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Nonrigidconnector:Thewandtoallaythestressesonabutment

ContempClinDent.2011OctDec2(4):351354.

PMCID:PMC3276866

doi:10.4103/0976237X.91802

Nonrigidconnector:Thewandtoallaythestressesonabutment
SauravBanerjee,ArlingstoneKhongshei,TapasGupta,andArdhenduBanerjee
DepartmentofProstheticDentistry,Dr.R.AhmedDentalCollege,Kolkata,India
Correspondence:Dr.SauravBanerjee,BK10,Sector2,SaltlakeCity,Kolkata700091,WestBengal,India.Email:drsauravb@rediffmail.com
Copyright:ContemporaryClinicalDentistry
ThisisanopenaccessarticledistributedunderthetermsoftheCreativeCommonsAttributionNoncommercialShareAlike3.0Unported,whichpermits
unrestricteduse,distribution,andreproductioninanymedium,providedtheoriginalworkisproperlycited.

ThisarticlehasbeencitedbyotherarticlesinPMC.

Abstract

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Theuseofrigidconnectorsin5unitfixeddentalprosthesiswithapierabutmentcanresultinfailureofweaker
retainerinthelongrunasthepierabutmentactsasafulcrum.Nonrigidconnectorplacedonthedistalaspectof
pierseemstoreducepotentiallyexcessstressconcentrationonthepierabutment.
Keywords:Matrix,nonrigidconnectors,patrix,pier
Introduction

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Connectors,theportionofafixeddentalprosthesisthatunitestheretainer(s)andponticareconsideredas
heartthrobofabutments,sinceunderocclusalloadmaximumstressesareconcentratedonthem.Selectionofthe
righttypeofconnectorcanmakearealdifferencebetweensuccessandfailure.Wearemoreaccustomedtotheuse
ofrigidconnectorinclinicalpracticesinceitsplacementrequiresminimumtechnicalandlaboratoryexpertise.The
realproblemariseswhenweencounter5unitfixeddentalprosthesis(FDP)withapierabutment.Teethindifferent
segmentsofthearchmoveindifferentdirections.Becauseofthecurvatureofthearch,thefaciolingualmovement
ofanteriortoothoccursataconsiderableangletothefaciolingualmovementofmolartooth.Thesemovementscan
createstressesontheabutmentsinlongspanprosthesis.Anonrigidconnector,astressbreakingmechanicalunion
ofretainerandpontic,isusuallyrecommendedinsuchsituation.[16]
CaseReport

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A26yearoldmalepatient[Figure1]reportedtotheDepartmentofProstheticDentistrywithmissingteeth#14and
#16,andhehaddifficultyinchewingandestheticproblems.Onexaminationitwasfoundthatthepatienthad
canineguidedocclusionbilaterally.Carieswasfoundin#24,whichwaslaterextractedandanFDPwas
fabricated.Radiologicallyandclinically,theabutmentteethwerehavingfavourablecriteria.Afterdiscussingallthe
treatmentoptionsandtheirprosandcons,itwasdecidedtorehabilitatethecasewith5unitFDPusingnonrigid
connectorsonthedistalaspectofpierabutment.Asemiprecisionattachmentnamedplasticdovetail(Sterngold
Attachments,Attleboro,MA,USA)[Figure2]wasselectedinthiscase.Ithadfrictionalretention,plasticpattern
maleandfemale,withbuiltinparallelingmandrels.
Figure1
Intraoralpreoperativeview

Figure2
Semiprecisionattachmentplasticdovetail
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Nonrigidconnector:Thewandtoallaythestressesonabutment

Fixation:Male/patrixcastaspartofponticpatternfemale/matrixcastaspartofcrownpattern.
Spacerequirements:height2mm,preparationdepth2mm,width2.6mm.
Procedure

1. Toothpreparationswerecompleted[Figure3]andimpressionwastakenwithpoly(vinylsiloxane)
impressionmaterial.
Figure3
Toothpreparation

2. Waxpatternwasfabricatedandrecessforthefemalewascutaccordinglytofittheplasticdovetailon
distalaspectofpierabutment.
3. Surveyingwasdonetodeterminetheposition/parallelismofplasticdovetail[Figure4].
Figure4
Surveyingdonetochecktheparallelism

