A silicone
rubber
of partial
dentures
attachment
Gary R. Goldstein, D.D.S.* Brookdale Dental Center of New York New York, N. Y.
for
primary
University,
College
retention
of
Dentistry,
0
verdentures have become popular as a method for preserving bone and teeth.lm3 As their use increases,new methods for reducing abutment stress,clinic time, and cost are being sought. The Cu-Sil attachment? method is one by which silicone gasketsare processedaround abutment teeth; this method seemsto serve the aforementioned purposes. Silicone gaskets allow for an effective border seal. Food particles are prevented from getting under the denture, and the high yield of the material minimizes lateral forces, making retention of questionable abutments possible.The primary retention is remarkable, and the denture appears to exert little force on the abutment. As major tooth preparation is unnecessary,endodontic and restorative procedures are not required. The denture is essentially tissue-borne. PROCEDURE
(1) Remaining teeth are surveyed and contoured to select a path of insertion similar to that for removable partial dentures. Teeth are modified to achieve an appropriate plane of occlusion, if necessary. (2 ) An impression is made, insuring adequate reproduction of all denture-bearing areas, and duplicate castsare obtained. (3) Centric and vertical relation records and try-in procedures are completed as with removable partial dentures. (4) The denture base is processedin the usual manner. Heat-curing or pour techniques may be used. A 2 mm. clearance for the silicone gasket between the abutment tooth and the base material is required. (5) On the duplicate cast, abutment teeth are lightly scored in the infrabulge area to insure contact of silicone and teeth after processing. *Assistant tDeveloped of Northwest
Professor,
Department
of Removable
by and patent No. 3,716,918 held Dental Laboratories, Inc., Milwaukee,
Prosthodontics. by J. W. Tale, Wis.
P. J. Stoiber,
and L. W. Etzel
Volume Number
36 4
Attachment
for
retention
of
partial
Fig. 1. Only canines remain in the maxillary arch. Occlusal stabilization periodontal therapy. Fig. 2. A, maxillary prosthesis using Cu-Sil attachments is inserted.
dentures
369
is needed prior to
(6) The apertures of the processeddenture (where the natural teeth will come through) are coated with a silicone rubber bonding agent* and allowed to dry. (7) The cast is soaked in water to allow sufficient moisture for curing of the silicone. Gingival crestsaround abutment teeth are lined with two layers of tinfoil to prevent impingement of the gasket on the gingival tissues. (8) The aperture walls of the denture are lined with uncured silicone rubber,? and the base is placed over the model so that the silicone will be molded to the abutments from the gingival margin to the height of contour. (9) The silicone is bench cured for 24 hours. Excesssilicone is removed with a high-speed, coarse, arbor-mounted abrasive disk, Mhich can also be used to taper the gasket to blend with the acrylic resin base. MODIFICATION
OF PROCEDURE
Where the mandibular ridge is small, placement of the gasket may weaken and encourage breakage of the denture base. In this situation, a grooved metal bracing wire is placed in the acrylic resin base before processingto insure strength. The material is easily repaired by coating the silicone and/or resin with bonding agent and by curing more silicone in the region. If the abutment is lost, the gasket is easily removed, and a denture tooth is substituted. Patient history I. A patient with only canines remaining in the maxillary arch required occlusal stabilization prior to periodontal therapy (Fig. 1) . The denture was fabricated and a Cu-Sil attachment placed (Fig. 2). Adequate thickness (Figs. 3 to 5) of the silicone facilitates preservation of the tooth through minimal force transmission. The patient can undergo periodontal therapy, and if one or both abutments
are lost, the silicone
Patient history 2. A patient
can be removed and a denture tooth placed. needing a replacement for an ill-fitting removable
*GE SS-4124 silicone plastics primer, General Electric Company, Cranford, N. J. tGE RTV 108 silicone rubber, General Electric Company, Cranford, N. J.
370
J. Prosthet. October,
Goldstein
Figs. 3 and 4. A minimum lateral forces.
Fig.
5. For
legend,
see Figs.
Fig. 6. An ill-fitting down of remaining
Fig.
7. Recently
thickness
of the
silicone
(arrows)
is necessary
1976
to reduce
3 and 4.
mandibular teeth.
completed
Fig. 8. A mandibular (arrows).
2 mm.
Dent.
removable
restorations
prosthesis
using
partial
denture
contributes
to periodontal
break-
fit well. Cu-Sil
attachments.
