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264

J. Dent.

1988; 16: 264-268

Abutment tooth and base movement with


attachment retained removable partial
dentures
G. M. Feingold, A. A. Grant and W. Johnson
Department
KEY WORDS:

J. Dent

1988;

of Prosthetic Dentistry, University Dental Hospital of Manchester


Partial dentures, Precision attachments, Function

16: 264-268

(Received 10 Februan/ 1988;

reviewed 10 March 1988;

accepted 20 June 1988)

ABSTRACT
Using a laboratory model for the distal extension removable partial denture situation, the
effect of resilient and rigid precision attachment retainers on abutment tooth and denture
base movement was studied. It was found that both abutment tooth and denture base
movement was least with the rigid and semi-precision attachments used compared to the
resilient attachments. Abutment tooth movement was generally towards the mesial,
except for the C and L attachment which produced distal movement.

INTRODUCTION
One of the accepted philosophies concerning the planning
and construction of the distal extension removable partial
denture is the use of stress-breaking devices as a means of
distributing the load between the abutment teeth and the
tissues underlying the base (Steffel, 195 1). The need for
stress breakers has been suggested because the vertical
displacement of the abutment tooth in its socket is
approximately 0.1 mm whereas that of the mucosa
underlying the base ranges between O-4 mm and 2 mm
(Steiger and Boitel, 1959). This tissue resilience differential of between 4 and 20 times the axial displacement of
the abutment tooth is generally regarded as indicating the
need for some form of stress breaking (Mensor, 1968)
in order to minimize damage to the tissues during
function.
The purpose of this study was to compare, using a
photographic method, the effect of resilient and rigid
precision and semi-precision attachment retainers on
abutment tooth and denture base movement in the distal
extension removable partial denture situation.
In experiments with various types of retainers using
models and strain gauges, Shohet (1969) compared the
stress they produced on the abutment teeth. He found that
precision attachments produced the greatest degree of
distal stress on single abutments and that a semi-precision
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attachment, the C and L, caused less abutment tooth


displacement and stress than the precision attachments.
Both Takanshi (1972) and Nally (1973) found that a
rigid precision attachment produced greater loads on
abutment teeth than did resilient attachments. Nally also
reported that the stress produced by a rigid attachment
was greater than that produced by a well-designed clasp
unit. Denture base movement was greater with resilient
attachments, while abutment tooth movement was little
affected.
Experimenting on models with deep rest preparations
and precision intracoronal rests, Cecconi (1974) found
that they both influenced abutment tooth movement in the
same manner. When the rests were at maximum depth,
abutment tooth movement was significantly reduced. The
effect of two types of stress-breaker on abutment tooth
movement and denture base movement was compared by
Cecconi et al. (1975) using models. Their results showed
that using the Pin Dalbo attachment, denture base
movement was significantly decreased when the stressbreaker was made rigid and that abutment tooth
movement was significantly decreased when the Ticonium
hidden lock was made rigid.
Photoelastic stress analysis was used by White ( 1978)
in experiments using a Dalbo and a Mays attachment.
The resilient Dalbo attachment produced identical stress

Feingold et al.: Attachment

retained removable partial dentures

265

patterns to that of the Mays attachment and resulted in


the greatest stress-breaking action. When the Dalbo was
deactivated, i.e. made rigid, stress on the ridge was
reduced, but none of the attachments tested resulted in a
wide distribution of stresses along the edentulous ridge.
Using the same experimental method, Kratochvil et al.
(198 1) compared the stress distribution using the Dalbo
MK extracoronal attachment, the Stemgold type 7
intracoronal attachment and the Thompson intracoronal
semi-precision retainer. They reported that all attachments
produced distal forces on the teeth and suggested that
splinted abutments were indicated. The Dalbo MK
attachment produced most force on the edentulous ridge
and least force on the abutment teeth.

