Michael Sherring-Lucas/Paul Martin | Attachments for prosthetic dentistry Introduction and applicationBritish Library Cataloguing in Publication Data Sherring-Lucas, Martin Attachments for Prosthetic Dentistry |. Title 6176 ISBN 1-85097-036-X a ‘qunlevence ‘books © 1994 by Quintessence Publishing Co., Ltd., London All rights reserved This book or any part there of may not be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without prior permission of the publisher. Lithography: rawy fotosatz ag Composition, Printing and Binding: Bosch-Druck, Landshut Printed in West Germany ISBN 1-85097-036-XContents Part! Introduction What is an Attachment? . Paralleling / Milling machine Storage of attachments parts, mandrels and tools Model analysis, planning and design Types of preparations 7 Selection of ideas for design . Hybrid cases Prospective planning Milled brace support Surveying and positioning attachments ‘TeesiotteallOyseiiiay a. eer E Open flame soldering 1. . Soldering materials me Open flame soldering for slides and similar attachments 2 poo Soldering attachments to Chrome Cobalt . Hydroflame gas generators ....... Adjustment and fitting attachments Adjustment tools and Accessories Assembling and disassembling attachments . Servicing attachments Part ll Construction of the master model Guide to basic milling procedures .... Construction of milled bracing arms : Mounting of an intracoronal slide attachment . The Cendres & Métaux SA Ceramic spacer techniqueContents Mounting of an extracoronal attachment..........- Mounting of anchor attachments ........ Mounting of bar attachments ..... Mounting attachments in cross arch connections Guidelines for mounting retentive elements | ... Guidelines for mounting retentive elements II . Guidelines for constructing screwed connections .. . Instructions for use of transfer jigs |—Intracoronal ... Instructions for use of transfer jigs I|— Extracoronal . . Instructions for use of transfer jigs Ill - Anchors Instructions for use of transfer jigs IV — Bars Mounting or replacement of Dalbo-S matrix . Mounting or replacement of Mini-Dalbo matrix . oe Readers additional notes Eee MRI cee aia t+ Glossary of laboratory terms ...... Bee re ee 80 SubjSGt iG rents nin thts cence a Pore ce pic 81 Cendres & Métaux SA Courses . . 84Part | “those who are enamoured of prac- tice without science are like a pilot who goes into a ship without rudder or compass and never has any cer- tainty where he is going.” Leonardo da VinciIntroduction The purpose of this manual is to provide basic information on the use of attachments and associated techniques and is essen- tially compiled for the Technician with limited knowledge of the subject. There are those with greater experience who will hopefully derive useful information which will enable them to improve their under- standing of attachment work, planning and technique application Attachments in one form or another have been used for many years and are not new by any means as there is evidence of wire and riveted devices dating back to the Egyptians. However, we are concerned with modern forms ranging from simple slides to sophisticated assemblies with many micro engineered parts fabricated in different alloys for different purposes. Cendres & Métaux SA precision attachments. are all prefabricated, machined to very fine tolerances and have a very precise smooth action. Usually they are adjustable, some have replaceable parts, others have a vari- ety of uses such as conversion from friction retention to snap retention. In addition there are those that are either resilient or non resilient. Non precision forms of attach- ments usually involve plastic pieces made in non-residual combustible plastic. To assist the reader the manual is divided into two sections. The first section is prima- rily concerned with descriptions of equip- ment, materials and techniques associat- ed with attachment work and the second part is compiled alongside the Cendres & Métaux SA catalogue dealing with each classification in order.What is an Attachment? An attachment is a precision connector made up of two or more parts. One part is connected to a root, a tooth or an implant The other part to an artificial prosthesis, and is used to provide mechanical connection between the two. For the most part attach- ments take the place of damaging clasp arms but can also be used to retain full or partial dentures on root anchors carrying studs or bars. Precision attachments offer the following additional advantages. Standard interchangable parts Adjustable Controlled wear Less wear Easy to repair Indications for Precision Attachments Fixed bridgework — Intracoronal attach- ments on non-parallel abutments. Partial dentures Overdentures Unilateral or bilateral free-end dentures Types of Precision Attachments Intracoronal (Fig. 1) Extracoronal (Fig. 2) Radicular Stud (Fig. 3) Bars (Fig. 4) How are Precision Attachments Connected Friction (Fig. 5) Mechanical retention (Fig. 6) Magnetic (Fig. 7) Screwed (Fig. 8) The Functions of Precision Attachments Screwed Rigid Hinge resilience Vertical resilience Rotational What is the Life Expectancy of an Attachment Used in the correct manner, normally 7 — 10 years, often longer. How do you Achieve the Best Results Correct treatment, planning and evaluation. Teamwork between the Dental Surgeon and the Dental Technician Regular adjustment of the attachments Regular relining of prostheses and good oral hygiene. Choosing a Precision Attachment Use the chart below to help when deciding which type of attachment would be suitable for the case in hand Decide which of the four types (Intracoro- nal, Extracoronal, Stud or Bar) as shown below would be suitable. Refer to the Cendres & Métaux SA Cata- logue to find the attachment(s) complying with your choice. ttPart | Fixed Screwed Screwed Rigid Rigid Hinge Resilient+Rotation Fig. 1 Intracoronal Fig.2. Extracoronal Screwed Rigid Rigid Resilient Resilient+Rotation “XS Fig.3Radicular Fig.4 Bar Once this choice has been made, decide then which connection you require 12What is an Attachment _ fon ty fk KS Fig.5 Friction Fig.7 MagneticPart | Fig. 9. PFG 100 paralleling machine Paralleling/Milling Machine The most important piece of laboratory equipment needed for precision attach- ment work is a quality paralleling/milling machine such as a Bachmann or PFG 100, both by Cendres & Métaux SA. (Fig. 9) A parallelometer has three functions. First, as a surveyor to determine paths of inser- tion. Secondly, to align attachments or other assemblies to an extremely high level of ac- curacy and finally milling, a process of wax (Fig. 10) or metal (Fig. 11) in-line, angled or parallel shaping to given contours depend- ing upon the type of work, with the added advantage that it can be used for angled or parallel drilling 14 Warning Do not attempt to parallel attach- ments using a surveyor. They are not suitable for such accurate high precision work. Storage of Attachment Parts, Mandrels and Tools It is recommended that all attachment com- ponents, mandrels and adjustment tools are stored in a miniature drawer system, are clearly identified and numbered. To reduce the risk of mixing parts only one drawer should be opened at a time.Model Analysis Planning and Design Fig. 10. Milling in wax a) Never use a distorted mandrel Ifin doubt, replace with a new one. b) Mandrels should only be adjusted to fit the attachment for which they have been designed c) Keep them clean and moisture free Model Analysis Planning and Design Undertaking planning is complex and pri- marily for the experienced technician with an extensive knowledge of attachments and associated techniques. Itis because of this, that random samples of design illustra- tions and explanations are shown below Fig. 11. Finishing metal with detailed attachment information in Part 2. Planning should always be done in close cooperation with the surgeon and to ad- dress this, itis imperative to obtain as much information as possible in order to form an opinion such as clinical notes, study mod- els and X-rays. Clinical notes will consist of details appertaining to the type of bridge~ work wanted, oral hygiene, tooth mobility and the possibility of physical handicap. (A patient with severe arthritis in the hands would be an unsuitable candidate for pa- tient removable unilateral saddles). Study models enable the technician to ap- praise the dentition, vertical dimension, spaces to be filled and clearance for at- tachments 15Part | Fig. 12 All valuable information when: designing complex work X-rays, though less important to the techni- cian, can provide useful information regard- ing bone loss, root angles, areas of hard and soft tissue and in some cases whether or not a tooth, which has broken down, should be incorporated in a design or ex- tracted to improve rather than compromise the design Model analysis is the means by which a technician can ultimately determine the type of attachment to use for a given set of circumstances. Whilst analysing study models, consider- ation must be given to the length of the free end-saddles when selecting attachments. As a general rule long saddle selections are usually designed as bilateral cases with 16 rigid attachments and short saddle sec- tions as unilateral or bilateral patient remov- able prosthesis supported on hinge or rigid attachments. However, with unequal length saddles only rigid attachments may be used in a bilateral prothesis. Only AFTER studying the model should a plan be conceived and the following obser- vations considered: 1) Oral hygiene. 