The
silicone
should
be 2 mm.
thick
Volume 36 Number4
Fig. 9. A grooved base material.
Attachment
metal
bracing
wire
is present
for
retention
in the lingual
of partial
flange
to prevent
dentures
371
fracture
of the
mandibular partial denture was treated with Cu-Sil attachments (Fig. 6). Kemaining mandibular teeth had been recently restored but were periodontally involved (Fig. 7). A mandibular removable denture using Cu-Sil attachments was fabricated (Fig. 8). The clip b ar was relieved in the denture to avoid excessive forces on the canines, and a grooved metal bracing wire was placed in the acrylic resin of the lingual flange for added strength (Fig. 9).
DISCUSSION The silicone attachment has many advantages over conventional removable partial denture and overdenture techniques: (1) abutment forces are minimized while primary retention is provided, (2) endodontic treatment is not needed, (3) abutment reduction is not required, (4) cast metal restorations are not needed, (5) the attachment is easy to repair or replace, and (6) it is inexpensive. Silicone can be used in conjunction with surgical stents, immediate dentures, treatment dentures for tissue conditioning, or a transitional prosthesis to determine arch form, plane of occlusion, and the vertical dimension of occlusion. The disadvantages of silicone are staining that results from use of tobacco, tea, etc., and absorption of oral flora, especially fungi. These can be overcome by soaking the denture in a glass of water containing one teaspoonful of bleach for yz hour each week. Prolonged soaking will bleach the base and teeth.
CONCLUSION A technique for primary retention of removable partial dentures described. A soft-tissue-borne restoration provides an increase in primary without an increase in forces to the abutment teeth, and the restoration minimal outlay of time and money.
has been retention requires a
References 1.
Loiscll, R. J., Crum, Basis for the Overlay
R. J.: Rooney, G. E., Jr., and Stuever, Denture, J. PROSTHET. DENT. 28: 4-12,
C. H., 1972.
Jr.:
The
Physiologic
372 2. 3.
J. Prosthet. Dent. October, 1976
Goldstein Zamikoff, 1973. Dodge,
I. I.: C.
Overdentures-Theory
H.:
PROSTHET.
Prevention
DENT.
DEPARTMENT
30:
of Complete 403-411, 1973.
OF REMOVABLE
BROOKDALE
DENTAL
and
Technique,
Denture
J. Am.
Problems
by
Dent. Use
Assoc.
86:
853-857,
J.
of “Overdentures,”
PROSTHOWNTICS
CENTER
OF NEW
YORK
UNIVERSITY
COLLEGE OF DENTISTRY 421 FIRST AVE. NEW
N. Y. 10010
YORK,
ARTICLES
Principles, Academy
TO APPEAR
concepts, of Denture
Surgical
Y. Adkins,
A surgeon’s
Porcelain
in prosthodontics-1976
of malignant
maxillary
sinus tumors
Jr., M.D.
view
A. J. Ballantyne,
practices
ISSUES
Prosthetics
management
Warren
Nasser
and
IN FUTURE
of mandibular
resection
and replacement
M.D.
shade
Barghi,
stability
D.D.S.,
after repeated
and Joel Goldberg,
firing
D.M.D.
The comparison of denture-base processing techniques-All-gypsum investment, silicone-gypsum investment, and fluid-resin technique. Parts I and II Curtis M. Becker, D.D.S., B.E., M.A.Sc., Ph.D.
Tissue David
considerations Benson,
Alloplastic Louis
M.S.D.,
tooth
A review Charles
of concepts
of silver amalgam
D.D.S.,
of amalgam D.D.S.,
N. E. M.D.S.
and
Jack
I. Nicholls,
implants
D.D.S.
Microstructure
An evaluation
subperiosteal
M.S.D.,
implants
Kai Chiu Ph.D.
James Taylor,
D.D.S.,
MS.
Ph.D.,
F. Bouschor,
Chan,
E. Smith,
for mandibular
D.D.S.,
J. Boucher,
Dale
M.S.,
of an enzyme Connor,
M.D.&.,
retention
and Jobe R. Martin,
D.M.D.
surfaces John
W. Edie,
denture Charles
M.Sc.,
Ph.D.,
and Daniel
B. Boyer,
D.D.S.,
cleanser M.
