Effects of rigid and nonrigid

extracoronal at tachments on
supporting tissues in extension base
partial removable dental prostheses: A
nonlinear finite element study
Hui-yuan Wang, MSD,a Yu-mei Zhang, DDS, PhD,b Dong Yao,
MSD,c Ji-hua Chen, DDS, PhDd
The Fourth Military Medical University, Xian, China; The 41st
Institute of the Fourth Academy of CASIC, Xian, China
Statement of problem. Resilient (nonrigid) and non-resilient (rigid) attachments are used in extension base partial
removable dental prostheses for retention. However, the biomechanical effects of these 2 types of retainers on the
terminal abutment and supporting tissues, which may influence clinical treatment planning, have not been compared.
Purpose. The purpose of this study was to compare the mechanical effects of 2 types of extracoronal attachments
(rigid and nonrigid) in distal extension removable partial prostheses on the alveolar ridge and abutment tooth periodontal ligament.
Material and methods. A finite element model of a human left mandible edentulous arch distal to the second premolar was fabricated. The second premolar was the terminal abutment for an attachment-retained denture. Two types
of attachments (rigid and nonrigid) were modeled in the study. For the nonrigid attachment, there was movement
between the patrix and matrix component of the attachment, but there was no movement between the 2 component
parts for the rigid attachment. Six levels of loading (100, 150, 200, 250, 300, and 350 N) were applied from 3 directions (axial, buccolingual, and mesiodistal) on the central fossa of the first and second molars. Denture motion and
stress distributions of denture supporting tissues were observed. Maximum equivalent stress values (SEQV) were recorded for 6 regions (cervical bone, cervical and apical periodontal ligaments, mesial and distal ridges, and mucosa).
The data were divided into 2 groups according to the attachment type. Paired t tests were used to compare the values
of the 2 groups. Factorial ANOVA was used to test the difference between the loading directions (=.05). Multiple
linear regression was used to analyze the interactions among the factors of region, direction, and level (=.05).
Results. Stress distributions in the rigid and nonrigid attachment models were similar but the magnitudes were different. For all 3 loading directions, significantly different stresses in the alveolar ridge and periodontal tissue of the terminal abutment were found between the rigid and nonrigid groups (P<.05). There were significant differences among
the 3 loading directions (P<.05). In the nonrigid group, the stress ratio of the mesial to the distal area was higher
than that of the rigid group from axial and mesiodistal loading (P<.05). Linear interactions were found between the
direction and level and region and level combinations (P<.05). Movement between the patrix and matrix components
increased as loading increased. The most obvious movement of attachment occurred when loading was in the buccolingual direction.
Conclusions. Stress on the terminal abutment can be reduced by the use of an extracoronal resilient attachment
that allocates more loads onto the distal edentulous ridge. The level of loading influenced the extent of reduction. A
resilient attachment with a universal hinge had the most movement when loading was in the buccolingual direction.
Interactions were found between direction and level, as well as region and level combinations (P<.05). (J Prosthet
Dent 2011;105:338-346)

The study was supported by National 11th Five-Year Scientific and Technological Support Project (Grant No.2007BA118B05)
PhD student, Department of Prosthodontics, School of Stomatology, The Fourth Military Medical University.
Professor and Vice Director, Department of Prosthodontics, School of Stomatology, The Fourth Military Medical University.
c
Researcher, National Key Laboratory of Combustion, Flow and Thermo-Structure, The 41st Institute of the Fourth Academy of
China Aerospace Science and Industry Corporation.
d
Vice Dean, Professor and Director, Department of Prosthodontics, School of Stomatology, The Fourth Military Medical University.
a

