retrofitting of crowns
to existing attachment-retained RPDs has been documented.
Common clinical protocol requires remaking of both fixed and
removable components of an attachment-retained RPDP. This
article describes a method whereby a metal ceramic crown can
be retrofitted to a resilient attachment-retained RPD.

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A Technique for Retrofitting a Metal Ceramic Crown

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C 2014 by the American College of Prosthodontists


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