2) Number of abutments. 3) Angle and height of abutments. 4) Length of free-end saddles. 5) Vertical height. 6) Guidance planes. 7) Ridge structure. 8) Possible physical disability. 9) Type of attachment — Rigid or resilient.Tae Fig. 13. Model analysis Types of Preparations Essentially there three basic types of prep- arations suitable for attachment work, Root anchor, intracoronal and extracoronal. 1. Root anchor Root anchors-play a large and important part in the design of removable and fixed appliances and therefore the following points must be observed to obtain maxi- mum retention and stability a) Maximum length post consistent with the length of the root. b)A preparation at gum level to keep the fulcrum point low. (Fig. 14) c) Bevelled shoulder diaphragm for in- creased retention. d) Anti rotation slot or well e) Use of a Cendres & Métaux SA post sys- tem for preparation and impression tech- nique. f) Cast-on wrought post Fig. 14 Root anchor preparation Causes of failure a) Post too short. b) Inadequate diaphragm. c) Using a cast post. d) Not using a recognized post system. e) Failure to heat treat. 2. Intracoronal Intracoronal preparations (Fig. 15) are made to accept an attachment within the circumference of the coronal surface thus reducing the stress on the attachment and leverage on the tooth. In order that the cor- rect size box is cut, it is essential the clini- cian is made aware of the type of attach- ment and it's overall dimensions and to ensure complete casting-on, diffusion and correct alignment the box should be en- larged by approximately 0.6 mm x 0.2 mm in width and depth respectively. Also, prep- arations should be reduced sufficiently on the lingual/palatal walll to allow for a milled bracing arm. See “Design and use of brac- ing arms” Ar;Part | Fig. 16 Extracoronal preparation Fig. 17 Posterior bridge link. Beyeler 21.03 fila Fig. 20. Anterior bridge link. CM-Interlock 22 01Selection of Ideas for Designs Fig. 21. Cylinatieal friction (retention) anchor, Dalbo 41.02 Potential cause of problems a) Non-alignment of box to other abutment teeth. b) Inadequate size of box. 3. Extracoronal A preparation suitable for an extracoronal attachment (Fig.:16) is a conventional abut- ment preparation, which allows for an at- tachment to be situated outside the coronal circumference of the tooth. Points to observe a) The preparation walls are near parallel sided to maximize retention of the crown. b) Preparation has sufficient depth to carry an extracoronal attachment. ‘af ROS Fig. 22 CM-Bar 55.01 Selection of Ideas for Designs This section is intended to give the reader an insight into design concepts by illustra- tions and types of attachment used. For more detailed information on attachments see Part 2. 1. Using slide attachments (Figs. 17-20) to correct malalignment of preparations re- quires only an elementary ability. 2. Post anchors to retain a denture. (Fig. 21) 3. Post and round bar retention for denture. (Fig. 22) This type of bar has a small cross section allowing for use in all cases especially with very close bites. 4. Post and oval bar retained denture. (Fig. 23)Part | Fig. 23. Dolder Bar 53.01 Hybrid Cases Hybrid cases are those with a mixture of bridge and denture work. They are usually complex, requiring considerable technical and occasional innovative skills. The follow- ing illustrations show a variety of options for the same case. Standing teeth are 321| 123 Option a) A chrome bilateral prosthesis supported on slides carried on crowns 3|3 using McCollum 22.03, PT-Snap 22.09 or 20 Fig. 24 Fig. 25 Biloc 22.10 adjustable slides with bracing arms and stabilizers. (Fig. 24) Option b) A chrome bilateral prosthesis supported on slides carried on crowns 3|3 using Dalbo-S 63.05 adjustable, resilient hinges or Mini-Dalbo 83.01 adjustable hinges. (Fig. 25) The above designs are all acceptable and are dependent upon a) Available space for attachments b) Patients preference c) Patients dexterity d) Oral hygieneProspective Planning Fig. 26. Simple fixed bridge Fig. 27 Modified advanced design allowing for the loss of 7. Prospective Planning 1, With the knowledge that the life expec- tancy of the 7| is short, a simple fixed bridge (Fig. 26) can be designed in such a way, that in the event of the 7 being lost, then part of the structure can be re-used in a future design, e. g. a bilateral prosthesis. The elements that make up the modified bridge are: a)CM 24.01 Combi-Snap screw slide which can be converted from fixed to retention by changing the screw on the 4| b) The telescope crown includes an Ipso- clip SE 144.02 (screw retention) on the ts c) Milled brace support. (Fig. 27) Itcan be seen, that by releasing the screws the pontic section and bracing arm can be removed and upon extracting the 7| the bracing arm and Combi-snap attachment are re-usable. A shorter screw is inserted into the slide to allow it to be used as a retentive element in the new design. FiPart | Figs, 28-28. Simple unilateral design utilizing original elements 2. For this exercise we will consider the im- plications of leaving the 7| in place and losing the | 456 (Fig. 30) To utilize the existing bridgework it is necessary to crown the |3 and use a matching Combi-Snap slide with a bracing arm to carry the |456 joined by a small 22 plate to the bridge 7654| and complete the prosthetic work. Changes to the screws must be made as follows: a) Combi-Snap. Exchange the screws to spreader screws. b) Ipsoolip. Exchange the SE screw fora RE spring stud. lockingMilled Brace Support Fig. 31 Intracoronal Milled Brace Support See “Guide to milling alternative methods” in Part 2. Experience has shown, that all adjustable slide attachments with the exception of the CM SG series need bracing arm support in partial bilateral and unilateral design to pro- vide additional stabilization. The stabilizer protects the attachment against the effects of torsion-rotation and leverage forces. Both stabilizer and attach- ment must be parallel to each other. To allow slide attachment and stabilizer to become a functional unit, the stabilizer (S) and the slide part of the attachment (G) must be connected by a cast bracing arm (U). The corresponding support is milled lingually-palatinally on the most distal abut- ment or pontic, possibly slightly conical in relation to the line of insertion. The cervical finishing line should be lower than the at- tachment but still a minimum of 0.5mm above the surrounding tissue. This will guide and facilitate the insertion of the den- ture. A button or an undercut groove (M) on Fig. 82 Extracoronal the mesial side of the first denture tooth fa- cilitates removal of the denture for the pa- tient. (Figs. 31-32) The stabilizer can be individually milled or made from prefabricated parts (Bar sleeve, Plasta or Interlock by Ceccato) and posi- tioned on the opposite side of the attach- ment (Fig. 33) and measure 2/3rds the depth of the milled surface of the crown or into the interdental space in bridges. In the case of an extracoronal attachment with limited vertical dimension it is recom- Fig. 33 Waxed up stabilizer. 23Part | as ——« Common path. Note malaligned 7 | Therefore the slide is aligned to a path common to $3 | mended, that an occlusal metal extension is included above the housing, also it is ad- vantageous to gum fit the first tooth of the denture to improve self cleansing qualities. (Fig. 32). Bracing arms are generally cast as a separate unit with retention into the ac- rylic work or, in the case of a chrome cobalt prosthesis, cast as an integral part of the chrome work. In some instances involving prospective planning milled brace sup- ports are fabricated for future use and re- main dormant until such time as they are needed. To perfect this technique a knowledge of milling is essential. Surveying and Positioning Attachments There are two parts to surveying a model. First, to establish correct parallelity of teeth 24 —— Wide angle/path of insertion common to all preparations. and secondly to find a path of insertion common to all abutment teeth. Both exer- cises are done with a parallelometer using surveying rods. In the first instance it is necessary to ensure correct alignment of the preparations and, in the event of mala- lignment, a slide attachment should be in- troduced and the final bridge made in two parts. (Fig. 34) Secondly, if all the abut- ments are reasonably parallel, a path of in- sertion should be established by taking an angle from the side of the abutment show- ing the least angle of tilt, resulting in a com- mon path of insertion, (Fig. 35) determining an angle/path of insertion common to all preparations. Only after surveying a model should attachments be introduced Rigid attachments. Rigid attachments must always face the di- rection of the ridge. (Fig. 36)Fig. 36. Rigid attachments must always face the direction of the ridge. Surveying and Positioning Attachments Fig. 37. 