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May 2011

Clinical Implications

In distal extension base removable partial prostheses, the use of extracoronal resilient attachments for retention protects terminal abutment health. However, due to the motion of the attachment during
function, an indirect retainer is recommended to stabilize the denture.
Although implant-supported restorations are increasingly used to
restore defective dentitions, the traditional partial removable dental
prosthesis (PRDP) is still indicated
because of, among other reasons,
lower cost and inadequate remaining alveolar bone. Among different
PRDPs, those with attachments, especially the extracoronal type, are
considered more efficient in restoring
function and providing retention.1,2
In most extracoronal attachment designs, the matrix component is cast
with the abutment crown and the
patrix is embedded into the denture
base. Retention force comes from the
interaction between these 2 components. Some attachments, such as the
resilient design, can help reduce stress
on the periodontal ligament (PL) of
abutment teeth, and are recommended for distal extension dentures.
Previous studies have investigated the effects of attachments on extension base PRDPs. Some authors
found that the resilient attachment
could protect the abutment.3 Extracoronal resilient attachment (ERA)retained dentures have been shown
more beneficial to abutment teeth
than bar retainers.4,5 Heckmann et al,6
showed that more stress is transferred
onto the denture-bearing area with a
resilient attachment than with a rigid
one; and Kratochvil et al,7 found that
a Dalbo attachment (APM-Sterngold) distributed more stress to the
alveolar ridge and reduced stress on
the abutment tooth. Moreover, some
studies on attachment-retained distal
extension dentures have shown that
non-resilient extracoronal attachments could result in torquing forces.
These can be transmitted to the terminal abutment because the connect-

Wang et al

ing parts are not located on the long

axis of the abutment.8 Similar findings
have also been reported for dental
implant biomechanics. Nishimura et
al,9 reported that rigid connectors,
in particular, caused slightly higher
stresses in the supporting structure
than nonrigid connectors. However,
other authors have indicated that
rigid contact between the attachment
patrix and matrix had more advantages and could reduce the movement of abutment teeth.10,11 Saito et
al,12 found that the displacement of
the denture base tended to be less
when the denture was designed with
a rigid connection to the retainer and
with cross-arch stabilization. However,
most of these studies were conducted
with photoelastic analysis. Many of
them lacked detailed data for precise
evaluation. Furthermore, the authors
did not report on stress analysis for
extension base PRDPs retained by extracoronal attachments.
Compared with other mathematical methods, finite element analysis is
considered more accurate in analyzing
the stress distribution in tissues with
complicated structures such as human alveolar bone. Load and boundary conditions, stress, strain, and
the displacement of each part of the
model for 3-dimensional (3D) finite
element analysis have been reported
in several studies.4,5,9 The purpose of
this study was to determine the biomechanical effects of distal extension
base PRDPs retained by extracoronal
attachments using a nonlinear finite
element method (FEM). The nonrigid
attachment design was hypothesized
to allocate more stress to the alveolar
ridge than rigid attachment, the extent of which is affected by the loading mode.

MATERIAL AND METHODS

3D model fabrication
Mandibular bone and teeth computerized tomography (CT) data were
obtained from a male volunteer with
an intact natural dentition without
obvious periodontal disease. The CT
scan was done after obtaining ethical approval from the Institute Research Committee. A CT scanner (PQ
6000; Picker International, Highland
Heights, Ohio) was used to obtain
digital imaging and communications
in medicine (DICOM) data. Using
image-processing software (Mimics
10.0; Materialise, Leuven, Belgium),
the scanned profiles in DICOM format
were translated into 3-D models and
were saved as stereolithography files.
The files were imported into reverse engineering software (Geomagic
Studio 8.0; Geomagic, Inc., Research
Triangle Park, NC) as polygon data.
In the Polygon Phase, small surface
holes were filled and the Relax and
Sandpaper commands were used
to smooth and flatten the model surface. In the Shape Phase, the model
contours were detected and optimized. Patches and grids were constructed on the surface. A non-uniform rational basis spline (NURBS)
surface in each patch was generated
by the Fit Surface command. Finally, the NURBS models were converted
into CAD (computer-aided design)
models. The solid model was generated and saved as Initial Graphics Exchange Specification (IGES) data. The
contour of the PL was obtained in the
Polygon Phase by offsetting 0.2 mm
from the outer shape of the tooth.
The IGES files of each part were
imported into computer-aided engi-

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Volume 105 Issue 5

neering software (Abaqus/CAE 6.9;
Abaqus, Inc., Pawtucket, RI). An attachment was used (ERA; Sterngold
Dental, LLC, Attleboro, Mass) as the
denture retainer. In the Part module
of the Abaqus software, the attachment model was generated according
to the manufacturers instructions for
the product. In the Assembly module, Boolean operations were performed to obtain different parts, including abutment, PL, alveolar bone,
attachment, crown, mucosa, and
denture base. The models for abutment, PL, bone, crown, and attachment matrix were merged together
with the retaining boundaries, and
the models for attachment patrix and
denture base were merged in the same
manner.

