Bull, Tokyo Med, Dent Uni 75 27-287, 10 A NEW CLASSIFIC: ON OF ATTACHMENTS Jamu Nakazawa and Hiroshi AMeMon*! Anstascr rt shea pr ew cin wen fat wep i lity attachets Sto coronal a rai tachment The {tachment ae cl ino the flowing sigh groupe: 1) The pre type tt inttcoogal tachment The streaking type of tacoma tah tent 0) The peeon typeof exacona atachnent. (The se bang ‘pp ofextitoronal sachet. 3) The pron typeof Httaracla tay ene (The re breaking type of naar stacker 1) The pee Sone eto) he wera peo Iymonvenos, Attachments usually consise of two closely fitting metal components, sale and female parts. One of hem is joined to one section of the prosthesis and the other part js set in a yestoration of an abutment tooth forming part of another section of the prosthesis, While they may be applicable 0 connecting (wo sections of a fixed or @ removable prosthesis, their most ‘common application isin joining a removable prosthesis to a fixed restora: “The invention of attachments is an attempt towards concealing the retentive element of 2 removable prosthesis within the body of the buiments oF of the prosthesis, and to replace the clasp with its various tunsitsfctory properties respective 0 hygiene, tooth mobility, caries ssceptibiigy, and aesthetics, Their design should be adapted to the cir Si et Departmen of Prosthetic Deminty (Chie: Prot 1. Naka zn), Scho! of Dentistry, Tokyo Medical and Dental Univerty (Tokyo Ha Shika Daigo, Rectived for pubis, June 4, 1970,famstances under which they may be used, for example, the space in whieh to conceal them, height and width of the abutment crown, depth ‘of preparation, the desirable continuity of a removable splint over several abutments, and also considerations of staies and dynamics of a remo. able dentate, ‘The variability of circumstances makes many specialized attachments exhibiting diverse shapes and function, Owing to the formidable number of ateachments, we cannot assess the relative merits ofall these units and choose the most elective attach- tment when indicted, ‘Therefore, it has been thought advisable to devise 2 classification, Several classifications have been devised, but there is none whieh entirely satisfactory and none which has been accepted for inter national tse." In this paper, the authors propose a new clasifieation Sf attachments. Drsien oF Cxassirscation Any clasication, to be wsetsl, must be based on suifciently broad principles, so thae all the definite characteristics of attachments may be Included in i, ‘The shape of attachmeats forme the bass for elasifcation, but this characteristic alone is not adequate and must be supplemented by the funetion served hy attachments. The present clasication was based fn the following three characteristics of their shape and fonction: (1), Coronal attachments and radicular attachments: Attachments are clasfed according to whether they are used in connection with the crown of a tooth or with the root of a pulples tooth. ‘The former i the coronal attachment and the latter isthe radicular stachment (@) External attachments and internal attachments: ‘They also fall nto two categories of external and internal attachment. External attach rents have parts of all their mechanism outside the sbutment toot, ‘whereas internal attachments take place within the comtosr of a tooth (@). Precision attachments and stresebreaking attachments: AI attach ments possess some form of a joint which when articulated restricts oF limits movement, and may therefore be classed as precision of streak ing. Precision attachments ate designed to prevent movement when fully anticalated, so that they provide a rigid connection hetween two sections ff the prosthesis, In contrast, stresebresking attachments are made 0 permit specific movement when fully articulated, 30 that they allow s certain amount of movement becween two sections of the prosthesis. In any Kind of clasiication, at any one time, a single principle should be used as the bast of division, When, for any reason, the principle is changed, that fact should be indicated, ‘The present claeifeation consists fof thee steps. The fist step is to elasily attachments into coronal andradicular ateachments. The next step is 0 divide the former into intra Coronal and extracoronal attachments, and the latter into intraradicular dnd extraradicalae