INTRODUCTION
Gillete gave the first semi-precision attachment in 1923.[1] The preservation of teeth instead of extractions to support an attachment retained fixed or removable prosthesis is a suitable treatment option. Prefabricated attachments are routinely preferred as they are more precise. In many cases, due to cost factor and unavailability of the exact size of the attachment required, it is difficult to use prefabricated attachments.[2] Berksun used custom-made attachment and found it to be easy to fabricate and cheaper with sufficient retention and stabilization of the prosthesis.[3]
In case of long-span bridges and pier abutment cases, precision attachment is must in an attempt to reduce the stresses on to the abutment tooth. Many a time, due to the cost of the precision attachments, patients are unable to afford these treatment modalities. This case report describes a novel technique of the fabrication of semi-precision attachment using a pen refill and sprue wax for long-span fixed partial denture (FPD) in a very cheap cost and with good fit and accuracy.
CASE REPORT
A patient aged 56 years reported to the department of prosthodontics for replacement of his missing teeth. The patient gave a history of caries and extraction for the loss of his tooth. On examination, it was found that 15, 21, 22, 24, and 26 teeth were missing. On radiographic and clinical examination, it was found that the abutments had good bone support and had no mobility. The patient was explained about the removable partial dentures, implant-supported fixed prosthesis, and tooth-supported FPDs as the different treatment options available. The patient agreed for FPD and it was decided to incorporate a custom-made semi-precision attachment for the fabrication of long-span FPD with 11, 21, 22, 23, 24, 25, 26, and 27. A novel technique for the fabrication of semi-precision attachment using a pen refill and sprue wax was done in an attempt to reduce the cost and to obtain good fit and accuracy.
The abutment teeth 11, 22, 24, and 27 were prepared [Figure 1] following the proper tooth preparation guidelines to receive porcelain fused to metal (PFM) bridge. After tooth preparation, gingival retraction cords were placed to obtain the adequate retraction. The impression was made with putty wash two-step technique with polyethylene spacer, using a stock tray. The impression was poured with dental stone (type IV, Kalrock, Kalabhai Karson, Mumbai, India) to obtain a final cast on which wax pattern was fabricated.
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Figure 1: Mirror image of prepared abutment teeth
The mesial half of the wax pattern of FPD was fabricated and a pen refill 3 mm in length to be used as a female component of the attachment was attached to the pattern in distal aspect of pier abutment. The internal surface of the refill was lubricated and a very thin wooden tooth pick coated with inlay wax was placed inside the refill to form the male component and distal half of the wax pattern for the FPD was completed. The two half of the pattern was removed and both male and female components of the attachment were inspected carefully [Figure 2]. Mesial and distal half of the pattern was again placed together and checked for fit and accuracy [Figure 3].
Figure 2: Wax pattern with refill attached to form female component and wooden stick coated with inlay wax formed male component
Figure 3: Mesial and distal half of pattern attached together
Casting of both halves of the pattern was done separately as per the standard recommended procedures. The finishing and polishing of the FPD substructure was done. Try in of the FPD substructure was done in the patient's oral cavity and checked for fit and accuracy of the attachments [Figure 4]. Porcelain buildup was done on the substructure to fabricate the final bridge. The trial of the PFM bridge with semi-precision attachment was done to check the accuracy. Occlusal corrections were done and finally the FPD was cemented in the oral cavity with resin-bonded glass ionomer cement (GC Fuji Plus, Alsip, United States) [Figure 5].
Figure 4: Mirror image of try in of fixed partial denture superstructure
Figure 5: Final prosthesis cemented in oral cavity
The recall checkup was done after 3 days, 1 month, and 6 months. The patient was very happy with the treatment given. He reported improved mastication, esthetics, and speech. The semi-precision attachment given was functioning very well and no food lodgment and any other problems reported. The patient has given his consent to publish this novel case report in the scientific journals.
DISCUSSION
There are various prosthetic treatment modalities for the rehabilitation of partially edentulous arches. Retention and stability are two important factors, which poses technical challenge to the prosthodontist to rehabilitate partially edentulous patients.[4]
Precision attachments had opened a new perspective for rehabilitation of missing teeth in prosthodontic. There are various precision attachments available in different sizes, configuration, and shape to be utilized in various clinical situations.[5] In case of pier abutment, if rigid connectors are used, it acts as a fulcrum during occlusal loading. When load is applied on the abutment tooth at one end of a fixed dental prostheses (mainly the posterior retainer), then forces will be released in between the abutment and the retainer at the other end of the prosthesis (anterior retainer). These cause loss of retention due to extrusive forces and may result in marginal leakage and caries of the abutment. Hence, in such clinical cases, nonrigid connectors are must to avoid complications and prosthesis failure.[6]
Precision attachment is expensive and increases the overall cost of the treatment.[7] In this case report too, the same problem arises and the patient was not ready to bear the cost of fixed dental prosthesis along with precision attachment. It was decided to give semi-precision attachment (custom made) to the patient to reduce the cost of the prosthesis. The semi-precision attachment was made using a pen refill and sprue wax for long-span FPD in a very cheap cost. It has also provided excellent result with good fit and accuracy. This novel technique has provided an alternative treatment modality in long-span bridges, where the patient cannot afford the high cost of precision attachments.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
REFERENCES
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