Table I. Material properties

Material

Elastic Modulus, E (MPa)

Poissons ratio

Dentin14, 15

18600

0.31

Periodontal ligament16

0.0689

0.45

Cortical bone17, 18

13700

0.30

Cancellous bone17, 18

1370

0.30

200000

0.33

Nylon21

2400

0.39

Denture base18

4500

0.35

0.37

Ni-Cr alloys19, 20

Mucosa18, 22

3.0

Energy [x1.E3]

Two groups of contact management were used in this study. In the

nonrigid group, the surfaces between
the patrix and the matrix, as well as
between the denture base and the
mucosa were defined as contacted
elements in the finite element analysis. In the Interaction module, the
surface between the patrix and matrix
components of the attachment was
set as a contact unit of finite sliding, and the friction coefficient was
set to 0.3. In finite sliding, there is
separation and sliding between the 2
surfaces and arbitrary rotation is allowed. The contact area between the
denture base and alveolar ridge was
considered as small sliding, with
the friction coefficient set to 0.1.13 In
small sliding, the rotation or sliding is minute, and contacting surfaces
can undergo only minimal sliding. In
the rigid group, only contact between
denture base and mucosa were considered and the surfaces of patrix and
matrix were tied together without any
movement.
In the Property module, material properties were assigned1422
(Table I). In the Mesh module, attachment components and mucosa

ALLAE Whole Model

ALLWK Whole Model

2.5

Contact surface, meshing, load, and

boundary management

2.0
1.5
1.0
0.5
0
0

0.5

1.0

1.5

2.0

Time

1 ALLAE-ALLWK data changes during loading process. X axis shows

2 loading steps. Y axis shows ALLAE and ALLWK value. ALLAE/ALLWK
value was within 5% at end of second loading step (0.66%).
were meshed by linear hex elements
(C3D8R). Crown, denture base, dentin, PL, and alveolar bone were meshed
by modified quadratic Tet elements
(C3D10M). Similar to previous studies,2325 the meshing of PL and bone
onto the tooth root area was refined.
In the Load module, the load
was applied to the central fossa of
the first and second molar. The loading force was respectively applied
from the axial (A), mesiodistal (MD),
and buccolingual (BL) directions. Six
levels of load magnitude were used
(100, 150, 200, 250, 300, and 350
N). According to the Saint-Venants

The Journal of Prosthetic Dentistry

principle,26 the sections farthest from

the analyzed field were constrained to
the zero boundary condition, including the inferior, mesial, and distal surfaces of the alveolar bone.
Convergence test and analysis
The study tested for convergence
and accuracy before analysis. Crucial
areas of the meshing model were adjusted, including tissues around the
PL and the contact area. In repeated
solution operations, the result of the
meshed model with different accuracies was found to be similar and

Wang et al

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May 2011
stable. Furthermore, the results were
evaluated using an energy time-history curve (Fig. 1). ALLAE (artificial
energy) is the total energy dissipated
as artificial strain energy and ALLWK
(external work energy) shows the total structural energy in the model during the loading process. The X-Y curve
showed the ALLAE/ALLWK value and
verified the precision of the model.
Under ideal conditions, ALLAE is
within 5% of ALLWK. The maximum
ALLAE/ALLWK was 0.66% in the last
loading step, which demonstrated
that the model were dependable.
Model calculation and data analysis
After analysis, the maximum
equivalent stress (SEQV) on the supporting tissues and denture movements were observed and recorded.
The regions included cervical bone,
apical and cervical PL, mesial and distal area on the alveolar ridge, and the
mucosa. The stress value was analyzed
using statistical software (SPSS 12.0;
SPSS Inc, Chicago, Ill). The difference
between the 2 groups was analyzed
by a paired t test. Differences among

loading directions were analyzed by

factorial analysis of variance (ANOVA, =.05). Multiple linear regression
analysis was used to determine the interactions among the factors (=.05).