4. Plasticdovetailfemalewasplacedwithinthecorrectcontouroftheabutmenttooth.Malepatternwas
removedfromthefemalepattern,keepingtheinsideoffemalepatternfreeofwax.Anyextensionofthe
femalepatternabovetheocclusaloftheabutmentwasleftremaining.
5. Afterinvestingandcasting,excessheightofthefemalewasreduced,metaltryinofthepartwiththe
matrix/femalewasdone[Figure5].
Figure5
Metaltryinofthepartwiththematrix

6. Male/patrixpatternwasseatedinthecastedfemale.Adjacentponticandabutmentwerewaxedupandthe
mandrelwascutofffromthemale[Figure6].Castingofthemalepatternwascontemplated.
Figure6
Waxpatternofpatrix

7. Nowmatrixandpatrixwereassembledtogether[Figure7].
Figure7
Matrixandpatrixassembledtogether

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8. Ceramizationwasdoneon#13,#14andbuccalfacingwasdoneon#15,#16,and#17.Theprosthesis
wascementedwithglassionomercement[Figures810].
Figure8
Postoperativeviewinsmile

Figure10
Postoperativeocclusalview

Figure9
Postoperativeintraoralbuccalview

Discussion

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Withrigidconnectors,anocclusalloadappliedontheabutmenttoothatoneendofanFDP(mainlythemolar
retainer)withapierabutment,thepiermayactasafulcrum.Tensileforcesmaythenbegeneratedbetweenthe
retainerandabutmentattheotherendoftherestoration(inthecanineretainer).Anteriororposteriorabutments
mayexperienceextrusiveforceandtheresultanttensileforceattheretainertoabutmentinterfacemayleadto
potentiallossofretentionfortheserestorations,thusresultinginmarginalleakage,cariesofabutment,andFDP
failure.[16].Nonrigidconnectorisusuallyrecommendedinsuchasituation.
Thereisaconflictingopiniononwheretoplacethenonrigidconnector.Markley[1]suggestedplacementonone
oftheterminalabutmentsandnotatthepierabutment.Adams[2]suggestedplacingtheconnectoratthedistalside
ofpier,andifdesired,addingonemoreatthedistalsideoftheanteriorretainer,whileGill[3]suggestedplacingitat
onesideorbothsidesofthepier.
Shillingberg[4]suggestedplacingtheconnectoratthedistalaspectofpierabutment.Sincethelongaxisofthe
posteriorteethusuallyleansslightlyinamesialdirection,verticallyappliedocclusalforcesproducefurther
movementinthisdirection.Thiswouldnullifythefulcrumeffectandthepatrix/maleoftheattachmentwouldbe
seatedfirmlyinplacewhenpressureisapplieddistallytothepier.Thispositionhasbeensupportedbyfinite
elementanalysisstudy[5]donebyOrucetal.Inthiscase,wehaveplaceditondistalaspectofthepier.
Thecontraindicationsofusinganonrigidconnectorinaposterior5unitFPDwithapierareasfollows:
1. Significantmobilityofabutments.
2. Ifthespanbetweentheabutmentsislongerthanonetooth.
3. Ifthedistalretainerandponticareopposedbyaremovablepartialdentureoranedentulousridge,while
thetwoanteriorretainersareopposedbynaturaldentition,allowingthedistalterminalabutmentto
supraerupt.[46]
Conclusion

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Thebonhomieofrigidandnonrigidconnectorscanincreasethelifespanofanabutmentin5unitFDPsasit
transferslessstressontheabutments.Also,allowingphysiologictoothmovement,iteliminatesanyhindranceas
againstafixedrestorationwithallrigidconnectors.Asmallamountoftimespentcanbeamiracleinthelongrun.
Theselectionofrighttypeofconnectorisanimportantstepwhensortingtreatmentplan.
Footnotes

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SourceofSupport:Nil.
ConflictofInterest:Nonedeclared.
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References

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[PubMed]
2.AdamsJD.Planningposteriorbridges.JAmDentAssoc.195653:64754.[PubMed]
3.GillJR.Treatmentplanningformouthrehabilitation.JProsthetDent.19522:23045.
4.ShillingburgHT,Jr,HoboS,WhitsettLD,JacobiR,BrackettSE.3rded.Chicago:Quintessence1997.
Fundamentalsoffixedprosthodonticspp.85118.
5.OrucS,EraslanO,TukayHA,AtayA.Stressanalysisofeffectofnonrigidconnectorsonfixedpartialdentures
withpierabutments.JProsthetDent.200899:18592.[PubMed]
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ArticlesfromContemporaryClinicalDentistryareprovidedherecourtesyofMedknowPublications

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