Management of a Challenging Prosthetic Case with the use of an Intraradicular Attachment: A Clinical Report

Case Report

J Dent & Oral Disord. 2015; 1(1): 1003.

Management of a Challenging Prosthetic Case with the use of an Intraradicular Attachment: A Clinical Report

Süleyman Hakan Tuna1¹*, Isin Kürkçüoğlu¹ and Feyza Özdemir Kisacik²

¹Department of Prosthodontics, Suleyman Demirel University, Turkey

²Department of Endodontics, Süleyman Demirel University, Turkey

*Corresponding author: Süleyman Hakan Tuna, Department of Prosthodontics, Faculty of Dentistry, Suleyman Demirel üniversity, Isparta, Turkey

Received: November 25, 2015; Accepted: December 18, 2015; Published: December 31, 2015


While the popularity of implant retained Overdentures has been increased in recent years, root retained Overdentures have been largely disregarded. This clinical report presents the prosthetic treatment of a patient who had abnormally positioned upper canine in the long span anterior edentulous area in the partially edentulous maxillae using an Intraradicular attachment system and a removable partial overdenture and also emphasizes the advantages of root retained Overdentures.

Keywords: Intraradicular attachment; Overdenture; ZAAG; Canine root


Although there may be several treatment choices for the management of a prosthetic patient, treatment options are somewhat limited in some unique cases. To overcome the prosthetic challenges, the most logical treatment planning should be selected because the success of prosthesis is primarily depends on a meticulous diagnosis and completion of an accurate treatment plan.

In the case of a long anterior edentulous space, a removable partial denture could lose its direct and indirect retention and support to a great extent. It would be subject to rotational displacement and tipping around the fulcrum. For tooth supported Overdentures preserving the roots in a long edentulous space is crucial for the success of the prosthetic treatment [1,2]. If the remaining roots are canines they become more valuable due to their strategic position [3]. It is widely accepted that the retention of the roots reduces alveolar bone resorption and maintain propriceptive mechanism [4-6]. The roots can be incorporated into the design of removable partial overdenture and further retention and stability can be achieved by the use of various precision attachment systems [7]. Different attachments such as stud attachments, Intraradicular attachments and magnets to anchor the prosthesis in order to increase the retention have been marketed by several manufacturers [4,8]. It is accepted that attachment-retained removable partial Overdentures may provide better aesthetics and improved function. Moreover, compared to the implant treatment, they are relatively more cost-effective treatment option and also a more conservative approach by preserving the patient’s own teeth and surrounding tissues [9]. There are various designs of precision attachment systems for the Overdentures including bars, ball and O-ring, studs and magnets in the market, promoted by several manufacturers. Basically, the selection of the most suitable system depends upon three factors: The number of the remaining natural teeth, the location of the remaining teeth and available space. In some cases, vertical space could be the principal consideration for the selection of an attachment [8,10,11]. In the case of decreased vertical space the use Intraradicular attachments should always be considered [2,9].

Currently, popularity of Overdentures has been increased in the literature with the use of implant-retained attachment systems; however, there are limited numbers of clinical reports about tooth-retained Overdentures. No specific report about the use of Intraradicular attachments in the case of long span anterior edentulous area and limited vertical space has yet been published. The aim of this case report was to describe the prosthetic treatment of a patient with an abnormally positioned maxillary canine tooth in the long span anterior edentulous area in the partially edentulous maxillae using a removable partial overdenture. Furthermore the importance of tooth-retained Intraradicular attachments which were recently ignored due to the increased popularity of implants was emphasized.

Case Presentation

A 57 years old female patient was referred to the Prosthetic Treatment Clinics, Suleyman Demirel University, Faculty of Dentistry, with the complaints of missing anterior teeth and poor aesthetic appearance. Furthermore, the patient stated that she had never been able to achieve an efficient chewing function in her life time. Medical and dental history and clinical examination revealed that the patient had no systemic problems and TMJ complaints.

Intra-oral examination revealed partial edentulism and she had the right canine, right first molar, left canine and left first molar in her maxillae and all teeth from the right first molar to the left first molar in her mandible (second and third molars were previously extracted). Her upper right canine was in markedly palatal position and in reverse articulation (Figure 1). However the tooth was healthy both clinically and radiographically. The upper right first molar had severe coronal damage requiring a post-core restoration and then a full coverage crown. The lower second premolar and first molar teeth had wear on their occlusal surfaces.