MATERIALS

AND METHODS

An acrylic resin model of a lowerjaw was produced which


incorporated a brass replica of a second premolar tooth. A
silicone material, Arbrosil 188 (Adshead Ratcliffe and
Co. Ltd, Belper, Derby, UK), 0.33 mm thick, was cured
between the root and the socket representing the perie
dontal membrane. The surface of the model was covered
with the silicone material at a thickness of 2 mm in the
premolar region, increasing to 3 mm in the molar area and
4 mm in the retromolar area. The upper surface of the
silicone material covering the crest of the ridge descended
from the distal gingival margin of the abutment tooth for
3 mm at an angle of 38 to the baseline. It then sloped
upwards for 23 mm towards the distal at an angle of 9 to
the horizontal, and then ascended for 5 mm at the
retromolar pad at an angle of 54. A metal denture base
with prepared attachment areas was cast to fit the residual
ridge.
In the first experiment a Dalbo unilateral extracoronal
attachment was used. The design of the Dalbo attachment
is based on the Roach system allowing movement to occur
in the vertical plane but not laterally.
In function, the attachment permits hinge action and
vertical movement and a combination of these basic
actions (Mensor, 1968). Two methods were used to alter
the functional resilience of the attachment. The first of
these was the removal of the stainless-steel spring. The
second involved drilling a O-5 mm hole through the
attachment. A 0.5 mm hard steel pin could then be passed
through the hole. This prevented both the hinge movement
and the vertical descent of the ball-shaped appendix,
rendering the attachment rigid in nature.
The base of the model was rigidly fixed to the frame of
the apparatus. Long indicator rods and pointers were fixed
to the denture base and crown, and loading of the denture
saddle was achieved by a static loading method at a
predetermined site on the saddle (Fig. I). For the
experiments reported here, a load of 10.5 4 kg was applied
20 mm from the abutment tooth. Movement of the free
end of the rods magnified movement of the denture base
and crowns which was measured using a photographic

Fig. 1. Model with indicator rods attached to the denture


base and abutment tooth crown. The apparatus for loading
the saddle is shown in position on the left side of the
model.

method. This involved double exposure of a film frameone exposure being obtained before loading and one
afterwards, as described in a previous communication
(Feingold et al., 1986). Two single lens reflex cameras
were used, one to observe movement as seen from the
anterior aspect of the model representing buccolingual
movement, and another to observe the model from the
lateral aspect to determine anteroposterior movement
(Fig. 2).

The effect of the Dalbo attachment when used in a rigid


state using the locking pin was first observed. Next, the
locking pin was removed and the experiment repeated.
The stainless-steel spring was then placed in position and
the experiment repeated with the attachment in its normal
resilient mode. Each experiment was repeated 10
times.
Further experiments were carried out using a Crismani
rigid intracoronal attachment; a Crismani unilateral
resilient attachment and a C and L semi-precision
attachment. The Crismani rigid intracoronal attachment
is basically a simple dovetailed slot device. The Crismani
unilateral resilient attachment is also of a dovetail slot

Fig. 2. Diagram to illustrate the arrangement of two cameras


set at right angles, to view the anteroposterior and bucce
lingual movement of the indicator rods.

266

J. Dent. 1988;

16: No. 6

Table I. Movement of abutment tooth and denture base when using a Dalbo attachment in different modes

Type of attachment
to abutment tooth

Lateral view photograph


Abutment tooth
Base movement
Direction of
movement mean
mean results
results (mm)
movement
(mm)

Anterior view photograph


Direction of
tooth movement

Direction of
base movement

Rigid Dalbo fixed


with pin

2.52
(0.04)

Mesial

2.96
(O-08)

Lingual

Lingual

Dalbo without
spring

3.14
(O-06)

Mesial

3.64
(0.081)

Lingual

Lingual

Dalbo with spring

3.23
(O-05 1)

Mesial

3.1 1
(0.04)

Lingual

Lingual

Figures in parentheses are standard deviations.