3-D Position of hinges Fig. 38 Attachment showing clearance. Hinge attachments. See Part 2 “Mounting hinge attachments”. Hinge attachments must be positioned three dimensionally, that is in both vertical and horizontal planes. (Fig. 37) Care and consideration must be given to ensuring, that there is sufficient space (ap- prox 1.0mm) under attachments for wax contouring and oral hygiene. (Fig. 38) Fig. 39. Anchor alignment with parallelometer. Anchors All anchors are soldered to root caps which have been horizontaly milled, thus simpli- fying their positioning, and must be sited with the aid of a parallelometer before wax- ing them into position for soldering, (Fig. 39) 25Part | Fig. 40 AGES OEE ml Bars Bars such as Dolder and Regulex are aligned in a vertical plane, at right angles to the ridge whether they are prefabricated or made of plastic. Prefabricated bars are measured accurately and positioned in wax cradles on the abutments, removed, then soldered in later. (Fig. 40) Procedure for waxing in attachments a) Using the ball and socket table of the paralleling machine ascertain the line of insertion and lock the table. This position is maintained throughout for both attach- ments and milling. See part 2. Model construction. b)Place the attachment in the mandrel making sure it is properly seated. c) Loosen the articulated arm and move the attachment into position d) Lock the articulated arm for both vertical and horizontal movement. ) Build-up wax behind the attachment being careful not allow wax to encroach ‘on the attachment. 26 f) Shape wax to the desired contour de- pending upon the type of attachment re- membering to build in strength where possible. g)Take a needle sharp tool and lightly scribe round the wax/attachment inter- face, this will prevent alloy flowing onto the attachment in the form of a skin. h) On completion of the wax work carefully raise the mandrel whilst holding the at- tachment to prevent vertical displace- ment and avoid any further work around the attachment. Points to observe 1) Make sure the attachments are “cast-on” type. 2) Lock the articulated arm and table. 3) Do not over wax. 4) Avoid wax on attachment working parts. If this occurs and remove the attachment steam clean. 5) If in doubt start again. Although there are many different types of attachments the principles shown above apply to most, if not all intracoronal and ex- tracoronal attachments. Sprueing, casting and cleaning As sprueing and casting techniques differ considerably from laboratory to laboratory, the writer lists below only basic principles to be observed. a) On curved span bridgework introduce a burnout rod (approx 1.2 mm) between the last teeth on the bridge to stop the bridge distorting. This will remain in posi- tion until completion of the bridgework in- cluding ceramicsTypes of Alloys b) Ensure primary and secondary sprues are large enough to prevent porosity. c) Use venting feeders to areas under at- tachments that will be difficult to cast. d) Follow the furnace temperature/time set- tings for the alloy in use. e) Do not overheat the casting ring or alloy as both can cause porosity and destroy the physical properties of the alloy. f) Devest with care. g) Protect the attachments when cleaning the bridge with an airbrasive machine. h) Clean attachment areas with a glass brush. Types of Alloys Great importance is placed on the type of alloy an attachment is made from as they are fabricated in a variety of alloys all serv- ing different purposes. (See chart “Alloys and Materials for Attachments”) The excep- tion to this rule is the use of non-residual combustible plastic (Korak) parts, which can be cast in any dental alloy with a mini- mum hardness of 260-270 HV and a mini- mum proof stress of 500 N/mm2, However, it is necessary to carefully consider the de- gree of precision required and wear capa- bility in the design before selecting the alloy, without that knowledge a cast attach- ment could fail. If there is any doubt al- ways resort to manufactured components. ‘Awareness of the melting point of any part of an attachment requiring soldering is es- sential to avoid disaster and therefore, be- cause of it's importance, will be dealt with separately under the heading “Soldering techniques”. eePart | Cendres & Métaux SA Alloys and Materials for Attachments Alloys and materials for attachments. Symboy Colour Composition Waling Hardness Name Au Picganed. 7 AG’ iCute Other range condition, as delivered % ee % % % °C HVS C=CERAMICOR white 600 190 200 10 1400-1400 205 H=HMA20 white @00 200 820-1850 210 High Meng Alloy E=EOR yellow —=—O«BSCCOSC*STSSC*«~sOSC Zaas B80- 940 265 EL=ELASTICOR yelow 610 135 escapee 850-1080 260 O=08v white 600 100 80 140 + Min, 1080-1700_280 Ni, Zn W=ALPA white 60 10 105 410 120 +I ‘880-960 235 D=DORAL white 750 200 403187 Fu20 980-1015 210 TSTTANIUM white 79891670 2 S=SYNTAX white 7900 1605-1660 360 A160 V_40 X= STEEL white Fe720 220 cr180 N90 Mn. Si white Aluminiumoxide (epecial quality) white? __ Non-residval burnout plastic transparent forthe casting technique G=GALAK diferent mouth resistant plastic colours __not suitable for casting 28Types of Alloys * Slow cooling in the cylinder or soldering block ‘See also page 7 “CM Casting-on or Soldering’ () 2 See page 13°CM Resin-bonding Technique” (*) 8 See page 12°CM Spacer Technique’ oO 4 See page 11 “CM Plastic’ oO ® Pickling: in a warm solution of 10 vol.% sulfuric acid (HsS0.). Donot pickle with nitric acid (HNO3) or hydrochloric acid (HCH, These acids destroy the alloy, Oxides arising from casting or soldering can also be removed by sandblasting, © annealing: ‘and hardening: 7 annealing and harder ® annealing ‘and harder ning: ning: () Reter to OM catalogue. 700°C 10 Min/H4eO 400°C 15 Min/siow cooling 850°C 10 Min(H4.O. 400°C 15 Minisiow coating 800°C 10 Min(H420 400°C 15 Min/siow cooling Fardnessafter Hard 0.2% Proof stress 0.2% Proof stress Metalic "Technical hints, casting-onor ening (Rp0.2%) (Rp 0.2%) Nimme connection _ fields of application soldering? condition after after soldering? possibilities asdelivered —casting-on' only! with thermal v5 _Nimm? treatment 205 Casiing-on or Non-oxidizing alloy for selthardening 205635 635 635 soldering casing-on with precious metal alloys or for so- dering with preciousinon- precious metal alloys 20 Casiing-on or Non-oxidizing alloy for self-hardening 210505 505 505 soldering casting-on or soldering with preciousinon- precious metal alloys S280 Soldering Alloy forattachmentsé selthardening 285° 690 655) 7408 620 Paris for atlachments ‘with high elasticity, for polymerisation, S300parialy 355" 770 640 ‘3007 Soldering _Alloy for attachments selthardening * high strength 3250 partially 200° 675 60 7208 Soldering Ag-Au-Pctalloy for, sel-hardening attachments? $235 partially 320° 685 370 360° Soldering __ Ag-P-Auralloy for selthardening atlachments® = 630 Not suitable Root posts, for casting-on or soldering 925 Not suitable Root posts, endodontic forcasting-on anchorsand attachments or soldering ‘Aunilary instroments split spring washer accordingto ‘Ceramic spacer (female dental alloy molder) for casting with used precious or non-precious alloys 0.2% Proot stress (Fp 0.2%) > 500 Nimm2 (see? andlor) aocording to Plastic attachment. dental alloy parts for casting with used precious ornon-precious alloys 0.2% Proof sess (Rip 0.2%) > 500 Nimme (sees) Plasiic altachment-pars for polymerisation, plastic sleeves and auxiliary parts 29Part | 45° Fig. 41 Paralleled anchor on cast root cap. Open Flame Soldering 1 Prior to investing an attachment, areas needing protection from solder must first be coated with antiflux and allowed to dry. Method a) Using a parallelometer place the anchor on the root cap and secure with non-re- sidual wax. (Fig. 41) b) Invest at approximately 45 degrees ex- posing 1/3rd of the anchor. (Fig. 42) c) Dry, then preheat to 400 °C/30 min d) Check melting range of attachment and alloy, selecting an appropriate solder with a melting point 100 °C below the at- tachment. . e) Remove preheated investment model from the furnace and immediately apply a brush flame continually rotating the model. f) Raise the temperature of the model to a dull red. Apply a small quantity of flux to 30 Fig. 42. Invested anchor on root cap. the solder area using a solder pencil. Apply a small amount of solder and con- tinue heating, finally directing the heat source to the back of the model to draw the solder through. g)Devest, clean with Degussa Neacid pickling agent following with a glass brush. h) Heat treat 400 °C/15 min in a porcelain furnace to harden the attachment. (Figs. 43-44) Note A badly soldered or a dry joint will fail and without heat treatment probably distort. Soldering Materials 1) Soldering investment 2) Pre-heat furnace. 3) Soldering block.Open Flame Soldering 1 400°C/15 Fig. 43 Heat treat for 15 min at 400 °C in the porcelain furnace, 4) Third armijig. 5a) Flux. Porcelain/metal. (C-Flux) b) Flux. Invested/freehand. (Soldering paste) c) Flux. Gold and CoCr. 6) Gas/propane, airfoxygen. 7) Torch with interchangeable tips. 8) Hydroflame microflame gas generator. See “Hydroflame gas generators” 9) Ribbon solder dispenser. 10) Pickling agent (Degussa Neacid) 41) Anti flux 12) Glass fibre brush CM Solders Aselection of solders should be kept avail- able, compatible with alloys and attach- ments used. Fig. 44 Sample selection and use 1, Metal/ceramic. S.G1. 1080 °C S.W1. 1080 °C S.G2. 825°C S.We. 825°C 2, Other gold alloys 8.G2! 825 °C $.G3. 740 °C 3. Non precious metals (CoCr) $.925 925 °C $.870 870°C Soldering is a very precise procedure, An inexperienced technician would be ad- vised to practice before attempting solder- ing delicate and expensive attachments and will find the use of a solder dispenser a valuable aid. (Materials list item 9) Points to observe a) Use small soldering models. b) Preheat to correct temperature and time. c) Correct flux. ) Solder compatible with alloy. 