Application of cast magnetic attachments to sectional complete dentures

for a patient with microstomia: A clinical report

Ikuya Watanabe, DDS, PhD,a Yasuhiro Tanaka, BS, MS,b Chikahiro Ohkubo, DMD, PhD,c and
Amp W. Miller, DDSd
Baylor College of Dentistry, Texas A&M University System Health Science Center, Dallas, Tex.,
and Nagasaki University School of Dentistry, Nagasaki, and Tsurumi University, School of
Dental Medicine, Yokohama, Japan
Patients with microstomia who must wear removable dental prostheses often state that they are unable
to insert or remove the prosthesis because of the constricted opening of the oral cavity. This article
presents a cast iron-platinum magnetic attachment system applied to sectional collapsed complete den-
tures for an edentulous patient with microstomia. With the use of lingual and palatal midline hinges
and a cast iron-platinum magnetic attachment, the sectional prosthesis was successfully and easily in-
serted and provided adequate function in the patient’s mouth. (J Prosthet Dent 2002;88:573-7.)

M icrostomia is often a sequela of burns, postoper-

ative head and neck trauma, surgical resection of facial
and oral neoplasms, and scleroderma.1 Patients with mi-
crostomia who must wear removable dental prostheses
often complain of an inability to insert or remove the
prosthesis because of the constricted opening of the oral
cavity. There have been several reports regarding the
fabrication of removable prostheses for patients with mi-
crostomia. Some treatments include the use of Co-Cr
frameworks with clasps to hold sectional complete den-
tures,2,3 the use of a sectional complete denture joined
by a post that slides into stainless steel tubing,4 and the
use of cast Co-Cr hinges and swing-lock attachments for
removable partial or complete dentures.5,6 There are few
reports of sectional complete dentures with dental mag-
netic attachments. Matsumura and Kawasaki7 used a
dental magnetic attachment for a sectional removable
partial denture for a patient with a severe undercut re-
sulting from ablative tumor surgery. They considered
the magnetic retention system to be clinically useful for
interrelating and retaining a segmented sectional pros-
thesis.
Currently, there are several commercially available
magnetic attachment systems for use in clinical den-
tistry. However, not all of the commercial magnetic at-
tachments are suitable for certain types of treatments. It
has recently been found that Fe-Pt alloys have magnetic
properties,8 and they have been investigated for possible
application to dentistry.9 Watanabe et al10,11 developed
this custom-made Fe-Pt magnetic attachment system
a
Assistant Professor, Department of Biomaterials Science, Baylor
College of Dentistry.
b
Research Associate, Department of Dental Materials Science, Na-
gasaki University School of Dentistry.
c
Instructor, Department of Removable Prosthodontics, Tsurumi Uni-
versity.
d
Professor, Department of Restorative Sciences, Baylor College of
Dentistry.
and reported that the cast Fe-Pt keeper yielded great
attractive force to a dental Fe14Nd2B magnet.10 Fur-
thermore, Fe-Pt alloys exhibit excellent corrosion re-
sistance because they contain a large amount of plat-
inum (approximately 70 wt%).11 Because they can be
cast in a dental casting machine, any size or shape of
castable magnetic attachment can be fabricated for pros-
theses. The cost of platinum for custom magnetic cast-
ings is comparable to the cost of commercially available
magnetic prosthetic components. Clinical indications
include magnetic retention for conventional intraoral
dental prostheses and intraoral or extraoral maxillofacial
prostheses. Implant-retained maxillofacial prostheses of-
ten have anatomically confounding factors that require
custom castings to align prosthetic retentive compo-
nents, allowing a favorable path of insertion. The cus-
tom-cast Fe-Pt magnetic attachment, therefore, has a
variety of custom applications compared with the com-
mercially available dental magnetic attachment.
This clinical report describes the use of cast Fe-Pt
magnetic attachments to treat an edentulous patient
with microstomia induced by scleroderma.
CLINICAL REPORT
A 67-year-old edentulous woman with microstomia
induced by scleroderma was seen for prosthetic evalua-
tion (Fig. 1). The diameter and circumference of her
mouth were approximately 32 mm and 95 mm, respec-
tively. The patient had extremely small complete den-
tures that were unserviceable, and she refused to un-
dergo surgical enlargement of the mouth aperture.
Preliminary impressions for both dental arches with
the use of 2 stock impression trays of each half of the
mouth, fabrication of sectional custom trays for the final
impressions, border molding, and final impressions were
accomplished according to a previous report.6 The max-
illomandibular relationship was recorded with sectional
collapsed occlusion rims fabricated with autopolymeriz-

