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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; Kargı Sa˘glık,
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) 164–167 

a castable attachment patrix was incorporated with the matrix on the RPD framework (Figs 5 and 6). Fig 3). 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). Low-viscosity poly(vinyl siloxane) impression material (Mucosa Xantopren. Germany) was applied to the intaglio surfaces of the mandibular RPD. The resin pattern and castable attachment patrix assembly was cast with a chrome-cobalt alloy (Biosil F. Turkey). Figure 2 Intraoral view of the denture in the mouth. The Netherlands) using a stock tray (Teknik Dis Deposu. Figure 5 View of attachment matrix in the mandibular RPD. Istanbul. Type IV stone (BEGO. A new treatment plan. The patient was instructed to apply slight occluding force in maximum intercuspal position. Singen. Figure 1 View of the patrix and matrix of the rk-1 castable attachment. Low-viscosity elastomeric impression material (Speedex. was developed and accepted by the patient. The castable attachment patrix was incorporated in the resin pattern with sticky wax (Keystone Industries GmbH. Hanau.Uludag et al A Technique for Retrofitting a Metal Ceramic Crown Figure 3 Mandibular prosthesis impression. Cavex Holland B. Coltene/Whaledent Inc. OH) was injected around the mandibular right canine. Germany) was poured into the impression. remaining mandibular arch. including fabrication of a resin pattern and castable attachment patrix assembly to form the substructure of the metal ceramic crown on the definitive cast. Haarlem. Figure 4 Resin pattern and castable attachment patrix assembly on the master model. and a pick-up impression of the mandibular RPD was made in a rigid stock tray with heavy-body elastomeric impression material (Speedex. Germany. After forming a resin pattern to fabricate the substructure of the metal-ceramic crown (Fig 4). Bremen. Fig 7) and was verified intraorally C 2014 by the American College of Prosthodontists Journal of Prosthodontics 24 (2015) 164–167  165 . Germany). Cuyahoga Falls. Impression of the maxillary arch was made with irreversible hydrocolloid (CA37. Kulzer. 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. which was placed intraorally. Degudent. Hanau.

Figure 10 Intraoral view of the attachment-retained crowns. Figure 9 Intraoral view of the metal ceramic crown. the traditional treatment approach requires remaking of both fixed and removable components of the attachment-retained RPD. Figure 7 Cast metal substructure of attachment-retained crown. Discussion Attachment-retained RPDs may fail due to decementation of the fixed components. (Fig 8). When the fixed components of an attachment-retained RPD fail. restorations and improper cementation techniques. Veneering porcelain was applied with conventional techniques and evaluated intraorally. 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. Figure 8 Intraoral view of the cast metal substructure. The metal ceramic crown with rk-1 attachment was finished according to manufacturer’s recommendations (Figs 9–11).A Technique for Retrofitting a Metal Ceramic Crown Uludag et al Figure 6 Resin pattern and castable attachment patrix assembly attached to the matrix.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) 164–167  .

Owall B.14:631-644 11. References 1. The increased technical sensitivity is a disadvantage of this technique. Int J Prosthodont 1998. This article describes a method whereby a metal ceramic crown can be retrofitted to a resilient attachment-retained RPD. Adachi K. Helvey GA: Retrofitting crowns to an existing removable partial denture clasp: a simple technique. Gen Dent 1985. J Prosthet Dent 2004. Uludag B. Common clinical protocol requires remaking of both fixed and removable components of an attachment-retained RPDP.98:478-482 23. et al: When to choose which retention element to use for removable dental prostheses. Barrett DA.80:619-629 19. Zitzmann NU. Dent Clin North Am 1970.15:889-899 10. Livaditis GJ: Fabricating abutment crowns for existing removable partial dentures using custom resin clasp analogs. Tsuruta S. Killebrew RH: Crown construction for broken down partial denture abutments.69: 631-633 17. Chen LB. B. J Prosthet Dent 1965. J Prosthet Dent 1965. Part I. irretrievable decrease of retention. Marchack BW.68:556-557 16. Yoon T. Owall B: Precision attachment-retained removable partial dentures. as well as increased patient satisfaction compared to remaking of both fixed and removable components of the attachment-retained RPD. Summary Several reasons for failure of combination FPDs and RPDs include fracture of the framework.76:315-320 C 2014 by the American College of Prosthodontists Journal of Prosthodontics 24 (2015) 164–167  167 . Long-term study ball attachments. fracture of the roots or teeth. Chang W: The fabrication of a CAD/CAM ceramic crown to fit an existing partial removable dental prosthesis: a clinical report. et al: A procedure for fitting a fixed partial denture to an existing removable partial denture. J Prosthet Dent 1992. Fujisawa M. et al: Fabrication of an all-ceramic abutment crown under an existing removable partial denture using CAD/CAM technology. Hansen CA. which may eventually be lost.11:574-579 A Technique for Retrofitting a Metal Ceramic Crown 7. Hill GM: Construction of a crown to fit a removable partial denture clasp. Goldberg AT. Part 3. Warnick ME: Cast crown restoration of a badly involved abutment to fit an existing removable partial denture. Proper impression techniques and the careful incorporation of the patrix assemblies are the key factors determining the outcome of the described technique. Polat S: Replacement of a lost removable partial dental prosthesis using ball-attachment analogs: a clinical report.22:161-167 5. Weiger R.91:392-394 21. J Prosthet Dent 1994. Jones RD: Constructing cast crowns to fit existing removable partial denture clasps. Silberman DM: An indirect procedure for making a crown under an existing partial denture. Int J Prosthodont 1991. Sahin V. J Prosthodont 2012. J Prosthet Dent 1976. Tallents RH: Crown construction to fit an existing removable partial denture.20:488-490 2. Advantages of this technique include decreased chair time and treatment cost. Although retrofitting of crowns to existing RPDs has been well documented. General practitioner results up to 2 years. J Prosthodont 2011. Smith FW: A technique for restoring abutments for removable partial dentures. El Wakad MT: Effect of splinting on load distribution of extracoronal attachment with distal extension prosthesis in vitro.40: 398-401 14.36:382-386 12. The construction of accurate full crown restorations for an existing clasp by using a direct metal pattern technique.11:93-94 8.108:143-146 22. Owall B: Precision attachment-retained removable partial dentures. Part 2. J¨onsson L: Precision attachment-retained removable partial dentures. Well-documented clinical studies are required to determine long-term results of this technique.Uludag et al the metal ceramic crown.38:226-228 13. J Prosthet Dent 1977. J Prosthet Dent 2012. Marchack CB. Gordon SR: Making a provisional crown under a clasp of an existing removable partial denture. Ewing JE. Polat S. J Prosthet Dent 1961. Technical long-term study. Uludag. Int J Prosthodont 2009. J Prosthet Dent 1996. J Prosthet Dent 2002. Russel MM: Making a crown fit accurately under an existing removable partial denture clasp assembly. Int J Prosthodont 1995. Rohner U. et al: A technique for fabrication of an extracoronal attachment-retained removable partial denture to fit an existing fixed partial denture. Teppo KW.21: 138-140 4.8:21-28 6. Pilling LO: The restoration of carious clasp-bearing teeth. J Prosthet Dent 2007. and decementation of the fixed components.33:48-50 15.71:206-208 18. J Prosthet Dent 1998.4:249-257 3. Sahin V. J Prosthet Dent 1993.15:309-311 9. El Charkawi HG.87:399-402 20. J Prosthet Dent 1978. no information regarding retrofitting of crowns to existing attachment-retained RPDs has been documented.