31Part | Fig. 45 1. Only solder the end part of the matrix to the chrome frame. Fig. 46 2. Investment model with CMSG and chrome frame. Open Flame Soldering Slides and Similar Attachments 2 Follow the directions’for “Open flame solde- ring. 1" except items b) and h). Investment models should always be as small as possible and cover all metal work leaving 32 only the area to be soldered exposed. Most casting alloys are self hardening and do not require heat treatment Note Do not attempt to clean attachments with an airbrasive machine as this will cause damage not visible to the naked eye. Soldering Attachments to Chrome Cobalt Example: CM SG Slide Method a) Align attachment to the chrome frame on the model, secure with Duralay or non re- sidual wax. — Area D (Fig. 45) b) Remove screw, separate from the bridge and carefully remove the plastic friction insert. C) Invest, exposing the area to be soldered (Fig. 46) d) Allow 35 minutes to set and burnout in a suitable furnace at 350 °C. e) Using a hydroflame gas generator (see under separate heading) solder the joint using the appropriate solder. (see CM Solders) f) Devest, clean, reassemble attachment and confirm proper alignment on the model. Points to observe a) Minimum space between the chrome frame and matrix for solder. b) Small investment model. c) Minimum solder. d) Ensure solder flows throughout the whole area to be soldered.Hydtroflame Gas Generators Fig. 47 Hydroflame gas generator. 3300°C += 2200°¢ 1850°C 200°C Fig. 48 Volatile liquiditemperature a Enorgy-W) Hydroflame Gas Generators AHydroflame gas generator is probably the most efficient method of soldering attach- ments to chrome cobalt frames. Due to their versatility they can be used for most micro soldering and micro welding processes in the laboratory. (Fig. 47) The machines are small, portable and have the ability to generate temperatures up to approximately 3000°C depending upon the volatile solution used without the aid of bottled gas. A gas generator uses the prin- cipal of electrolysis of water to produce oxygen/hydrogen gas, the characteristics of which can be altered by passing it through a booster unit containing a volatile solution such as acetone, methylethyl- ketone or methylated spirits. Each of these solutions will give a different temperature with methyl-ethyl-ketone providing the best all round temperature for the majority of dental laboratory applications producing temperatures up to 1850 °C. (Fig. 48) 33,Part | Fig. 49. Emery boards and graphite. Because the flame is totally clean and free of oxides soldering precious metals can be achieved without the aid of flux resulting in porous ‘free joints. Flame size is adjusted through a range of interchangeable differ- ent sized torch tips and the only other ex- pendable materials used are the volatile liq- uid in the booster and distilled water making the unit running costs very eco- nomic. Note The above information applies to the Dero- tor hydroflame gas generator and need not apply to other makes. Information and photograph supplied by kind permission of Quayle Dental Manufac- turing Co Ltd. Worthing, West Sussex. Adjustment and Fitting Attachments All attachments leaving the Cendres & Métaux SA factory have been adjusted to their correct friction level or retention. How- 34 ever, laboratory procedures are diverse and varied and there are occasions when they tighten or marginally distort requiring microscopic adjustment after casting-on or soldering, In addition plastic burnout parts invariably need some minor adjustment. Easing attachments is a very precise oper- ation and must be approached with great care using micro files, emery boards, colloi- dal graphite (Fig. 49) and burs. To achieve optimum results it is advisable to make ad- justments under at least 2.5 x magnifying binoculars or loupes. Method 1 Slides a) Identify high spots (tight areas) by coat- ing the patrix with an identifying paste or graphite, allow to dry and gently reas- semble the slide. b) Remove the patrix and note the shiny area. This is the high spot which needs easing. c) Minimal reduction can be achieved with colloidal graphite by sliding the two sec- tions together until they are free. d) Should the area be large, for example a flat plane, then the use of emery boards and microfiles is essential to retain an even reduction over the whole length of the patrix or matrix, finishing with colloi- dal graphite to give a smooth finish. Method 2 Biloc or tubes made in plastic. Itis very rare that a burnout attachment part is cast to perfection. There are many con- siderations which affect castings such as expansion, microscopic imperfections cre- ated in the investment and casting whichAdjustment and Fitting Attachments Fig. 50. Biloc matrix with CM drill and guide pin. need adjustment before a matrix and patrix fit together properly. Tube and sleeve type attachments present a special difficulty due to their shape which can only be resolved with a fine rose head bur such as a CM 22.10.36, Carbide drill CM 22.10.37 and graphite. (Fig. 50) a) Follow Method 1a) b) c). b) Use CM carbide bur CM 22.10.3. ©) Guide pin CM 22.10.38. d) Finish with graphite. e)Flat planes are corrected with emery boards Note a) When using a CM carbide drill which is dimensionally ‘correct care must be taken to avoid irreparable damage b) Remove only a little at a time. c) Check that the sliding action is smooth. Method 3 Bars fabricated in either Korak or precious metal Following the principals outlined in the sec- tion “Adjusting slides" adjustment of bars Fig. 51. Gold coping/bar solder join can be achieved with emery boards and colloidal graphite. When soldered joins are used in bar work for example, a Dolder bar connected to root caps, the joins should maintain the bar shape where ever possible to ensure the maximum length of matrix is used. (Fig. 51) To simplify this technique bars must be measured carefully before soldering leav- ing a minimum area to be soldered. Re- member to heat treat the assembly at 400 °C/15 min Points to observe a) Use emery board in exactly the correct plane b) Finish with colloidal graphite. c) Check the degree of friction or passive- ness and if necessary repeat the proce- dure. Important When using an emery board always lay the board on a flat surface and lightly work the 35Part | bar back and forth evenly until the correct contour is established. Regularly check the fit - remember if too much is removed it cannot be replaced! Adjustment Tools and Accessories All adjustable attachments have specially designed tools for activation, deactivation and screws. All are clearly identified in the CM catalogue and usually ordered with the attachment to be passed on to the surgeon on completion of the case. As some tools are very similar it is essential that the appro- priate adjustment tool is sealed in a plastic bag and identified with the CM code and patient's name or, if itis known the surgeon has a suitable tool, then only a CM code number should be recorded both in labora- tory and patient's records. For a complete understanding of the follow- ing tools the reader will find it helpful to refer to the CM catalogue and corresponding ref- erence numbers. CM Screwdrivers Illustrated below are some of the screwdri- vers made by Cendres & Métaux SA. Alll dif- fer slightly and some can be used on more than one type of attachment but it is import- ant to use the designated driver to avoid damaging the screw head. Also, a set of watchmakers screwdrivers is necessary in the laboratory to complement the CM. range, however, these should not be used on GM screws which have parallel slots as the blades are tapered and could damage the head. 36 Thomas spanner key is used to accept interchange- able blade inserts. cs 25.02.20 Typical blade insert. 33.01.50 Cap screws. ae 142, 14.236 Buccal and lab screwdriver. 43.01.50 Split ring. 32,02.510 Retention core CM Activator/deactivator Like screwdrivers there are a large number of adjustment tools from simple blade ad- justers to hand screw activators with micro adjustment, some of which are illustrated below.Adjustment Tools and Accessories 22.08.15 McCollum slide activator. Other instruments and tools mh 31.02.816 Plastic ring insertion tool for placing ring over anchor matrices to prevent acrylic flowing into attachment La 32.02.515 Heating rod used to remove matrices from an acrylic denture. ~——p 31.01.25 Conod anchor activator. 51.01.25 Dolder activator for 51.01.2 +5 @ Y 51,01.225 Dolder deactivator for 51.01.2 sleeve. N.B. Alternative deactivator for 51.01.5 31.07.25 Fah anchor Activatorideactivator. '32,09,22 Transfer jig used in an impression to sup- port an anchor matrix. ———— 21.01.250 Separating tool for most separable attach- ments. CM attachment tweezers are an essential part the technicians kit making separation an easy oper- ation. Assembling and disas- sembling attachments Breaking down and reassembling attach- ments requires care as so many parts are miniscule and can be lost. Besides using the correct tool it is recommended that at- tachments should be broken down over a clean light coloured surface and all compo- nents placed in small containers then ident- ified. Helpful tips 1) To reduce the risk of losing micro studs and springs place each parton a double sided sticky pad placed inside the stor- age container. Parts are less likely to be misplaced when removing the lid 37Part | 2) Assembling attachments with springs re- quires a degree of dexterity and should be done with utmost care ensuring the spring is the correct way round (some are tapered) and both spring and screw are properly seated. 