Tab/e I/. Movement of abutment tooth and denture base using Crismani attachments in rigid and resilient modes

Type of attachment
to abutment tooth

Lateral view photograph


Abutment tooth
Base movement
Direction of
movement mean
mean results
results (mm)
movement
(mm)

Crismani slide
(rigid)

1.02
(0.06)

Mesial

Crismani slide
(resilient)

3.78
(0.05 1)

Mesial

2.31
(O-09)
3.76
(O-1 3)

Anterior view photograph


Direction of
tooth movement

Direction of
base movement

Lingual

Lingual

Lingual

Lingual

Figures in parentheses are standard deviations.

design, but having a spring-loaded platform extending


horizontally over the saddle area-it
is capable of
permitting hinge movement, vertical translation and slight
rotation in the coronal plane because of the slight taper of
the dovetail section (Ray, 1969).
The C and L attachment consists of two parts: a
conventionally produced spring clip which provides
additional retention to a prefabricated mesially placed
occlusal rest which fits into a casting having a prepared
parallel-sided rest seat of dovetail form (Preiskel, 1979).
This semi-precision device allows tissuewards rotation of
the saddle to occur when a force is applied. All
experiments were repeated 10 times.
Transfer jig for loading experiments
precision attachments

using

It was necessary to make a new crown for each of the


precision attachments used in the experiments and a jig
was constructed to ensure that the abutment tooth
movement indicator rods and pointers were exactly the
same length for all the experiments and to enable the
crown retention screw hole and the threaded hole in the
buccal cusp of the crown to be in the same relative position
for all the crowns.

RESULTS
The results obtained using the Dalbo attachments (Tubk
I) show that least tooth movement occurred with the

attachment in a rigid mode. The crown of the abutment


tooth moved in a mesial direction. Table II also indicates
less tooth movement using the rigid Crismani intracoronal
attachment than that which occurred with the Crismani
unilateral resilient attachment, and that abutment tooth
movement was again in a mesial direction.
Tooth movement resulting from the use of the C and L
attachment was less than that of either the rigid Crismani
or the rigid Dalbo device, and with this attachment the
movement of the abutment tooth was in a distal direction
(Table III).
Measurements in each of the tables are in millimetres in
the magnified dimensions as measured from the pointers.
The actual tooth and denture base movement may be
determined by the application of suitable correction
factors.

DISCUSSION
In this study, using the Dalbo and Crismani attachments
in a rigid state, the magnitude of abutment tooth
movement was significantly reduced when compared to
the precision attachments in a resilient state. This is in
agreement with the study of Cecconi et al. (1975), but is
contrary to the results of the studies carried out by Shohet
(1969), Nally (1973) and Takanshi (1972) who found
that rigid precision attachments produce greater abutment
tooth movement than resilient attachments.
Using the resilient precision attachments, Nally (1973)

Feingold et al.: Attachment

retained removable partial dentures

267

Table /IL Movement of abutment tooth and denture base when using the C and L attachment

Type of attachment
to abutment tooth
C and L

Figures in

Lateral view photograph


Abutment tooth
Base movement
movement mean
Direction of
mean results
results (mm)
movement
(mm)
o-57
(O-07)

parentheses

are standard

Distal

Anterior view photograph


Direction of
tooth movement

2.39
(O-09)

Direction of
base movement

Lingual

Lingual

deviations.