RESULTS
When the PRDPs were retained by
the rigid and nonrigid attachments, the
stress was concentrated on both the alveolar ridge and the periodontal tissue
of the terminal abutment teeth. Stress
in the cortical bone was greater than
that in the cancellous bone (Fig. 2).
Figure 3 shows the stress in cervical
PL and alveolar bone for the 2 types of
attachment designs. The stress distributions were similar, but more stress
appeared in the rigid design. Table II
shows the maximum SEQV for the different attachment contacts. Table III
indicates the stresses for the 2 attachment groups with different loading directions of the alveolar ridge (mesial
and distal areas) and the periodontal
tissues (PL and alveolar bone) around
the second premolar. The paired t test
indicated that alveolar ridge stress in
the nonrigid group was lower than

that of the rigid group with axial loading (P<.001), but the result was the
opposite with those of mesiodistal
(P=.006) and buccolingual (P=.001)
loading. Stress in the rigid group in
the PL and bone was higher than that
in the nonrigid group for all 3 loading
directions (axial: P=.002, mesiodistal:
P=.015, buccolingual: P=.001).
Stress on the alveolar ridge was
higher in 2 regions, the mesial and distal ends of the denture base area (Figure 4). Table IV shows the maximum
SEQV ratio (mesial/distal) of the 2
ends under different loading and attachment contacts. The paired t-test
showed that the ratios of the nonrigid
group were higher than that of the
rigid group for axial and mesiodistal
loading (axial: P=.004, mesiodistal:
P<.001, buccolingual: P=.098).
Based on the ANOVA, the stresses
at the 6 locations showed significant
differences among the 3 loading directions (P<.001). Stress was not concentrated on the apical area of the alveolar bone. In the cervical bone area,
the effect of loading direction was
axial less than mesiodistal which was
less than buccolingual (Fig.5A). In PL

2 Equivalent stress distributions in tissues and denture in nonrigid attachment (Axial loading, 350N). A, Mesialdistal section of entire model; B, Buccal-lingual section of alveolar bone; C, Mesial-distal section of denture base; D,
Mesial-distal section of ERA attachment; E, Mesial-distal section of first premolar and second premolar PL; F, Buccallingual section of second premolar root and PL. Note in A, stress was not uniformly distributed around abutment
tooth and wide stress distribution under distal extension base, compared with mesial area (red color indicates highest
values of SEQV).

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3 Equivalent stresses of PL and alveolar bone in rigid and nonrigid attachment (Loading level: 200N; with rigid
design in left and nonrigid design in right; red color indicates highest values of SEQV). A, PL, axial load; B, Alveolar
bone, axial load; C, PL, buccolingual load; D, Alveolar bone, buccolingual load; E, PL, mesiodistal load; F, Alveolar
bone, mesiodistal load.

Table II. Maximum equivalent stress (MPa) of supporting tissue with 200N loading
Design

Loading
Direction

Rigid

Nonrigid

Alveolar Bone

PL

Edentulous Ridge

Cervical

Apical

Cervical

Mesial

Distal

Mucosa

AL

13.10

3.66

0.86

20.29

6.04

1.29

BL

130.60

23.57

4.12

23.57

13.18

4.80

ML

24.59

1.57

0.71

3.72

3.98

0.99

AL

8.04

2.51

0.71

17.20

4.48

1.34

BL

120.57

21.03

3.45

25.01

14.01

4.67

ML

22.29

1.53

0.70

5.70

4.22

1.01

PL: periodontal ligament; AL: axial loading; BL: buccolingual loading; ML: mesiodistal loading.

Table III. Paired t test between rigid and nonrigid attachment design in different loading directions
Paired Groups
(Rigid and
Nonrigid Group)

Mean (MPa)
PT

AR

PT

AR

PT

AR

PT

AR

PT

AR

Axial loading

2.31

2.67

2.68

1.47

3.66

6.29

17

11

.002

<.001

Mesiodistal loading

0.79

1.78

1.24

1.22

2.71

3.35

17

11

.015

.006

Buccolingual loading

4.65

1.61

4.83

1.33

4.09

4.21

17

11

.001

.001

SD (MPa)

df

PT: Periodontal tissues; AR: Alveolar ridge

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May 2011

Table IV. Mesial/distal ratio of maximum SEQV on alveolar ridge

Axial
Loading

4 Equivalent stress distributions

in edentulous area ridge (Occlusal
view, nonrigid attachment with 200N
mesiodistal loading). Stress distributions are primarily on mesial and
distal region of the ridge (red color
indicates highest values of SEQV).