3) Holding screws on a screwdriver can be frustrating and being very small, they tend to fall off. To overcome this problem dip the end of the screwdriver in petro- leum jelly or silicone grease and place the screw on the driver and position the screw. The converse applies when re- moving a screw. 4)When separating attachments always use CM Attachment Tweezers when ap- propriate. Servicing Attachments Parts wear and need to be replaced from time to time. Some have replaceable friction, or spring elements that can be changed in the surgery, others like anchor matrices can be changed in the surgery or laboratory and remaining attachments require labora- tory servicing 1) Studs, springs and plastic friction ele- ments for the most part are easily removed and replaced and are usually dealt with in the surgery. There is no spe- cific time lapse between servicing, how- ever, but like the motor car regular servic- ing is essential and all replaceable parts should be changed annually. 2) Anchor matrices lose their efficiency and should be changed. As most anchors are adjustable, the néed for replacement is less frequent. Nevertheless inspection 38 and adjustments should occur at six monthly intervals. Changing anchor matrices can be done in the surgery by cutting out the old matrices from the denture and at the same time bor- ing a channel through to the lingual wall. (Fig. 52) Fit new matrices over the patrices before repositioning the denture, followed by flowing a small amount of cold curing ac- rylic resin into the channel to secure the new matrices. Alternatively, the laboratory process allows for relining of the denture at the same time by first placing a spacer over the patrix (Fig. 53) before taking the impres- sion, then inserting a transfer jig into the spacer in the impression (Fig. 54) before casting the model Position the new matrices on the patrices prior to processing the acrylic denture. 3) Replacing worn patrices for slide and hinge attachments is considerably more difficult, but can be done with clinical co- operation. For this exercise we shall as- sume, that McCollum patrices on a par- tial denture have worn and must be replaced within the denture. The most reliable method ensuring complete ac- curacy is to provide the surgeon with new patrices (left and right for McCol- lum), which have soldered serrated ex- tensions added to be used for retention in the acrylic saddles. The surgeon will then cut away the old attachments and sufficient acrylic to enable the new attachments and denture to be located properly in the mouth. (Some of the teeth on the denture will be partially de- stroyed). The located attachments and denture are then cold cured together, removed and sent to the laboratory to complete the restoration.Servicing Attachments 4h Fig. 52 Fig. 53 Fig, 54 Fig. 55 Model with transfer jig in situ 39Part Il — Detailed Attachment Technique Construction of the master model Before commencing work involving the use of Precision Attachments, it is strongly rec- ommended, that a master model is con- structed, Use the model pattern with guide grooves (Fig. 56) (80204) and the model disc (80 206) to manufacture the socket of the master model. (Split cast with magnetic fix- ation). Grind a hole in the model base to accept the axis socket. Determine path of insertion ‘on model and fix position on paralle- lometer/milling unit using the universal joint table (80 195) and a surveying sod (83 320 or 80 363). (Fig. 57) Fix the parallelometer axis rod (80 364) with the socket (80 365) into the chuck of the parallelometer. Lock all movements of the parallelometer except for the vertical and fill the hole in the model with Duralay or similar material. Gently lower the socket into the Duralay and maintain the position until the resin has completely hardened. (Fig. 58) Carefully open the universal table and remove the model vertically and swing the arm away from the working area. The predetermined axis of insertion can now be transferred in this manner. Remove the universal joint table and re- place it with the magnetic table. (Fig. 59) Place a thin plastic foil over the magnetic table to prevent plaster contamination when forming the base. Fix the base disc on the magnetic table and place the model mag- net on the model disc. (Fig. 60) Isolate the model with plaster separator and form the base of the split cast model (Fig. 61) The finished model can now be fixed in any position on the magnetic table without any danger of the axis of insertion being al- tered. (Fig. 62) aGuide to Basic Milling Procedures Fig. 63 Guide to Basic Milling Procedures Before any milling work can be considered a split cast master model must be con- structed. (As described in Part II section 1.) Wax-up to full contour in area to be milled. Incorporate any attachments that are to be used including stabilizers for milled bracing arms. (Fig. 63) Carefully mill wax coping using wax cutters (80 366) to take the main bulk of wax from the surface to be milled. Careful milling here saves time later. Speed — 3000 rpm. Invest and cast, preferably in an alloy which does not have a high palladium content. (Palladium alloys are very hard and there- fore difficult to mill). The alloys which are suitable for milling are mentioned on the CM alloy chart. di Devest and clean casting. Never sandblast where attachments are used as irrepairable damage can be caused. Attachments must only be cleaned using steam, in an ultra- sonic cleaner and/or with a fibre glass brush (80 305, 80 305) Using Knetotherm putty (80 851) fabricate a metal milling die. Paint liquid graphite (80 241) inside casting and dry with airline. Push casting into Knetotherm putty (if not available, Formasil will work) to a depth of 1 1/2 cm and shape into a die with under- cuts. (Fig. 64) Melt metal die material (Frasstumpf Metall 80 729) in a pouring spoon over the bunsen (do not overheat), pour into mould and allow to cool (approx 3-4 mins). : Remove metal die together with casting from Knetotherm mould and clean. Replace casting on to model which should be in it's original position on the parallelometer/mill- ing unit. Fix transfer instrument (80577) into the chuck and position over the casting. Gently lower the transfer instrument onto the casting and lock the vertical and hori- zontal movements of the unit. Fix transfer in- strument to the casting with sticky wax or Duralay, allow to harden, and gently lift the casting away vertically and swing the arm 43Part Il Fig. 65 away from the working surface of the model. Rernove the model from the mag- netic table. Do not remove the transfer in- strument with the casting from the chuck Place a thin plastic foil over the magnetic table and fix a milling plate (80 208) to the centre of the table. Gently swing the paral- lelometer arm with the fixed casting back to the centre of the table and put the metal die in position into the casting. Fix the casting to the die with sticky wax. Mix a small amount of fast setting plaster (Whip-mix mounting stone, Calspar etc) and place onto the milling disc. Gently lower the milling die into the plaster, lock the unit and allow to partially set. Shape the milling model into a dome and allow to harden fully. (Fig. 65) When set, open the chuck, remove casting from the milling model and clean off all traces of sticky wax and resin residues. Do not use boiling water as this may distort the die. Check the exact position of the casting on the milling model, To help with smooth movement of the mill- ing model and to protect the surface of the 44 magnetic table, use the glass plate (80 194) on the table. Tip A small amount of Duralay powder sprin- kled onto the glass plate also helps the disc to slide smoothly, You are now Ready for Milling Before you undertake any milling work it is worthwhile spending 10 or 15 minutes prac- tising on a brass training stump to famil- iarise yourself with the cutting strength of the tungsten cutters. We think the easiest way to mill is to lock the vertical and hori- Zontal movements of the unit and move the model against the cutter. This gives you much more control as opposed to locking the model and moving the cutter. Always mill in one direction. Speed - 5000 - 15000 rpm depending on the individual in- strument. Do not mill backwards and for- wards as this will cause vertical lines and grooves in the milled surface. Take your time when milling, do not try to remove a lot of material in one movement. You cannot put it back. Always use milling oil (80 235). Always tighten the cutters in the chuck with the key. Always keep your finger on top of the cast- ing. The rotary action of the cutter together with it's cutting pattern can cause the cast- ing to lift away from the die. There are two common milling designs. 