attachments. Finally, chey are classified into precision types and sresebreaking types (Table 1), [Fr hs: oz Exvosmioy oP Arracnnents wy tate New CLassstexvion ‘rhe authors believe that the present clasificaton will be found more uundestandable if the widely used attachments are classified into these tight groups, and their chit specimens are described and discussed accord ing to it, They ate listed in Table 2 by reletence to reliable textbook, but i¢ is inevitable that error of omission Will occur, because many prac titoeers in diferent countries have invented number of attachments, How ever, our survey indicates that some of them seem to be rather duplications, and hetefore we ssppose, with few exception, the eseenti be mentioned (Table 2), devices will (1). Precision type of intacoronal attachments “The precision type of intracoronal attachments i applied 10 those units that ate placed within the contour of a tooth swown, and making 2 rigid connection between «wo sections of the prosthesis. Majority intracoronal_ attachments Belong &0 the precision ype. ‘The retention provided by this type of attachments primarily depends on frictional surface area of contact between the two parts, Tt is particularly true in inlay clasp attachments, telescopic crowns, channel shoulder pin attach ments, Beyeler attachments, ete» whose retention entivl between the parallel walls of their two parts relies on friction However, retentive features are modified in several kinds of them. Constant insertion sad removal of the prosthesis will cause the attach“ale 2 “The pee clanieaton claifyingataciments ia ght gop Fret if fanmade | Tiny cp attachment, “Felewaple own, Channel sowlicy pin wach Beyeer tachment. Sern despact a | SPH dowel goa half crown, Rrowe-Screso attachment. Gollan sh ment. Supple atacmatt No. 6. Ney hayes attachment. Stem type 7, ahd Sere Gt, Crim tact. Sehtrmane atachent. Her 2. Sheer sping Sa soins FAC ng Taclip 799 attachment. Prema wi ‘Ses ieaking ype of intacoronal sttachinents Pechion dove wast alacant, Sphere joie. Gummer pln be nay a redone af ernacoonal atcha ‘Contac, Morgan ascent Seaprox. Drickenelo ath Po Unig.” Ney spi hngualacacent Spe ponte techni De. Pars atch | nese bade, Fosume bar. Aniiews bat. Stiger and Boitel bat. Dotder ‘Sue aking pe of exracooma sachets | Ney iat extation seer, Stem siearbrakeratachment. Gran cembined wit. rake Cslonh Pe. Surier Sin binge. Hall Ns Inge Cand Ainge. Speedce hinge Her lock Nob inge. D-E Nageype saros taker, Rotatlot jit, Sehrwergelenk nach Gothes. Genk noch ‘ages! vom A. uD. Blagg. Inoue attache. Gerber O97 hinge ble PR Gechice Schamier. Gacy. Hotr stew, Ans conjuncor. Share. ‘eth nach Gerber” Vesa tachment. Ciao atachmen Tetecope (sme Hae) Mono Redutor nach Zc owe te atahnent. Supper attachment No.3 and No. 5. Bey ata ment. Dopfeticherir ach Srny.Gigoldattarhmen Sell xk. Outage Tek Ear bck, Selvaderstagechiebe, Frey jt “asc 52" Roach all aetacimen, Roach fae atchment. Commer rage DMBGelnk. BBS nach beat Miller. Mising link. Eig types of smorabe clip. Kapleatachment” Dro attachment. Nici atachen, Bag [einselh, Type 6 wembresker Ail rotation ot, Finberg attache Peclon type of Ineaadieuar atcha ‘ons QDHA. Gaur aaciot. Geter G6 attachment Cond slide Block.A NEW CLASSINEXTION OF ATEACHMENTS 2s ‘esp post athient Ipwlip 7 tact ‘Ses breaking Pe Perenherwtg mich Soni Norboni. Da G4 wid OP. Anes and Sen Inger stud stachmet, Gerber 26 atackmen, B&G anh, Rodhermann |B pot conear 68 HA and 0.” Roper mah Ber Preckon ype of exzaadicuiyatachmen ‘Seger abd Hotel bats Doler bar ‘Sire braking ype of etardiular attachment jin Glinowe attachment, Ackermann tat Jl ments co wea, 0 that some form of adjustment is utilized in Ney Chayes attachments, Stern type 7, MeCollum attachments, Spc dowel, lingual halé crowns, Brown-Soerensen attaciaments, Gollobin attachments, and so on (Fig. 1}. On the other hand, auxiliary reentive deviees are incorporated jn some attachments 19 provide more Yetenton for a given frictional atea. Many of the devices consist basically of 2 mechanical lock, far example, f springloaded piston on the male pare engaging socket within femate element. This type of arrangement is found in Sherer spring-lock attachments, Steen G/L, Crismani attachments, Schaezmana attachments, ‘tc. Fig. 2). Phe Stn al ig. rg. 2 