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Case Report

An innovative method for magnet retained over denture.


K. Balu
Reader, Dept of Prosthodontics,
KSR Institute of Dental Science and Research,
Tiruchengode, Namakkal (Dt), Tamil Nadu, India
Address for Correspondence :
K. Balu
K.A.V. Dental Clinic
357 D-18, Suramangalam Main Road,
Salem - 636 005
Tamilnadu, India.
e-mail : dr_balu@yahoo.com
ABSRACT:
Application of magnetic forces in retention of prosthesis has
been tried for decades. As a better alternative to conventional
attachments, magnetic attachments offer various advantages. This
article presents an innovative, economical and easy way of fabrication
of magnet retained overdenture. Their merits and fabrication
methods are explained in detail.
Key words:
Break away load, keeper, magnetic system
Introduction
Retention and stability of dentures have been a
continuing problem for dentists in clinical practice.
Universally prevalent there always a group of patients
for whom conventional prosthodontic techniques
have been inadequate to fulfill their satisfaction. In an
attempt to alleviate their problems, a variety of
materials and methods have been tried such as
springs, suction cups, adhesives, attachments,
implants and magnets.
As a mature retentive technique and a better
alternative to conventional methods, magnetic
attachments are applied in various types of
1
prosthesis . Magnet retained overdenture is one such
method which fulfills dentist and patient needs. This
innovative method was initiated way back from 1950
with the invention of Alnico bar magnets and later on
progressed with the introduction of Platinum-Cobalt,
Cobalt-Samarium and the recently introduced
3,7
Neodymium- Iron- Boron magnets . Even though
they are smaller in dimension and have excellent
retentive force, they are costly when imported to India.
This article presents a clinical case report of
fabrication of maxillary overdenture retained by
magnets .The method is new and innovative and also
economical and time saving
Introduction
A 60 year old male patient reported to dental
clinic willing to replace missing natural teeth. Clinical
examination revealed completely edentulous
mandibular arch and partially edentulous maxillary
arch with few remaining natural teeth which are
periodontally weak. After adjuvant radiographic
evaluation, hopeless teeth were removed.
Periodontally favorable maxillary right central incisor
and maxillary right second premolar were left intact
which later on serve as overdenture abutments.
Magnet retained overdenture were prepared as two
components namely root component and denture
component.
a) Preparation of Root component
Conventional Dental magnets (Ali brother
Electronics, Ritchie Street, Chennai, India) were used
for this study. All magnets used for this study are
circular in shape and measure 3mm wide and 2 mm
thick. Intentional root canal treatment was performed
on the retained maxillary right central incisor and
second premolar. Later on both the teeth were
decoronated about 1mm from free gingival margin
using carborundum disc. The surface of the section
was smoothened and rounded to eliminate sharp
margins. The temporary filling material and gutta
percha was removed from the pulp chamber and part
of root canal and a cavity was prepared to a depth of 2
to 3 mm and width slightly more than 3 mm with a
fissure bur. Retention grooves are then cut in the
buccal and lingual axio-pulpal line angles with an
inverted cone bur. The extension of cavity depends on
the size of tooth and enough tooth structure should be
left to prevent lateral perforation or weakening and
breakage of the cavity walls. Impression of the
prepared cavities was made with an elastomeric
impression material (Impregnum soft, 3M ESPE, St
Paul, MN, USA) and poured in dental stone (Gold
Stone, Asian Chemicals, Rajkot, India).
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The cast prepared from this impression was used for
cutting and fitting the magnets to the prepared
cavities. Then magnets were cut to required size using
high speed hand piece and diamond burs. Care
should be taken not to overheat the magnets during
cutting procedures because this may damage their
physical properties. Each magnet was cut
approximately to fit the prepared cavity and fit was
verified. Magnets were held by a strip of stainless steel
matrix band material (Matrix Band no-8, Khusboo &
Co, Aligarh, India). The projecting edges of matrix
band material serve as stops to ensure that the
magnet is held flush with root face during trial fitting
and cementation procedures. Now magnets are
ready to be cemented into their respective cavities.
Prepared cavities are isolated, dried and magnets
were cemented (Fig 1) with an adhesive resin (RelyX
U100, 3M ESPE, St Paul, MN, USA). Excess cement
was removed, sharp dentin edges rounded and finally
smoothened and polished.
b) Preparation of Denture component
Preliminary impression of maxillary and
mandibular arches were made using impression
compound (Aslate, Asian Acrylates, Mumbai, India)
and cast prepared in dental plaster (Kalabhai Karson
Pvt Ltd, Mumbai, India). Acrylic custom tray (DPI-RR
Cold Cure, DPI,Mumbai,India) with wax spacer
(Modelling Wax No 2, Hindustan Dental Products,
Hyderabad, India) was fabricated. An additional wax
spacer to the dimension of denture magnet, about
3mm x 2 mm was placed over the root face on
preliminary cast. Border moulding was done with low
fusing compound (DPI Pinnacle Tracing Stick, DPI,
Mumbai, India), wax spacer removed, relief holes
given and tray kept ready for definitive impression.
