Fabrication of a Co-Cr Precision Attachment in Association with

a Zigomatic Implant

Prepared and presented by Ruan S. de Jongh

BTech: Dental Technology Student at Peninsula Technikon

Contents

Patient history

Background information

Possible treatment plan

Possible technical treatment plan

Most suitable treatment option

Treatment option of choice

Laboratory procedures and final placement

Patient History

29 year old female1974 – complained about swellingTumour in right maxilla (Myxoma)Myxoma appeared 1 year earlier

2002 – Hemimaxillectomy From midline including 2.2 —1.8

Obturator made in 2002 by Ms Galloway 4th year student in 2002 Started with this current case

Condition and background information

Currently tumor is removed

Patient’s maxillary right

Tumour was benign

Wearing obturator

Patient in stable and ready for advancements.

Possible Treatment Plan

Hollow-bulb obturator

Already in existence

Co-Cr precision attachmentOsteotomy

Possible Technical Treatment Plan

Cobalt chrome removable denture

Surgery (R 14 000 = 3h) Anaesthetics = R 1 000 ph

Specialist = R 1 000 ph

Zigomatic implant ± R 8000

Fabrication of attachment bar ± R 1 000

Fabrication of Co-Cr appliance ± R 1 500

Total cost adding up to ± R16 500

Possible Technical Treatment Plan(continued)

Private hospital

Ward fee = R 500 p/day

Total cost = R 205

Surgery = R 165 Ward fee = R 40 (1 month) I.D.S. pays for implant

Possible Technical Treatment Plan(continued)

First visit Impression

Surgery – placement of zigomatic implant

Healing time (± 6 weeks)

Second visit Impression with analog in place

Construction of attachment bar

Possible Technical Treatment Plan(continued)

Third visit Impression with attachment bar Co-Cr appliance is constructed

Fourth visit Co-Cr appliance is placed

With 1st try-in

Fifth visit Final placement of Co-Cr removable

denture

Most Suitable Option

Co-Cr precision attachment

Implant support

Improved stability compared to an obturator

Patient is ideal candidate

age

benign tumour

have retentive teeth

Treatment Option of ChoiceCobalt-Chrome precision attachment

Advantages

Good aesthetics

Very stable

Reasonable cost

Hygienic

Superior strength1

DisadvantagesMovement during function

Retention diminishes with use

Fracture - porosity1

Laboratory Procedures

First Visit Cast of primary model

Changes are notified2

Laboratory Procedures(continued)

Second Visit Final model cast with analogs Construction of Attachment Bar2

Cast in Co-Cr Worked off and polished

Laboratory Procedures(continued)

Second visit (continued) Plastic clips preferred (nylon)

Laboratory Procedures(continued)

Third Visit Construction of Co-Cr Precision Attachment1

Duplicated

Co-Cr appliance constructed in wax

Invested

Cast

Sprues removed

Sandblasted

Trimmed

Polished

Laboratory Procedures(continued)

Fourth Visit Placement of Co-Cr precision Attachment

1st try-inOR

Final placement

References1. G. Jenkins, Precision attachments.

Removable Partial Prostodontics, Ch 6,Moscow:Quintessence Publishing, 1999: 78-80.

2. University of Pennsylvania Health System. Advances in Head and Neck Reconstruction. 2002: 132-143

3. D. Henderson, Major and Minor Connectors, 6th Ed.Removable Partial Dentures, Ch 4,Mosby Company, London. 1981: 20-39

Thank You!

Special thanks to:Prof J.Morkel

Dr P.van Zyl

Ms Z.Nortje