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Fig. 1. Diameter and circumference of patient’s mouth were
approximately 32 mm and 95 mm, respectively, because of
scleroderma.
Fig. 3. Co-Cr metal frameworks that collapse with use of
lingual and palatal midline hinges.
ing PMMA resin (tray resin; Shofu Inc, Kyoto, Japan),
commercial dental magnetic attachments (Hicorex
4513; Morita Corp, Kyoto, Japan), and clip hinges
(binder clip 36; Kokuyo, Osaka, Japan). The master
casts were mounted on an average-valued articulator
(Dental Hobby; Shioda Co Ltd, Tochigi, Japan), and
the artificial teeth (Endura; Shofu Inc) were convention-
ally arranged. The trial dentures could be sectioned and
collapsed as shown in Figure 2. The anterior segments
included artificial incisors and canines and could be con-
nected to the posterior segments with dental magnetic
attachments. The posterior segments could be collapsed
with the use of hinges located at the center of the den-
ture bases. The correct maxillomandibular relationship
was confirmed in the patient’s mouth by using the max-
illary and mandibular sectional collapsed trial dentures.
Placement and removal of the trial prosthesis were dem-
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WATANABE ET AL
Fig. 2. Sectional collapsed trial dentures fabricated with clip
hinges and dental magnetic attachments.
Fig. 4. Cast Fe-Pt magnet with concave design.
onstrated and, with practice, were easily accomplished
by the patient.
Each denture was composed of 1 anterior and 2 poste-
rior segments. Anterior segments included artificial inci-
sors, both canines, and cast Fe-Pt magnets (Fe:30.1%, Pt:
69.3%, Nb:0.6%). Posterior segments included bilateral
premolars, molars, and cast Fe-Pt keepers (Fe:33.7%, Pt:
66.3%).Cast Co-Cr (Partial Denture Alloy; Jelenko, Ar-
monk, N.Y.) (Co: 63.0%, Cr: 28.5%, Mo: 6.0%) metal
frameworks were fabricated for all segments except for an
anterior segment of the mandibular denture. The Co-Cr
metal frameworks in the posterior segments could be col-
lapsed with the use of lingual and palatal midline hinges
(swing-lock attachment; Idea Development Co, Dallas,
Texas) that allowed for insertion into the mouth (Fig. 3).
The anterior segments could be connected to the posterior
segments by means of the Fe-Pt magnets and keepers.
VOLUME 88 NUMBER 6
WATANABE ET AL
Fig. 5. Sectional collapsed complete dentures.
The wax pattern for the left half of the Co-Cr frame-
work was fabricated on a phosphate-bonded refractory
cast (Snow White; Shofu Inc), and the plastic pattern of
the concave hinge cylinder was embedded at the lingual
or palatal midline of the framework wax pattern. The
half pattern of the framework and hinge were cast with
the Co-Cr alloy by use of a vacuum-induction casting
machine (Argon Caster; Shofu Inc). After the cast
framework of the left half was polished, the complete
framework was replaced on the master cast. The wax
patterns for the right half of the framework and convex
hinge were fabricated on the refractory cast, in which the
left half of the framework was embedded, and then cast
with the Co-Cr alloy. This procedure followed the man-
ufacturer’s instructions for fabrication of the swing-lock
attachment hinge.
A pattern for the anterior segment of the maxillary
denture of the Co-Cr framework was made on the
polished Co-Cr framework, seated on the master cast,
and cast separately. The polished Co-Cr framework
was replaced on the master cast, and the Fe-Pt keeper
patterns were then fabricated. They were invested in a
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THE JOURNAL OF PROSTHETIC DENTISTRY
mold with a magnesia-based investment (Titavest CB;
Morita Corp) and cast from a custom-made Fe-Pt
ingot with the use of a high-frequency centrifugal
casting machine (Jelenko Eagle; Jelenko). The wax
patterns for cast Fe-Pt magnetic attachments were
designed to be convex for the keeper and concave for
the magnet components (Figs. 3 and 4). This conca-
vo-convex design allowed for rigid connection of the
anterior segment to the posterior segment. The pat-
terns of the Fe-Pt magnets were made on the polished
cast Fe-Pt keepers on the master cast and fabricated in
the same manner as the Fe-Pt keepers. Figure 4 shows
the Fe-Pt magnets after casting. The Fe-Pt keepers
and magnets underwent heat treatments according to
procedures reported by Watanabe et al.10,11 The Fe-Pt
magnets were magnetized with the use of a magne-
tizer (MSD-200-3500P; Nihonkokan, Tokyo, Japan)
after heat treatment. The cast Fe-Pt keepers were then
laser-welded (TLL7000; Tanaka Laser Co, Tokyo, Ja-
pan) to the Co-Cr framework (Fig. 3). After prepara-
tion of the Co-Cr frameworks and Fe-Pt magnetic
attachments, denture-base PMMA resin (New Mod-
575
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Fig. 6. A, View of maxillary complete denture before sectioning and collapsing. B, Insertion of collapsed posterior segments.
C, Insertion of sectioned anterior segments. D, Frontal view of patient after insertion of maxillary and mandibular dentures.
ern Core; Sankin, Tokyo, Japan) for the anterior and