found only average abutment tooth movement and that


denture base movement was greatly increased. The
experimental results are in agreement with those of Nally
(1973) concerning denture base movement, but differ in
regard to abutment tooth movement. They show a
significant increase in denture base movement and
abutment tooth movement with the Crismani resilient
precision attachment (P < O-001).
Using rigid precision attachments Cecconi et al. (1975)
found that denture base movement was significantly
reduced, while White (1978) found a marked reduction in
stress on the ridge. This study is in agreement with the
results of Cecconi.
In the present studies, when the locking pin was
removed from the Dalbo attachment and the spring placed
in position, changing the attachment from a rigid to a
resilient state, there was a highly significant increase in
abutment tooth movement and significant increase in
denture base movement (P < O-001 and P < O-005
respectively). When the spring was removed producing an
unrestrained Dalbo, no significant change in abutment
tooth movement took place, but there was a significant
increase in denture base movement (P < O*OOOS).White
(1978) found that when the Dalbo was progressively
changed from a rigid inactive state to a more active state,
at first using the spring and then without the spring, the
stresses on the ridge increased and there was stress
directly below the root apex of the abutment tooth,
confirming reduced abutment tooth movement.
Shohet (1969) found that the greatest amount of distal
stress of the abutment tooth was produced by an
intracoronal rigid precision attachment and that the C and
L attachment did not produce any distal displacement or
stress to the abutment tooth. This study is in agreement
with Shohet (1969) with regard to the small amount of
abutment tooth movement, but not with regard to
intracoronal precision attachments. When comparing the
C and L attachment to the rigid Crismani attachment,
abutment tooth movement was significantly greater for the
Crismani attachment (P < O-002) but there was no
significant difference in denture base movement between
the two systems. However, the direction of the abutment
tooth movement was distally and it was the only system
using this experimental model that produced distal
abutment tooth movement. This is not in agreement with
Goodman and Goodman (1963) who stated that the
equipoise principle of the design of the C and L

attachment
produced
a mesial abutment
tooth
movement.
If the hypothesis of Christadou et al. (1973) derived
from the result of in vivo observations is correct, &e
resultant of a vertical force applied to an angular ridge
produces a mesially directed force to the denture base and
to the abutment tooth. Then, if the abutment tooth moves
even a small distance distally, it would imply that the
distal force of the C and L attachment must have cancelled
out the mesially directed force.
If it is considered that the best retainer design is one that
produces the least abutment tooth and denture base
movement, then the C and L attachment and the rigid
Crismani attachment are the retainers of choice of those
tested. This is shown graphically in Fig. 3 where denture
base and abutment tooth movement are related for various
retainer systems.
Duncans new multiple range test on the order of
ranking of the five retainer systems shown indicates least
denture base movement for the Crismani rigid and the C
and L attachments. The same test for abutment tooth
movement indicates least effect from the rigid Crismani
attachment.

.
00
.
:?
0
4

4
2
t

01
0

Abutment

tooth

..T*

I
3
movement

i.:

(mm)

Fig. 3. The relationship between denture base and abutment


tooth movement for various retainer systems. 1, Dalbo
resilient attachment; 2, Dalbo attachment with spring
removed; 3, Crismani rigid attachment: 4, Crismani resilient
attachment; 5, C and L attachment.

268

J. Dent. 1988;

16: No. 6

CONCLUSIONS
1. In general, the use of rigid precision attachments
as
retainers
for the distal extension
removable
partial
denture reduces both abutment
tooth movement
and
denture base movement compared to that resulting from
the use of resilient attachments.
2. The Crismani slide attachment
and the C and L
semi-precision
attachment
produced the least abutment
tooth and denture base movement.
3. The direction of abutment
tooth movement
was
generally mesially except for the C and L attachment
which produces distal abutment tooth movement.

Acknowledgement
The apparatus
used in this study was produced
by
Mr H. Todd, dental instructor, to whom grateful acknowledgement is made.

References
Cecconi B. T. (1974) Effect of rest design on transmission of
forces to abutment teeth. J. Prosthet. Dent. 32, 14 l-l 5 1.
Cecconi B. T., Kaiser G. and Rahe A. (1975) Stressbreakers
and the removable denture. J. Prosthet. Dent. 34,
145-151.