Denture component magnet was placed facing the
cemented root component magnet and definitive
impression of maxillary and mandibular arches were
made using Zinc oxide Eugenol impression paste (DPI
Impression Paste, DPI, Mumbai). Set impression was
removed from patient's mouth and inspected for
defects (Fig 2). The denture magnet which gets
embedded within the impression was removed and
master cast prepared in dental stone. Complete
denture was then fabricated by conventional material
and methods (DPI Heat Cure, DPI, Mumbai). Finished
complete denture was tried in patient's mouth and
kept ready for insertion.
The tissue surface of mandibular complete denture
which contains the cavity corresponding to the denture
magnet was slightly enlarged and undercut created
with inverted cone bur to freely accommodate the
magnet. Denture magnet was placed facing the root
magnet. Autopolymerising acrylic resin (DPI-RR Cold
Cure) was mixed and placed into the cavity and
complete denture inserted into patient's mouth and
patient asked to occlude with minimal force.
Complete denture was later removed from mouth,
excess acrylic flash trimmed and removed (Fig 3).
Finally finished and polished prosthesis was inserted
into patient's mouth (Fig 4). Regular post insertion
instructions and advises were given to the patient.
Fig 2- Definitive Impression with embedded denture magnet
Fig 4- Prosthesis delivered
Fig 3- Processed denture component magnet
Fig 1- Cemented root component magnet
K.Balu An Innovative Method for magnet retained over denture
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Discussion
In this article, fabrication of overdenture
using magnets was discussed. Basically there are
two types of magnetic systems namely open field
1,4,8
and closed field systems . Open field system
involves two cylindrical magnets, one embedded in
the denture and the other cemented to the root canal
treated teeth which was decoronated at the gingival
margin where as in the closed field system, the
magnetic assembly consists of magnet with
protective stainless steel end plates embedded in the
denture and a ferromagnetic alloy (detachable
keeper) cemented into the root.
The main advantage of this system over the
conventional magnetic systems was that of time
8-14
saving, simple and very economical method .The
procedure of crown decoronation, preparation of
cavity to accommodate magnets, making impression
of the prepared cavity, preparing working casts,
modifying and cementing root component magnet
and making definitive complete denture impression
can be completed in one appointment on a short time
span. More over by placing denture component
magnet over root magnet while making definitive
impression creates an exact negative depression on
the tissue surface of complete denture. These
procedures eliminate the chance of alignment error
between the approximating surfaces of both the
magnets. But a word of caution needs to be
mentioned while fixing denture magnets with auto-
polymerizing acrylic resin. The force needed to
separate magnets was designated as breakaway load
13,14
expressed in terms of grams . The value of
breakaway load is inversely proportional to the
distance of separation and inclination between the
magnets. Patient was instructed to apply minimal
occlusal or bite force while fixing denture magnet as
more pressure would displace magnets inwards which
in turn decrease the breakaway force when the
denture was later on inserted in patient's mouth. This
was justified by the fact of REAL-EFF (resiliency and like
effect). To summarize, it would be fair to explain that
this complete overdenture would be more retentive in
patient's mouth as soon as it is inserted. These
magnets are wholly biocompatible in the human body
and by itself exert no deleterious effects in human
tissue. Inert magnetic field is harmless to human body.
This can also be safely used for patients with cardiac
pacemaker but magnets must not be brought closer
16.
than 1 cm during trial procedures
But we need to mention some drawbacks of this
concept. Since the concept of open field magnetic
system was involved in this case report, the magnets
surfaces were exposed to oral fluids leading to tarnish
and corrosion. This may lead to a gradual decrease in
retentive force upon usage. Even so upon failure, a
new similar pair of magnetic system can be
incorporated without disturbing the denture
component. But the most challenging drawback was
that even though studies have proved that they are
biocompatible, some open field uncoated magnets
2
exhibit significant cytotoxic effects which may be
attributed due to the release of corrosion by products
from them. Hence magnets should be replaced as
2,6,7
early as signs of corrosion develop . Extensive
research will hopefully provide a permanent magnet
which will be resistant to the adverse environment of
the oral cavity and allow the full potential of prosthesis
retained by magnets to be realized.
Conclusion
The concept of overdenture retained by
magnets was detailed in this study. This method offers
various advantages and convenience over their
conventional counterparts in spite of certain
drawbacks. Extensive research is going on around the
world especially in the US and Japan pertaining to
magnets sizes which are getting reduced, attractive
forces becoming higher, better encapsulation, newer
alloys, laser welding of protective end plates and so
on. Hope such research would bring in a universally
acceptable system.
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