Mesiodistal

Buccolingual

Nonrigid

Rigid

Nonrigid

Rigid

Nonrigid

Rigid

100N

3.69

3.43

1.36

0.91

1.78

1.77

150N

3.64

3.38

1.32

0.92

1.81

1.80

200N

3.84

3.36

1.35

0.93

1.79

1.79

250N

3.82

3.35

1.42

0.95

1.88

1.79

300N

4.25

3.34

1.35

0.95

1.85

1.78

350N

4.04

3.34

1.39

0.94

1.80

1.79

250
Axial loading
Mesiodistal loading
Buccolingual loading

SEQV (MPa)

200

150

100

50

100

150

200

250

300

7
Axial loading
Mesiodistal loading
Buccolingual loading

Axial loading
Mesiodistal loading
Buccolingual loading

6
5

SEQV (MPa)

SEQV (MPa)

38
36
34
32
30
28
26
24
22
20
18
16
14
12
10
8
6
4
2
0

350

Loading (N)

4
3
2
1

100

150

200

250

Loading (N)

300

350

100

150

200

250

Loading (N)

300

350

5 Effect of loading levels on maximum equivalent stress (SEQV) of supporting tissues in nonrigid group. Extent
of SEQV changes differently in each areas of the model. A, Alveolar bone (Cervical area); B, PL (Apical area); C, PL
(Cervical area).

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Volume 105 Issue 5

240

45

220

Rigid
Nonrigid

200

35
30

SEQV (MPa)

SEQV (MPa)

180
160
140
120
100

25
20
15
10

80

60
40

Rigid, apical area

Nonrigid, apical area
Rigid, cervical area
Nonrigid, cervical area

40

100

150

200

250

300

350

100

150

200

Loading (N)

250

300

350

Loading (N)

6 Effect of buccolingual loading level on maximum equivalent stress (SEQV) of PL and alveolar bone in rigid and
nonrigid attachment designs. A, Alveolar bone, cervical area; B, PL.

7 Rotation movement of ERA attachment under buccolingual

loading. Rotation of attachment was most obvious with 350N
load. Image shows movement changes in different loading levels.

Table V. Multiple linear regression on interaction variables.

Nonrigid

Rigid

Coefficient

Coefficient

Direction x Level

25.57

2.57

.012

25.11

2.33

.022

Direction x Region

12.93

1.39

.166

17.84

1.79

.076

Region x Level

29.49

3.27

.001

33.12

3.46

.001

Region x Direction x Level

0.30

0.03

.978

4.16

0.36

.717

Variable

tissue, stresses under the axial and

mesiodistal loading directions were
close and less than that under buccolingual loading (Figs. 5B, 5C). Figure
6 shows stress under the buccolingual
loading. Multiple linear regressions

showed that interactions existed between the direction and level, as well
as the region and level (Table V).
Movement between the patrix and
matrix components increased with increasing loading force. Buccolingual

The Journal of Prosthetic Dentistry

rotation was the most obvious motion when loading was from the buccolingual direction (Fig. 7). However,
under axial and mesiodistal load, the
displacement was reduced.

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May 2011
DISCUSSION
Based on the results of this study,
the hypothesis that the nonrigid attachment design can allocate more
stress to the alveolar ridge than a rigid
attachment was confirmed. The stress
distribution was affected by loading.
Among different loading conditions,
maximum buccolingual loading had
the greatest effect on the periodontal
tissues.
Different attachment designs permit different movements between the
component parts, which affects dental biomechanics. The nonrigid attachment used in this study had a hinging
motion. Several types of attachments
have hinge resilience, which allows
movement around a given point, providing stress-breaking action to the
denture. For example, the Dalbo attachment belongs to the hinge type
and permits vertical movement with
limited hinge movement.18 The ERA
permits universal hinged movement.
Its retention partially depends on the
interaction between the patrix and
matrix components. In this attachment, axial force can be transferred to
the long axis of the abutment. In addition, the combination of attachment
and clasp can reduce the effect of
horizontal force, which benefits abutment health. However, the abutment
tooth can also be injured if a hinge attachment denture is inappropriately
designed.
In this study, 2 contact modes of
attachment produced different results with the same loading force. To
identify the difference, interactions
between contacting parts, minute distortions of the nylon patrix, and denture movement were considered during the modeling process. However,
all of these confounding factors could
produce unreliable results. Therefore,
a convergence test was done to ensure the dependability of the study.
The results indicate that the stress
distributions under the 2 attachment
designs (rigid and nonrigid) were similar. Given that the patrix and matrix
were bound together in the rigid at-