1. Milled surface should be 1/3 parallel and 2/3 tapered with a shoulder cut freehand around the top with a rose head bur. (Fig. 66) Keep the cervical finishing line lower than any attachment but at least 0.50 mm. above the surrounding tissue.Milling Designs Fig. 66 2. Parallel surface cut with a round ended carbide cutter leaving a rounded shoulder at the base of the crown and a tapered shoulder cut at the top with a 6 degree shoulder cutter (Fig. 67). Fin- ishing line should be just about level with the bottom of any attachment, Construction of Milled Bracing Arms (See Part | — “Design of the bracing arm”) There are two methods of constructing the Milled Brace Support 4. To construct the milled brace support arm to cast onto the patrix of the attach- 3 eee Fig. 67 ment in one piece, we recommend the following lift-off technique. Before start- ing wax-up, make sure any adjustable at- tachments have been deactivated and the metal surface of the primary part is thoroughly cleaned. Warm the primary part to about 37°C and apply molten wax in one go. Bredent outer coping wax or Dentaurum Grundler wax is recom- mended because of its ability to resist distortion. Check for folds or creases in- side the wax pattern, as this may cause a bad fit. Products such as Bredent Mod- elling resin UV or Kulzer Palavit GLC can also be used if you are concerned about possible distortion during the lift off pro- ceedure. When using self curing or light curing resin, the outer surface must be covered in wax. Otherwise the investment may 45Part Il crack, due to the expansion of the resin during the preheating process. Stress re- lieve whole object for 15 minutes before lifting off in a mixture of 95% water and 5% Pro-Wax (80 242) at a temperature of 40°C. Take care when lifting off, this should be done in one movement. To construct a bracing arm as an integral part of a chrome framework reset the pa- trix into the matrix, block out undercuts and areas which are required for proper functioning of the attachment. Duplicate and cast an investment model. Wax up the partial framework and the bracing arm separate from the attachment. An important consideration when designing the frame is, that a box is waxed up to frame the patrix. This will become the sol- dering base or a housing for those at- tachments which can be fixed with com- posite when the partial frame is finished. yp Invest carefully and cast When cast, clean in the ultrasonic or with a fibre glass brush. Do not sandblast. If sec- ondary part is a very tight fit do not grind inner surface. Paint one part with graphite paste and blow dry with the airline. Adjust ment is achieved by inserting and removing the secondary part several times. Clean in the ultrasonic or with steam. The inner sur- face of the secondary part may be lightly polished with a soft polishing brush and some high polishing paste. 46 Mounting of an Intracoronal Slide Attachment These basic instructions apply to the follow- ing attachments: 21.01.2CC CMSlide 21.01.5 KK CM Piasta-slide (plastic) 21.03.2 CC —_ Beyeler slide 21.03.3 CC Beyeler slide 22.02.4 CC —Crismani slide 22.03.1 CC — McCollum slide 22,03.2 CC — McCollum slide 22.03.5 CC Mc Collum slide 22.05.8 CC — Schatzmann slide 22.07.65 CC — Schatzmannslide 22.09.2 HC CMPT-Snap slide 22.10.3 KD CMBiloc slide 22.10.33 KC CMBiloc slide 24.01.5 CC CM Combi-Snap screw retained slide Construct a split cast master model before commencing, as described in Part Il sec- tion 1 Wax up abutments ete. to full contour. (Fig. 68) Set up the first tooth of a partial denture and make a silicon key for use as a guide later. Prepare a box in the distal aspect of the abutment tooth wax up, large enough to ac- cept the matrix of the attachment with space either side. (Fig. 69) Mark the centre of the jaw ridge. Separate the attachment and degrease the matrix. Fix the paralleling mandrel together with the matrix into the parallelometer. The matrix should be mounted parallel to the path of insertion, over the centre of the jaw ridge and as close as possible to the preparation. (Fig. 70)Mounting of an Intracoronal Slide Attachment Fig. 68 Fig. 70 Note It is advantageous to avoid any shortening of the attachment to retain maximum sur- face area for friction. Mount the matrix in it’s final position. The matrix should be bounded with wax on 4 sides. Fig. 71 Where necessary, prepare and wax-up for a milled brace support. (Fig. 71) Remove any unnecessary wax and finish to the desired contour. Replace patrix and check for clearance with the silicone key. With Schatzmann at- tachments, remove stud spring and screw prior to placing into the matrix. 47Part 1! Fig. 73 Fig. 72 Fig. 74 Fig. 75 48Mounting of an Intracoronal Slide Attachment Fig. 76 Attach sprues (Fig. 72) and apply debub- blizer onto wax surfaces only. Do not apply debubblizer to the attachment matrix. Fill up matrix with the appropriate invest- ment using a paint brush or instrument and invest. (Fig. 73) Allow the investment to completely set Place the cylinder, with the opening down, into the furnace. (Fig. 74) Raise the tem- perature to 250 °C for wax elimination. After 20 minutes, invert the cylinder with the opening up, (Fig. 75) in the furnace (especially important when using plastic attachments). Fig. 77 Slowly raise the temperature to 850 °C. Keep atthis temperature, for minimum 1/2 hour de- pending on ring size, until the sprue hole(s) are the same colour as the furnace walls. Cast at once, and let cylinder cool to room temperature. Due to differing laboratory techniques and equipment, the times and temperatures shown above are for guidance only and are dependent upon a. Investment b. Size of ring c. Type of alloy Remove the investment, preferably with a devesting unit (Fig. 76) and clean with steam, or in the ultrasonic. Do not sandblast an at- tachment. (Fig. 77) 49The Cendres & Métaux SA Ceramic Spacer Technique Fig. 84 Check the function of the attachment by re- placing the patrix, If necessary proper fit- ting is modified by the use of colloidal graphite. (Figs. 78 and 84) Special notes for Biloc attachments. ‘Small casting fins or imperfections can be removed with the Biloc drill 22.10.36. (Fig 79) (See Part | - “Procedure for waxing in attachments”, Note g) If necessary calibrate the Biloc cylinders using the 22.10.37 spiral drill and 22.10.38 guide pin. (Fig. 80) (max speed 5000rpm) It is imperative that the guide pin is used dur- ing this proceedure to prevent the drill slip- ping from one cylinder to the other causing irreparable damage. Finish the milled brace support taking care to avoid the attachment face. (Fig. 81) Replace the patrix into the matrix and ad- just height to the occlusal plane. (Fig. 82) The patrix should always be placed into the matrix during any trimming or polishing operation. Porcelain Application The matrix must always be thoroughly cleaned before each firing. Remove any porcelain particles with afine brush. (Fig.83) Subsequent sandblasting to remove porce- lain after firing will damage the attachment. The Cendres & Métaux SA Ceramic Spacer Technique These instructions apply to the following at- tachments: 22.10.3 ID Biloc 22.10.3 IC Biloc 22.11.5 ID CM Box Construct a split cast master model before commencing. (As described in Part Il seo- tion 1) Wax up abutments etc. to full contour. (Fig. 84) 51Part 1! Fig. 88The Cendres & Métaux SA Ceramic Spacer Technique Fig. 89 Prepare a box in the abutment tooth wax-up to accommodate the ceramic spacer. (Fig. 85) Introduce the spacer into the wax-up using the parallelometer. Set into the wax leaving a minimal wall thickness of 0.3 — 0.4 mm. Ensure, that the bottom of the spacer is not resting on the papilla and that itis following the line of the jaw ridge. (Fig. 86) Wax up to the stop plate of the spacer and lift the parallelometer chuck away from the spacer shaft. Prepare wax-up for a milled bracing arm. Remove any unnecessary wax and finish to the desired contour. Shorten the parallelometer shaft with a double sided diamond disc. (Fig. 87) At- tach sprues, apply wetting agent and invest using a fine grained investment. (Fig. 88) Fig. 90 Allow the investment to completely set Place the cylinder, with the opening down, (Fig. 89) into the furnace. Raise the tem- perature to 250 °C for wax elimination. After 20 minutes, invert the cylinder with the opening up, (Fig. 90) in the furnace (espe- cially important when using plastic attach- ments). Slowly raise the temperature to850 °C. Keep at this temperature for minimum 1/2 hour depending on size of ring, until sprue hole(s) are the same colour as the furnace walls. Due to differing laboratory techniques and equipment, the times and temperatures 53Part 1! 50 um Fig. 91 Fig. 92 50 um Fig. 93 shown above are for guidance only and are dependent upon: a. Investment b. Size of ring c. Type of alloy Cast at once in a precious or non precious alloy which has a 0.2% proof stress of mini- mum 500 N/mm?. Bench cool cylinder after casting. Do not quenth Devest carefully and remove remains of ce- ramic spacer with 50 micron glass beads. (Fig. 91) 54 Fig. 94 Insert the patrix and trim to the desired height. The CM-Box patrix can be short- ened by approximately 2mm, the Biloc pa- trix 1 mm. (Fig. 92) The following instructions apply to the CM-Box only Apply porcelain to the desired stage for try- in. Remove oxides formed during the firing cycle with 50 micron glass beads. (Fig. 98)The Cendres & Métaux SA Ceramic Spacer Technique Fig. 95 Try-in and take a new rubber base impres- sion with the crowns/bridgework in place and the patrix removed. Pour impression When set, remove the impression material and insert the duplicating aid (22.11.525) into the matrix, Block out all undercuts and duplicate. (Fig. 94) Note The duplication aid is slightly oversize in the area marked “X" than the actual patrix to provide space for the composite resin fixa- tion which is explained later. Fig. 96 Fig. 97 Place the modelling aid (22.11.5238) onto the duplicate model (Fig. 95) and incorpor- ate into the chrome wax-up. It is possible to construct the framework together with the bracing arm in one piece. However, this requires perfect accuracy of the fitting surface which cannot be guaran- teed. Therefore the following alternatives are suggested. 