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Passively retained precision attachment partial dentures have been used successfully on natural tooth abutments since the 1920s. However, the dental profession has not advocated their use with implant abutments. When used in the passive manner that has proven successful on natural tooth abutments, precision attachment cases on implant abutments can be an excellent treatment option. This type of case has been used successfully for more than 17 years and offers tremendous advantages over the conventional overdenture approach to removal restorations on implant abutments.
Key Words: precision attachments, double tilt, implants
INTRODUCTION
Dr Per-Ingvar Branemark, the originator of the osseointegrated implant, has long recognized the need for finding new alternatives to restore the dental arches with implants. ''For those patients who have difficulties in accepting and functioning with a mechanically unstable prosthetic replacement for lost structure and function,'' he noted, ''solutions certainly still remain to be found. The decisive prerequisite is how to identify for each individual patient, an adequate, reliable and affordable therapeutic alternative that can be realistically provided in his or her entire life-present and future.''1
When fixed bridgework cannot be made on implants, most practitioners generally make overdentures on the implant abutments. In fact, the entire approach to making implant restorations has been adapted from denture procedures, rather than from crown and bridge procedures. Dentures on implants have shortcomings that can be circumvented with a solution adapted from crown and bridgework: the precision attachment case.
Precision attachment partial dentures can be combined with implants to ideally restore the upper and lower arches. The precision attachment case is also an excellent solution for difficult restorative problems that cannot be restored with fixed bridgework.
MATERIALS AND METHODS
Background: precision attachment cases on natural teeth
The precision attachment partial denture case has enjoyed a long track record of success on natural tooth abutments. Examination and follow-up of more than 1500 cases during a 50-year period by Drs Elliot and Edward Feinberg overwhelmingly demonstrate that precision attachment cases offer one of the most successful approaches to removable partial denture therapy.2 These cases were all created according to the same basic principles, even though the materials differed. The basic principles include full shoulder preparation of the abutment teeth, a 3-dimensional approach relating the preparations to the...