Christadou L., Osborne J. and Chamberlain J. B. (1973)


The effect of partial denture design on the mobility of
abutment teeth. Br. Dent. J. 135, 9-18.
Feingold G. M., Grant A. A. and Johnson W. (1986) The
effect of partial denture design on abutment tooth and
saddle movement. J. Oral Rehabil. 13, 549-557.
Goodman J. J. and Goodman H. W. (1963) Balance of
force in precision free-end restorations. J. Prosthet. Dent.
13, 302-308.
Kratochvil F. J., Thompson W. D. and Caputo A. A.
(1981) Photoelastic analysis of stress patterns on teeth and
bone with attachment retainers for removable partial
dentures. J. Prosthet. Dent. 46, 21-28.
Mensor M. C. (1968) The rationale of resilient hinge-action
stressbreakers. J. Prosthet. Dent. 20, 204-215.
Nally J. N. (1973) Methods of handling abutment teeth in
Class I partial dentures. J. Prosthet. Dent. 30, 561-566.
Preiskel H. W. (1979) Precision Attachments in Dentistry,
3rd edn. London, Kimpton.
Ray G. E. (1969) Precision Attachments. Bristol, Wright.
Shohet H. (1969) Relative magnitude of stress on abutment
teeth with different retainers. J. Prosthet. Dent. 21,
267-282.
Steffel V. L. (195 1) Fundamental principles of partial
denture design. J. Am. Dent. Assoc. 42, 534-544.
Steiger A. A. and Boitel R. H. (1959) Precision work for
partial dentures. Stebo Zurich Switzerland Berichthaus
143-144, 157-205.
Takanshi S. (1972) Experimental studies of stress-breaking
mechanisms in some kind of precision attachment applied
to free-end saddle dentures. J. Tokyo Dent. Coil. Sot.
12, g&138.
White J. T. (1978) Visualisation of stress and strain related
to removable partial denture abutments. J. Prosthet. Dent.
40, 143-151.

Correspondence should be addressed to: Professor A. A. Grant, University Dental Hospital of Manchester, Department of Prosthetic
Dentistry, Higher Cambridge Street, Manchester Ml5 6FH, UK.

Book Review
Oral Radiology: Principles and Interpretation,
2nd
edition.
Paul W. Goaz and Stuart C. White. Pp. 791. 1987.
St Louis, C. V. Mosby. Hardback, f38.00.
In the 5 years since its initial publication, this has become
the most frequently recommended dental radiology
textbook in US dental schools. Its popularity is well
justified and says much about its excellence and
suitability as a teaching aid. The new edition consists of
30 chapters, 20 of which have been revised, four others
re-written and a new chapter on endodontic radiology
added: as a result it now has 87 more pages and 162
additional illustrations.
The book is divided into seven sections, the first of
which is a highly interesting historical account of the
development of dental radiology and radiography,
illustrated with examples of some of the early dental
X-ray machines and equipment. Sections 2. 3 and 4 give
accounts of the physics, the biological effects, and the
safety and protection aspects of radiation. These have
been updated and it is to be welcomed that
measurements of radiation are now given in SI units.

Section 5 is concerned with imaging principles and


includes a perspicuous description of latent image
formation and an improved chapter on quality assurance,
a subject which does not receive much attention in
textbooks from this country. Section 6 describes intraoral
and extraoral radiographic techniques and principles,
including some specialised radiographic techniques, and
the last section provides a comprehensive illustrated
account of disorders affecting the maxillofacial region.
It is a book which is hard to fault and errors appear to
be few: in figure 12.26 illustrations 8 and C are
transposed and I am uncertain whether the arrows in the
two illustrations in figure 15.8 point to the same area of
calcification. The quality of the reproduction of the
radiographs is generally satisfactory and the text easy to
read and understand. It is a book which I can thoroughly
recommend not only for dental undergraduates and for
those studying for their Fellowship but also as a
reference book for the general dental practitioner. It
certainly seems to have impressed Professor Roentgen
sufficiently to turn his head! (compare figure 1 .l in both
editions).
P. J. G. Rout