posterior segments was polymerized separately in ac-
cordance with the manufacturer’s directions. The cast
Fe-Pt magnets were embedded in the anterior seg-
ments when the base resin was polymerized. Figure 5
shows the complete dentures, which could be sec-
tioned and collapsed with the use of the lingual and
palatal midline hinges and the Fe-Pt magnetic attach-
ments.
The patient was given home care instructions regard-
ing the operation of the sectional collapsed complete
dentures. Because it was impossible for her to deliver the
dentures into the mouth without sectioning and collaps-
ing (Fig. 6, A), the collapsed posterior segments were
first inserted into the mouth (Fig. 6, B). The sectioned
anterior segments were then inserted and connected
to the posterior segments as shown in Figure 6, C.
Figure 6, D, shows a frontal view of the patient after
placement of the maxillary and mandibular sectional col-
lapsed complete dentures.
DISCUSSION
Fe-Pt dental magnetic attachments are clinically
useful for retention of prostheses because of their ex-
cellent attractive force. As the attachment keeper is
placed onto the root canal of the abutment tooth or
implant abutment, the size of the keeper and its mag-
net is circumscribed by the size of the abutment tooth
or implant abutment. Several sizes of magnets and
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WATANABE ET AL
keepers are available in prefabricated, commercial
dental magnetic attachment systems. However, pre-
fabricated magnetic components are designed to be
“flat on flat” to allow easier displacement by a force
parallel to the flat connection plane. Because the
Fe-Pt magnetic attachment system (magnet and
keeper) can be cast in a dental casting machine, any
size or shape of castable magnetic attachment can be
fabricated for prostheses. In this situation, convex wax
patterns were designed for the keeper and concave
patterns for the magnet (Figs. 3 and 4). This concavo-
convex design rigidly connects the anterior segment
to the posterior segment and prevents wear of the
magnetized components and stress concentration at
the lingual and palatal midline hinge during mastica-
tory functions. This design also prevents denture de-
flection and may minimize the possibility of breakage.
The Fe-Pt magnetic attachment (magnet and
keeper) must be heat-treated in order to have mag-
netic properties after casting. These magnetic proper-
ties can be achieved as a result of the order-disorder
phase transformation of the binary Fe-Pt alloy sys-
tem.9 Fe-Pt keepers require solution heat treatment
to produce disordered Fe-Pt atoms, whereas ordered
Fe-Pt magnets can be made by using an aging heat
treatment after solution treatment. The Fe-Pt magnet
then must be magnetized to arrange the magnetic
direction of the ordered Fe-Pt atoms. After magneti-
zation, heat sources such as soldering and brazing can
VOLUME 88 NUMBER 6
WATANABE ET AL
reduce the magnetic properties, resulting in a de-
crease in the attractive force between the Fe-Pt mag-
net and keeper. Therefore, laser welding (Fig. 3) is the
most favorable method of welding the Fe-Pt magnet
or keeper to the other alloys. Because laser energy can
be concentrated on a small area, there are fewer effects
of heating and oxidation on the area surrounding the
spot to be welded.12 If Fe-Pt magnets lose magnetic
properties after clinical use because of a surrounding
magnetic field, they can be remagnetized to restore
the attractive force without any damage to the den-
ture components.
The magnetically connected sectional prosthesis de-
scribed in this clinical report was convenient for this
patient in terms of insertion/withdrawal, and it has
functioned very well for 2 years. No visible fracture or
wear has been observed in this magnetic, hinged, col-
lapsible prosthesis. Follow-up appointments to monitor
prosthesis function or treatment complications will con-
tinue.
SUMMARY
This clinical report described a cast iron-platinum
magnetic attachment system applied to sectional col-
lapsed complete dentures for an edentulous patient with
microstomia. With the use of lingual and palatal midline
hinges and an Fe-Pt magnetic attachment, the sectional
collapsed complete dentures were successfully and easily
inserted and continue to provide adequate function in
the patient’s mouth.
We express our grateful appreciation to Mr Saiji Shimoe, SDT, of
Nagasaki University for his laboratory assistance.
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Reprint requests to:
DR IKUYA WATANABE
DEPARTMENT OF BIOMATERIALS SCIENCE
BAYLOR COLLEGE OF DENTISTRY
TEXAS A&M UNIVERSITY SYSTEM HEALTH SCIENCE CENTER
3302 GASTON AVE
DALLAS, TX 75246
FAX: (214)828-8458
E-MAIL: iwatanabe@tambcd.edu
Copyright © 2002 by The Editorial Council of The Journal of Prosthetic
Dentistry.
0022-3913/2002/$35.00 ⫹ 0 10/1/130095
doi:10.1067/mpr.2002.130095
CONTRIBUTING AUTHORS
Naoki Baba, DDS, PhD, Instructor, Department of
Prosthodontics, Nagasaki University School of Den-
tistry, Nagasaki, Japan; and Kenneth S. Kurtz, DDS,
Clinical Associate Professor, International Program in
Prosthodontics, New York University, New York, N.Y.
577