1. The modelling aid is cast together with the chrome framework. The bracing arm, together with a suitable retention is made 55Part Il 250-300 ym Fig. 98 Fig. 99 Silicon Fig. 100 56 Fig. 101Mounting of an Extracoronal Attachment separately. (Fig. 96) Framework and bracing arm are connected during poly- merisation of the denture. 2. Wax-up and cast the bracing arm and the modelling aid together with addi- tional retention for the denture acrylic, (Fig. 97) After devesting and trimming, insert the pa- trix into the master model and check the fit of the framework and finish the denture. Prepare the slide attachment and the chrome framework for bonding with ad- hesive by cleaning thouroughly. Insert the patrix into the transfer jig (22.11.52) in order to protect the functional parts. Blast the retention area with 50 micron aluminium oxide. Blast the inside of the retention hous- ing of the chrome framework with 250-300, micron aluminium oxide. (Figs. 98-99) Do not touch the sandblasted surfaces. Remove the patrix with the attachment tweezers from the transfer jig, withdraw the activation screw and fill the activation slot and screw hole with silicon compound or wax. (Fig. 100) Insert the patrix immediately into the matrix. Isolate areas which are not to be in contact with the adhesive with va- seline. Prepare a sufficient amount of adhesive. Only use adhesives which are suited for bonding attachments. During the develop- ment of this attachment the following pro- ducts were tested successfully. PANAVIA EX CAVEX NIMETIC CEM ESPE MICROFILL PONTIC KULZER Apply a thin layer of adhesive to the reten- tion part of the attachment patrix and on the inside of the retention housing. Place the completed denture onto the master model and keep in position until the adhesive has set. Where possible hold in position for 1-2 minutes longer than prescribed by the manufacturer. After setting remove surplus adhesive from the attachment and the den- ture. Clean off all traces of silicon or wax from the patrix and replace the activation screw. Leave for 12-24 hours for adhesive to fully harden before inserting into the mouth, To replace the patrix, remove the adhesive by blasting with a micro-blaster and 50 micron aluminium oxide and repeat the above proceedure. (Fig. 101) Note All adhesive proceedures must be carried out on a dry model. You cannot proceed with this method in the mouth. Mounting of an Extracoronal Attachment These basic instructions apply to the following attachments 23.02.2 CC Mini-Conex 23.02.55 CC Conex 23.03.2 CC Mini-Conex 23.03.5 CC Conex 23.06.2 DK Mini-SG Slide 23.06.2 DC Mini-SG Slide 23.06.2 KK Plastic Mini-SG Slide 23.06.5 DC SG Slide 23.06.5 DK SGSlide 23.08.2 CC Regulex 2502.2 CC Flecher 25.03.5 CC Screw Conex 25.08.2 CC Screw Regulex 63.05.2 EC DalboS 63.05.2 DK DalboS 83.01.2 EC Mini-Dalbo 57Part 1 Fig. 104 83.01.2 DK — Mini-Dalbo 83.02.5 CC Roach 83.02.5 EC Roach 83.03.5 DK Plastic Roach Construct a split cast master model before commencing. (As described in Part Il sec- tion 1) Wax up abutments étc. to full contour. (Fig. 102) Set up the first tooth of a partial den- ture and make a silicon key for use as a guide later. 58 Mark the middle of the jaw ridge and pre- pare a box to mount the stop plate of the at- tachment into the wax up. (Fig. 103) Sepa- rate the attachment, degrease the male part, fit into the mandrel and fix into the par- allelometer chuck. For a rigid prosthesis, the attachment should be mounted parallel to the direction of insertion in line with the centre of the ridge. Pay attention to the ver- tical as well as the saggital plane. For a resilient prosthesis, to ensure the hinge action of Dalbo, Mini-Dalbo, RoachFig. 105 A~ Across the arch Mounting of an Extracoronal Attachment Fig. 106 H-Horizontal Fig. 107 P—Parallel to the Mid Line and Plastic Roach attachments functions correctly the following points must be ob- served, The patrix must be mounted correctly in 3 dimensions (Fig. 108) Across the Arch (A) at right angles to the Mid Line (M) Horizontal (H) Parallel (P) to the Mid Line (L) (Figs. 105-107) Fig. 108 On a lower case observe Fig. 108 where possible. However, if you find that the at- tachment encroaches into the lingual sur- face of the denture, it can be mounted on a Disecting Line between the Jaw Ridge and the Mid Line (M) Note The angle from the Mid Line to the disecting line should not exceed 6 Degrees. 59Part Il Fig. 109 Fig. 110 Fig. 111 Replace matrix (after removing any cones, screws etc.) and check clearance with the silicon key. Ensure that the marginal wax up is not over- contoured. Proper oral hygiene should al- ways be possible. Take this into account when mounting this type of attachment. The distance between the ridge and the attach- ment should not be less than 1 mm. This will prevent tissue irritation caused by food en- trapment and/or plaque build up. 60 Fig. 112, With 23.06 SG attachments make sure that the guiding grooves of the male part (A) are free of wax. (Fig. 109) Where required, prepare and wax up for a milled brace support. (Fig. 110) Bracing supports should not be used with resilient or hinge attachments. Remove any unnecess- ary wax and finish to the desired contour. If the abutment crowns are to be full porce- lain crowns, ensure that the stop plate is en- tirely framed with cast alloy. Pay attention toMounting of an Extracoronal Attachment Fig. 113 the coefficient of expansion of the cast alloy and the alloy of the attachment. A small groove or channel should be cut between the stop plate and the wax up. (Fig. 111) This is to prevent cast alloy flowing onto the friction surface of the male part of the at- tachment. Also, do not use any stress re- lieving agent on the attachment otherwise a film of cast alloy may form on the attach- ment surface. (See Part | - “Procedure for waxing in attachments”) Prior to investing, remove all screws, ad- justable cones etc. With Regulex and Flecher attachments we advise you to paint asmall amount of colloidal graphite or anti- flux into the threaded part as a precaution. (Fig. 112) Invest carefully using a paint brush or small instrument to ensure that there are no voids in and around the attachment. Fig. 114 Allow the investment to completely set. Place the cylinder with the opening down (Fig. 113) into the furnace. Raise the tem- perature to 250 °C for wax elimination. After 20 minutes, invert the cylinder with the opening up (Fig. 114) in the furnace (espe- cially important when using plastic attach- ments) Slowly raise the temperature to the final temperature. Keep at this temperature for minimum 1/2 hour depending on the size of ring, until sprue hole(s) are the same colour as the furnace walls Due to differing laboratory techniques and equipment, the times and temperatures shown above are for guidance only and are dependent upon: a. Investment b. Ring size c. Type of alloy 61Part I Fig. 115 Fig. 116 Cast at once, and let cylinder cool to room temperature. Remove the investment, preferably with a devesting unit and clean with steam, or in the ultrasonic. Do not sandblast an attach- ment. (Fig. 115) Check the functions of the attachment such as vertical, hinging or rotational move- 62 Fig. 117 ments. If necessary proper fitting is modi- fied by the use of colloidal graphite. It is ap- plied to only one part and blow dried with air. The adjustment is achieved by inserting and removing the parts several times. Clean off graphite in the ultrasonic cleaner. The matrix should be mounted on the patrix during trimming or polishing to avoid any damage to the patrix. (Figs. 116-117)Mounting of an Extracoronal Attachment Fig. 118 | a! Fig. 119 Fig. 120 Porcelain should be built up with the matrix removed. The patrix has to be thoroughly cleaned before each firing. Remove any por- celain particles with a fine brush. (Fig. 118) Finish the milled brace support secondary part. We suggest, that with extracoronal at- tachments, that the first tooth of a partial denture should be designed as a pontic. This is for three reasons. Hygiene, aesthe- Fig. 121 tics and a ready made thumb nail latch (M) for ease of removal. (Fig. 119) Solder, spot weld or polymerise the matrix to the partial framework. Make sure all mov- able parts such as screws, cones, springs etc. are removed. Do not solder an attach- ment that is designed for polymerisation Block out all areas which are required for proper functioning. (Figs. 120-121) 63Part Il —K—> Age Fig. 122 lounting of Anchor Attachments The following instructions refer to: 31.01.2 Conod 31.02.8 Dalbo-Z 31,06.2 Baer 31.07.2 Stepped Eccenter 3202.5 Gerber RZ 32.07.4 Mini Gerber 32,09.2 Micro-Fix 33.01.5 Schubiger 41.02.8 Dalbo-Z 43.02.8 Dalbo-B For 31.01.5/6 and 41.01.5/6 Rothermann — See end of this section. Construct a split cast master model before commencing. (As described in Part II sec- tion 1) Wax up root cap to obtain a horizontal plane at right angles to the path of insertion. (Fig. 122) . Alter casting and fitting, mill the root cap at right angles to the path of insertion (Fig. 123) 64 Fig, 123, Set up the teeth and make a key with For- masil or similar material. (Fig. 124) The key is to be used to check and determine the Fig. 124Mounting of Anchor Attachments 4 45° Fig. 125, Fig. 127 position of the attachment patrix prior to sol- dering. The patrix should always, where possible, be positioned in the centre of the tooth. Place the patrix, using the correct parallel- ing mandrel, onto the root cap and fix with wax. (Fig. 125) Check position and clearance with the key. Remove root cap and patrix ready for sol- dering. With the Gerber RZ 32.02.5 and the