Besides these, phanger attachments, such as Ipsoclip 788 attachments and Pressomatic units, are employed mainly to increase the retention between the outer remoable crown and the inner core. The Ipsoclip attachment is a springloaded plunger, and the Pressomatic unit is kept ‘under tension with a rubber cartidgeBe |. NAKAZAWA and HL AMEMORE @) Suessbeeaking type of intracoronal attachmer ‘These attachments also have the ewo parts joined in the contour of tooth crown, but they diller from the precision type of ineracoronal atcachmengs in that they allow some movement between two sections of the prosthesis. A small number of intracorenal attachovents fall into this ype The precvion dowel rest attchment has a bowlike occlusal rest seat in the abutment casting for support of the partial denture, and a dimple ‘on the lingual sutfte of the abutment casting forthe purpose of retention (Fig, 8. Us stresebreaking clfece is due to the Mexbilty of che lingual arm engaging the dimple on the abutment casting. The pin-in-thednlay attachment, devised by Cummer, consists of a ring in inlay and a stud attached to the flexible bar of the denture, and permits saddle movement ‘without stain upon the abutment tooth wf (Precision type of extraroronal attachments ‘The precision type of extracronal attachments is defined as the attachments having part or all of their mechanism outside a tooth crows find providing a rigid connection between two sections of the prosthesis. 1 includes three groups ‘The fst group comprises those forming 4 projection from the crown ‘of a tooth, to which the prosthesis is attached, such as Condit attachments, Morgan attachments, and Snap-rox attachments (Fig. 4). The second group are bole units, They are used t0 connect two parts of « sectional denture in the mouth, Bach part of the denture is inerted separately and the pene locks them together with the bole, The last group ate several kinds fof bar units, sich 39 Bennet blade, Fossume bars, and Andrews bats. They consist «sentially of a Bar and one or more sleeves. The bar spans an edentulous area to join together mainly the crowns of abutment teeth, tnd the sleeves connect the denture 16 the bat.(4) Stessbreaking type of extracoronal attachments ‘Thee attachments are designed to be placed outside a tooth crown, and to permie specific movement hetween two sections of the prosthesit ‘when fully articulated, A wide variety of attachments ate included in this group, TThe hist category comprises Stern stresebreaking ateachments, Hruske Getenke, Serini hinges, Crismani combined units, Conod hinges, Gelenke nach I. Reichborn-Kjennerud, Rotation joints, and so on (Fig. 5). These are basically he inseparable joints allowing hinge movement, ‘The second category, the group of separable joint allowing hinge movement, is repre sented by Inoue attachments, Gerber hinge blocks, P. R. Gese nieve, and Holer screws ig. 6), The third category is the joint which allows vertical movement, and is vesiliont or selEteturning by a coil spring. The representatives are Tete scope (Systeme Egert) and Mono-Reductoren nach Zuccli. The fourth ca gory, the now-eslient joint allowing vertical movement, is represented by Toos tube attachments, Suple attachments No. 3 and No. 5, Berry atte ments, Griswold attachments, Shell locks, Ear locks, and. Schrédersta schiebe (Fig. 7) The fh category, the separable joint allowing movement in more1. NAKAZAWA and HL AMEMORI ig. than eo dinections, comprises Roseh ball attachments, Roach lat attach ments, Cammer sagandpin attachments, Dalbo 687 attachments, and [ASC 52 (Fig 8) Finally, the sixth category, the inseparable joint allowing movement in more than two dnections, represented by Kayle attach rents, Dresch attachments, BALESchiléser nach Beat Miller, Biaggi Res Tiensgelenke, BMBGlenke, and Axial totation joins , 4 (6) Precision type of intraradicular attachments ‘The precision type of éntraradicular attachments 15 defined as the wnits that are used with the toot of desitalized tooth, taking place within the contour of a tooth, and providing a rigid connection Between two sections ofthe prosthesis, This group consists of various attachments exhib> ining diverse form, First, several kinds of stod attachments, such as Gerber 686 attachments, Bona 601 A, and Guur attachments, belong to tis type (Fig. ). Their male part consists of a studshaped projection to be soldered to the di pphragim of a post crown, and cheir female part's embedded within the acrylic resin oF soldered to a metal framework of the prosthesis, and fits lover the male putt. Second, serew block systems are good examples of this ‘ype. They join the prosthesis to pulpless roots by screwing, and typified by Corsoran attachments, Heddy attachments, Scaubiger attachments, and Heaska units (Fig. 1) ‘Third, Kelly atachments and Peeso splitpin and tube attachments ae also included. The Kelly atachment consists of two small thimbles,ig. 9. cach closed at one end, and in which one elescopes within the other with tight contact, The inner thimble is soldered co the diaphragm of a post crow, an the outer one is joined to a prosthesis. The Peeso splitpin and tube autachtnent has 4 split eylinder and a tube in the root of a pulpless oot. Fourth, the plunger attachments, for example, the Iproclip 784 attachment, fall frequently within this group, for they can be incorporated in the inner section joined ta a devitalized abutment tooth (Fig. 1). Me sea Hak (Present ascinan Perret ne cee Dye eit (6) Stessbreaking ‘ype of intaradicular attachments ‘These attachments are also used with devitalized roots, an take place ‘within the contour of a tooth, but they ditler from the precision type of innaradicular attachments in that they permit specife movement between two sections of the prosthesis. Most of stud altachments, sich as Gerber {696 adtachments, Bona 604 and 604 P, Rothermann units, Anderes and Schonenburger stud attachments, BC anchars, and Verenkeriagen mack Sandri-Nerboni, belong to this type (Fig. 12) (Precision type of extraradicular attachments “The precivien type of extratadicular attachments i dessibed as being used wih the roots of devitalized teeth, having a part or all of its mech anima outside the contour of a tooth, and preventing movemene between two sections of the prosthesis. 1 is represented by the bar units, sich ss Steiger and Boitel bars, and Delder bar units (Fig. 18}. Theie barspans edentulous area Lequently between the 1001 of pulpless teeth, although they are also used with the crowns of teeth, and their Ushaped sleeve fits over the bar to provide a vigid connection. (8) Stessbreaking type of extraradicular atachinents These attachments ate also used with the devitalized root, and have a part or all of their mechanisms outside the contour of a tooth, but dey allow a certain amount of movement beeween two sections of the prosthesis Bar joints belong to this type (Fig. M). They act as splins, span the edentulous regions to join «wo or more pulpless roots, Dolder bar joints permit vertial and rotational movements, but Gilmore attachments and Ackermann bar attachments, if they are bent to an antero-posterior ‘curve, might allow only a slightly rocking motion. Concresivr Resianss ‘One of the requisites for a good classification is that it must be easied ‘out 10 a poine beyond which further classification is impossible, bn the abovementioned classification, each group can be further divided into appropriate subgroups on the basis of some principle different from each‘ther, but i¢ cannot be done on the basis of a common principle In several kinds of attachments, itis dificult to determine in which sroup they should be placed, for ie may depend on the manner in which they are used, The Steiger and Boitel bat, and the Dolder bar unit are included in extearadicular attachments when they are used with the root Df pulpless tooth, but wed with the tooth crown, they belong to extra coronal attachments, Another example i found in the intracoronal attach iments, such as the Ney Chayes attachment and the McCollum attachment ‘which cam be used extracoronally in splicpontic technique. They are cated jn an artificial tooth cantilevered from the splinted abutments. In these attachments, each case should be determined separately. 11s thonght that this elasication satisfies practical requitements of aan acceptable method of clasifeation, but it show stand the test of years of succesful applicaion, Reveneners $) Kay, 6-12 Poon aha Pn ik So ned, el 5 5} Prsbeo|.M Pwn ny eo Mot el Paling Co, chia o) Micah] Onna i MMos tat ge Dil Heme Tse 11) Nabsaves, Ls Bbansogubigat (arial dents in Japan), Ngan abot,