Schoenfeld,
D.D.S.,
Ph.D.,
and
Ross
L.
rubber
of partial
dentures
attachment
Gary R. Goldstein, D.D.S.* Brookdale Dental Center of New York New York, N. Y.
for
primary
University,
College
retention
of
Dentistry,
0
verdentures have become popular as a method for preserving bone and teeth.lm3 As their use increases,new methods for reducing abutment stress,clinic time, and cost are being sought. The Cu-Sil attachment? method is one by which silicone gasketsare processedaround abutment teeth; this method seemsto serve the aforementioned purposes. Silicone gaskets allow for an effective border seal. Food particles are prevented from getting under the denture, and the high yield of the material minimizes lateral forces, making retention of questionable abutments possible.The primary retention is remarkable, and the denture appears to exert little force on the abutment. As major tooth preparation is unnecessary,endodontic and restorative procedures are not required. The denture is essentially tissue-borne. PROCEDURE
(1) Remaining teeth are surveyed and contoured to select a path of insertion similar to that for removable partial dentures. Teeth are modified to achieve an appropriate plane of occlusion, if necessary. (2 ) An impression is made, insuring adequate reproduction of all denture-bearing areas, and duplicate castsare obtained. (3) Centric and vertical relation records and try-in procedures are completed as with removable partial dentures. (4) The denture base is processedin the usual manner. Heat-curing or pour techniques may be used. A 2 mm. clearance for the silicone gasket between the abutment tooth and the base material is required. (5) On the duplicate cast, abutment teeth are lightly scored in the infrabulge area to insure contact of silicone and teeth after processing. *Assistant tDeveloped of Northwest
Professor,
Department
of Removable
by and patent No. 3,716,918 held Dental Laboratories, Inc., Milwaukee,
Prosthodontics. by J. W. Tale, Wis.
P. J. Stoiber,
and L. W. Etzel
Volume Number
36 4
Attachment
for
retention
of
partial
Fig. 1. Only canines remain in the maxillary arch. Occlusal stabilization periodontal therapy. Fig. 2. A, maxillary prosthesis using Cu-Sil attachments is inserted.
dentures
369
is needed prior to
(6) The apertures of the processeddenture (where the natural teeth will come through) are coated with a silicone rubber bonding agent* and allowed to dry. (7) The cast is soaked in water to allow sufficient moisture for curing of the silicone. Gingival crestsaround abutment teeth are lined with two layers of tinfoil to prevent impingement of the gasket on the gingival tissues. (8) The aperture walls of the denture are lined with uncured silicone rubber,? and the base is placed over the model so that the silicone will be molded to the abutments from the gingival margin to the height of contour. (9) The silicone is bench cured for 24 hours. Excesssilicone is removed with a high-speed, coarse, arbor-mounted abrasive disk, Mhich can also be used to taper the gasket to blend with the acrylic resin base. MODIFICATION
OF PROCEDURE
Where the mandibular ridge is small, placement of the gasket may weaken and encourage breakage of the denture base. In this situation, a grooved metal bracing wire is placed in the acrylic resin base before processingto insure strength. The material is easily repaired by coating the silicone and/or resin with bonding agent and by curing more silicone in the region. If the abutment is lost, the gasket is easily removed, and a denture tooth is substituted. Patient history I. A patient with only canines remaining in the maxillary arch required occlusal stabilization prior to periodontal therapy (Fig. 1) . The denture was fabricated and a Cu-Sil attachment placed (Fig. 2). Adequate thickness (Figs. 3 to 5) of the silicone facilitates preservation of the tooth through minimal force transmission. The patient can undergo periodontal therapy, and if one or both abutments
are lost, the silicone
Patient history 2. A patient
can be removed and a denture tooth placed. needing a replacement for an ill-fitting removable
*GE SS-4124 silicone plastics primer, General Electric Company, Cranford, N. J. tGE RTV 108 silicone rubber, General Electric Company, Cranford, N. J.
370
J. Prosthet. October,
Goldstein
Figs. 3 and 4. A minimum lateral forces.
Fig.
5. For
legend,
see Figs.
Fig. 6. An ill-fitting down of remaining
Fig.
7. Recently
thickness
of the
silicone
(arrows)
is necessary
1976
to reduce
3 and 4.
mandibular teeth.
completed
Fig. 8. A mandibular (arrows).
2 mm.
Dent.
removable
restorations
prosthesis
using
partial
denture
contributes
to periodontal
break-
fit well. Cu-Sil
attachments.