Wang et al

tachment, attachment resilience was

concluded as the major factor for the
difference and not the attachment
structures. The difference should lie
in the magnitude of the stress values.
Nishimura et al9 reported that the
least stress was observed when using
a nonrigid connector, and a rigid connector in particular situations caused
slightly higher stresses in the supporting structure. That result is similar to
the findings of this study. The authors
thought that limiting the stress would
help protect the alveolar ridge from
excessive load; that under certain occlusal forces, the resilience of the attachment could be adjusted to distribute the force properly between the
abutment and alveolar ridge.
The cervical region of the bone
around the abutment tooth showed
higher sensitivity to loading. The
maximum SEQV of the rigid group
was higher than that of the nonrigid
group (axial: 57.3% to 64.3%, mesiodistal: 6.4% to 10.5%, buccolingual:
5.8% to 8.3%). Therefore, regardless
of how the force level changed, the
stress ratio of these 2 groups was constant. However, the absolute value increased as loading increased.
SEQV distributed mesially and distally on the alveolar ridge. The mesial
stress was affected by the forces from
both the abutment and the denture
base, whereas the stress distributed
in the distal area might have been
caused by vertical movement of the
distal denture base. The maximum
SEQV ratio of the mesial and distal
area of the rigid group was less than
that of the nonrigid group when loading was from the axial and mesiodistal
directions. This result indicates that
the loads transferred by the nonrigid
attachment were higher in the mesial
area. The resilience, therefore, is affected by the vertical movement of
the attachment, but not by rotation.
This also shows that the resilience of
the ERA attachment could help transfer some force to both mesial and distal ends of the alveolar ridge.
Loading along the buccolingual
direction had the greatest effect on

the supporting tissues. The maximum

SEQV was distributed to the buccal
and lingual parts of the periodontal
tissue under both axial and buccolingual loading and the stress was on the
buccal and distal parts under mesiodistal loading. The biggest movement
of the denture base appeared when
loading was from the buccolingual direction. This indicates that the shape
of the alveolar ridge had the greatest
influence on rotation. In addition,
certain parts (including PL, periodontal bone and the residual ridge) did
not show compromised periodontal
support in the model. Therefore, even
if a resilient attachment is used, a
cross-arch major connector is recommended for most clinical situations.
As an initial investigation of an
attachment-retained distal extension
prosthesis using the nonlinear finite
element method, the study has limitations. The study was performed with
a single abutment design. Results
may be different with additional factors such as multiple abutments or a
cross-arch major connector. The contact between the attachment matrix
and patrix should be considered further because the exact friction coefficient has not been reported and this
parameter was found to have a large
effect in this pilot study. Aside from
the loading conditions, the mechanical function of the attachment could
also be affected by the supporting
structures,27 such as periodontal support, mucosal thickness, and resilience. These should be investigated
further.

CONCLUSIONS
Within the limitations of the study,
the following conclusions were drawn:
1. Compared with rigid attachment, nonrigid attachments can reduce stress in the supporting tissues
around the terminal abutment of extension base PRDPs.
2. Lateral force has the greatest effect on the terminal abutment in distal extension base PRDPs with universal hinge attachments. Interactions

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Volume 105 Issue 5

exist between direction and level and
region and level.
3. Movement of the component
parts in the attachment is most affected by buccolingual loading.

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Corresponding author:
Dr Ji-hua Chen
Department of Prosthodontics, School of
Stomatology
The Fourth Military Medical University
145 Changle Xi Road
Xian, Shaanxi
CHINA
Fax: +86-29-84776329
E-mail: jhchen@fmmu.edu.cn
Copyright 2011 by the Editorial Council for
The Journal of Prosthetic Dentistry.

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