High Retention Hybrid Bar Attachment Metal Based Dentures For
Comestic Defects Implants
The use of teeth as overdenture abutments is beneficial to
patients. The psychological aspect of patients losing teeth should
not be underestimated and this has been well documented.13 Careful selection of strategic abutment is important. The decision
must first be made to retain the teeth as overdenture abutments and
then the attachments should be planned. The attitude of the patient
to the treatment should be assessed. Only those who understand the
limitations and benefits of attachments should be treated with
attachment retained overdentures. Hence, patient selection is
critical to the success of the treatment.
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Tooth-borne overdenture bar attachment therapy is a treatment
option rarely chosen in today’s aggressive marketing of implant
treatment.14 Most of the reported cases in the literature on the combination of
bar and O-ring attachment overdentures are implant supported.15,16 In the reported literature,17–21 tooth supported overdentures are retained by stud attachments and
there are very few reports with regard to bar/clip attachment.22,23 The use of bar and O-ring attachment is very rare for the tooth
In the present report, a bar and O-ring retained mandibular denture
was fabricated. The O-ring attachment used was basically the
implant prosthetic component. The O-ring is functionally classified
as a resilient attachment. It does not transfer forces to the root
and only acts as a retentive devices. Hence, the O-ring system is
considered to be the best attachment that acts passively on the
remaining abutment teeth.24 It also provides adequate retention, is easy to insert/remove and
is comfortable for the patient. There are however, some
disadvantages such as the gradual loss of retention due to the wear
of O-rings, and the need for periodic replacement. Rodrigues et al25 conducted a study to evaluate the retention force of an O-ring
attachment system at different inclinations to the ideal path of
insertion. They concluded that O-ring studs perpendicular to the
occlusal plane were adequately retentive over the first year and
that the retentive capacity of the O-ring was affected by stud
inclinations. The O-ring studs were perpendicular to the occlusal
plane. A surveyor was used for this reason, and the studs were
placed parallel to each other without any inclinations.
A bar attachment was used since this provided the splinting
mechanism between the overdenture abutment teeth which stabilized
and strengthened the abutment teeth. The bar also allowed the
forces of mastication to be shared by the abutment teeth.12,26 Various bar attachment methods are used for overdenture bar
fabrication.12,27–28 But since the bar was used to connect the abutment teeth and not to
retain the clip on it, a 2 mm round sprue former was used for bar
fabrication. The bar and stud framework was luted to the teeth
using adhesive cement. An intra-canal dowel extension was not used
for the copings since the teeth were not parallel.
One of the O-ring studs was placed on the distal aspect of the
right lateral abutment and another was placed mesial to the left
lateral abutment. Since the bone support on the distal aspect of
the left lateral abutment was compromised, the stud was placed
mesially so as to prevent the forces of insertion/removal
endangering the abutment. In the present clinical situation, there
was 21 mm of inter-occlusal clearance. Hence the stud attachment
was incorporated above the bar on the mesial aspect of the left
The bar was contoured and the intaglio surface of the prosthesis
was relieved. This allowed freedom of movement for the O-ring
attachment when the denture base moved slightly.
The bar and O-ring retained overdenture showed good retention. The
patient was pleased with the treatment and was satisfied with the
esthetics and function of the denture. Homecare hygiene
instructions and dietary advice with regard to caries control were
reinforced. The patient was advised to clean the bar and attachment
with a interdental tooth brush using warm salt water. Initially,
follow-up was once a week for a month. Later evaluation was done
once in every 6 months. At the time of follow-up, routine
maintenance such as oral prophylaxis was carried out. The denture
has been in use for 2 years now without any problems and the
patient is extremely pleased with it.