Schubiger screwblock 33.01.5, paint a small amount of colloidal graphite onto the Fig. 126 45° Fig. 128 threaded part of the soldering base and at- tach the soldering core. Paint the root cap carefully with the solder- ing investment mix, being sure to fill in all grooves and angles. (Figs. 126-127) The root cap should be sited into the invest- ment at an angle of 45 degrees to the work- ing surface. (Fig. 128) Use a glass or metal plate under the investment to avoid pos- sible changes to the powder-water ratio (See Part | - “Open flame soldering”). The soldering block should be as small as 65Part Il 400°C/d: ae ee Fig. 129 Fig. 130 Heat treat for 15 mins at 400 °C in the Porcelan furnace I Fig. 131 Fig. 132 possible. It is easier to reach the working temperature and to control the soldering process. After soldering is completed, bench cool. When cool and before polishing, harden the attachment and root cap at 400 °C for 15 minutes in the porcelain furnace, and bench cool. (Figs. 129-130) Pickling Pickle the rootcap after soldering and hard- ning to remove surface oxydation. Dilute sulphuric acid is preferred. The acid (not 66 the root cap) should be hot for rapid and ef- fective cleaning. Note If metallic tweezers are used or in contact with the root cap while it is immersed in the acid, base metal can be easily precipitated by electrolytic action onto the surface caus- ing contamination. A fibre glass brush may also be helpful to remove oxides With all anchor attachments listed above, we supply, where possible, a plastic spacer.Fig. 133 Use this spacer as protection for the patrix during final trimming and polishing. (Fig. 131) Spacers are also used when making dupli- cate models for chrome frameworks. The spacer is larger in height and diameter than the original female part and does not have any undercuts. This will enhance the construction of basket type retentions in the chrome framework and guarantees an even thickness of ac- rylic resin surrounding the female part dur- ing polymerization. The Mini Gerber 32.07.4 is designed to be resin-bonded into the chrome framework. Plastic spacers may also be used as a tem- porary friction attachment. Chamfer the edge of the root cap to an angle of 45 degrees, above the gingiva pa- pill. This helps with proper oral hygiene. (Fig. 132) 32,01.5/6 and 41.01.5/6 Rothermann an- chors do not have to be exactly parallel to the path of insertion and therefore do not have a paralleling mandrel. When attaching to the root cap prior to sol- Mounting of Bar Attachments dering, ensure that the “V" cut is facing to- wards the anterior region. When 2 or more anchors are used the “V” on each one should be all facing in'the same direction: (Fig. 133) Mounting of Bar Attachments These basic instructions apply to the follow- ing attachments: 51.01.2 EE Dolder Bar - Posterior 51.01.5 EE Dolder Bar — Posterior 52.08.3 KC Regulex Plastic Bar §3.01.2 EE Dolder Bar — Anterior 53,01.5 EE Dolder Bar — Anterior §5.01.2 EO or PR3_ CM Round Bar and Rider Fig. 134 67Part 1 Fig. 195 51.01 Dolder Bar Construct a split cast master model before commencing, (As described in Part | sec- tion 1) Follow instructions for preparing a root cap for anchors. See “Instructions for mounting anchors” and Part 1 “Surveying and posi- tioning of attachments”, 68 Fig. 136 53.01 Dolder Bar Joint Important Notes Once this stage has been completed and if the root canals are parallel you may proceed. If not, you must consider the further use of one or more attachments such as the Schubiger Screwblock 33.01.5 to construct a removable bar section. (Fig. 134) If this is your choice, follow the complete instruc- tions for mounting an anchor attachment.Mounting of Bar Attachments Fig. 137 52.08 Regulex Dolder Bars 51.01 and 53.01 may only be used in straight sections and should never be curved or mounted at an angle. (Figs. 135- 136) However, they can be edge contoured to overcome irregularities in the ridge shape and level of the root caps. Edge ben- ding a heavy duty. bar is achieved by measuring the bar, allowing an excess to accomodate the bends, followed by cutting a“V" shape approximately 2/3rds deep out of the bar at the bend (on the fitting surface side) and then adjusting the bar to the cor- rect contour. Ensure the bar will lay flat ona glass plate before investing and soldering the closed "V" cuts and finally heat treating (See part 1 - “Open flame soldering”) Regulex Bars 52.08 may be subdivided, stepped or curved. (Fig. 137) CM Bar 55.01 may be bent and curved to follow the contours of the ridge. (Fig. 138) Fig. 138 58.01 CM Bar Fig. 139 Mounting onto Root Caps Fit bar section into the mandrel and insert info the parallelometer chuck. CM Bar 55.01 is mounted free hand. Deactivate the channel (Dolder bar) patrix (Regulex) or riders (CM bar) and place onto the bar to check clearance with the silicone key. (Fig. 139) 69Part 1 Fig. 140 Gently lower bar into place using the vertical height adjustment of the paralielometer and fix with wax. (Fig. 140) Ensure that there is sufficient space between the underside of the bar andthe tissue for hygiene purposes. Remove the channel, patrices or riders and ensure the bar is attached securely with Du- ralay to the root cap. When completely set, remove complete as- sembly for investing. (Fig. 141) Root Caps with Schubiger Anchors or Implant Cases Using an internal measuring device, (Fig. 142) measure accurately the space be- tween the abutments before attempting to cut the bar to size. Accuracy is very import- 70 Fig. 141 ant at this stage as too large a gap between the bar and the attachment or implant collar could pull the abutments together during the soldering process causing stress. Fit bar section into the mandrel and insert into the parallelometer chuck. CM Bar 55.01 is mounted free hand. Gently lower bar into place using the verti- cal height adjustment of the parallelometer and fix with wax. Ensure that there is suffi- cient space between the underside of the bar and the tissue for hygiene purposes. Deactivate the channel (Dolder bar), patrix (Regulex) or riders (CM bar) and place onto the bar to check clearance with the silicone key. Remove the channel, patrices or riders and ensure the bar is attached securely with Du- ralay to the attachment or implant collar. Remove screws from the attachments or im-Mounting Attachments in Cross Arch Connections ~ Transverse Locks Fig. 144 plant heads and remove bar complete with the collars for investing. (Fig. 143) Paint the root caps and or collars with the in- vestment mix being sure to fill in all grooves, angles etc. Place a small block of soldering investment onto a glass plate (to avoid possible changes to the water-powder ratio) and gently set the assembly in place as shown. (Fig. 144) The soldering block should be as small as possible. It is easier to reach the working temperature and to control the soldering process. After soldering is completed, bench cool When cool and before polishing, harden the attachment and root cap at 400 °C for 15 minutes in the porcelain furnace, and bench cool. (See Part 1 — “Open flame soldering” and “Adjustment and Fitting of Attachments") Mounting Attachments in Cross Arch Connections — Transverse Locks Most intracoronal and extracoronal attach- ments when used in unilateral free-end situ- ations require additional support by way of a cross arch lingual or palatal bar con- nected to an attachment on the opposite side of the arch. This connection provides stabilization which prevents lateral and tortional-rotation movements. The following example is of a Dalbo S at- tachment connected by a palatal bar to a Roach ball attachment. (Fig. 145) Important Notes The attachments used must both follow the same path of insertion If the attachment used is a resilient or hinge type, the attachment mounted as a trans- verse lock must also be resilient to allow for the vertical and or rotational movements. If a rigid attachment is used then the trans- verse lock can be either rigid or resilient. Fig. 145 71Part I Fig. 146 Guidelines for Mounting Retentive Elements | These basic guidelines apply to the follow- ing attachments: 102.02.1 Ipsoclip RE 102.02.2 Ipsoclip Posterior 102.03.2 Ipsoclip Anterior These attachments are normally used in situations where additional mechanical retention is required on removable recon- structions. (I.e. telescopic crowns or milled bars.) The following example shows an ipsoclip mounted in the secondary part of a tele- scopic crown. (Fig. 146) In this situation you must ensure, that there is sufficient room on the buccal surface of the preparation in order that the anatomical shape of the crown is not overcontoured. 72 Fig. 147 Important notes Ensure that, when mounted, the stud and spring can be easily removed for servicing or replacement. |.e. 102.02.1 or 102.02.2 should be mounted following on same line as (rear opening) lingually or palatinally. 102.03.2 (front opening) is usually mounted in proximal spaces and is invisible when the removable section is seated. The spring and stud can therefore only be reached when the prosthesis is removed from the mouth. Attachments must be completely disas- sembled prior to casting on or soldering After casting and trimming the primary and secondary parts should be joined and a pin recess constructed for the rear opening attachments. (Fig. 147) The primary casting should be spot drilled with a centre drill through the stud opening Do not use a rose head drill as damage will be caused to the circumference of the stud hole.