The
silicone
should
be 2 mm.
thick
Volume 36 Number4
Fig. 9. A grooved base material.
Attachment
metal
bracing
wire
is present
for
retention
in the lingual
of partial
flange
to prevent
dentures
371
fracture
of the
mandibular partial denture was treated with Cu-Sil attachments (Fig. 6). Kemaining mandibular teeth had been recently restored but were periodontally involved (Fig. 7). A mandibular removable denture using Cu-Sil attachments was fabricated (Fig. 8). The clip b ar was relieved in the denture to avoid excessive forces on the canines, and a grooved metal bracing wire was placed in the acrylic resin of the lingual flange for added strength (Fig. 9).
DISCUSSION The silicone attachment has many advantages over conventional removable partial denture and overdenture techniques: (1) abutment forces are minimized while primary retention is provided, (2) endodontic treatment is not needed, (3) abutment reduction is not required, (4) cast metal restorations are not needed, (5) the attachment is easy to repair or replace, and (6) it is inexpensive. Silicone can be used in conjunction with surgical stents, immediate dentures, treatment dentures for tissue conditioning, or a transitional prosthesis to determine arch form, plane of occlusion, and the vertical dimension of occlusion. The disadvantages of silicone are staining that results from use of tobacco, tea, etc., and absorption of oral flora, especially fungi. These can be overcome by soaking the denture in a glass of water containing one teaspoonful of bleach for yz hour each week. Prolonged soaking will bleach the base and teeth.
CONCLUSION A technique for primary retention of removable partial dentures described. A soft-tissue-borne restoration provides an increase in primary without an increase in forces to the abutment teeth, and the restoration minimal outlay of time and money.
has been retention requires a
References 1.
Loiscll, R. J., Crum, Basis for the Overlay
R. J.: Rooney, G. E., Jr., and Stuever, Denture, J. PROSTHET. DENT. 28: 4-12,
C. H., 1972.
Jr.:
The
Physiologic
372 2. 3.
J. Prosthet. Dent. October, 1976
Goldstein Zamikoff, 1973. Dodge,
I. I.: C.
Overdentures-Theory
H.:
PROSTHET.
Prevention
DENT.
DEPARTMENT
30:
of Complete 403-411, 1973.
OF REMOVABLE
BROOKDALE
DENTAL
and
Technique,
Denture
J. Am.
Problems
by
Dent. Use
Assoc.
86:
853-857,
J.
of “Overdentures,”
PROSTHOWNTICS
CENTER
OF NEW
YORK
UNIVERSITY
COLLEGE OF DENTISTRY 421 FIRST AVE. NEW
N. Y. 10010
YORK,
ARTICLES
Principles, Academy
TO APPEAR
concepts, of Denture
Surgical
Y. Adkins,
A surgeon’s
Porcelain
in prosthodontics-1976
of malignant
maxillary
sinus tumors
Jr., M.D.
view
A. J. Ballantyne,
practices
ISSUES
Prosthetics
management
Warren
Nasser
and
IN FUTURE
of mandibular
resection
and replacement
M.D.
shade
Barghi,
stability
D.D.S.,
after repeated
and Joel Goldberg,
firing
D.M.D.
The comparison of denture-base processing techniques-All-gypsum investment, silicone-gypsum investment, and fluid-resin technique. Parts I and II Curtis M. Becker, D.D.S., B.E., M.A.Sc., Ph.D.
Tissue David
considerations Benson,
Alloplastic Louis
M.S.D.,
tooth
A review Charles
of concepts
of silver amalgam
D.D.S.,
of amalgam D.D.S.,
N. E. M.D.S.
and
Jack
I. Nicholls,
implants
D.D.S.
Microstructure
An evaluation
subperiosteal
M.S.D.,
implants
Kai Chiu Ph.D.
James Taylor,
D.D.S.,
MS.
Ph.D.,
F. Bouschor,
Chan,
E. Smith,
for mandibular
D.D.S.,
J. Boucher,
Dale
M.S.,
of an enzyme Connor,
M.D.&.,
retention
and Jobe R. Martin,
D.M.D.
surfaces John
W. Edie,
denture Charles
M.Sc.,
Ph.D.,
and Daniel
B. Boyer,
D.D.S.,
cleanser M.
Schoenfeld,
D.D.S.,
Ph.D.,
and
Ross
L.
