An innovative method for magnet retained over denture.
K. Balu Reader, Dept of Prosthodontics, KSR Institute of Dental Science and Research, Tiruchengode, Namakkal (Dt), Tamil Nadu, India Address for Correspondence : K. Balu K.A.V. Dental Clinic 357 D-18, Suramangalam Main Road, Salem - 636 005 Tamilnadu, India. e-mail : dr_balu@yahoo.com ABSRACT: Application of magnetic forces in retention of prosthesis has been tried for decades. As a better alternative to conventional attachments, magnetic attachments offer various advantages. This article presents an innovative, economical and easy way of fabrication of magnet retained overdenture. Their merits and fabrication methods are explained in detail. Key words: Break away load, keeper, magnetic system Introduction Retention and stability of dentures have been a continuing problem for dentists in clinical practice. Universally prevalent there always a group of patients for whom conventional prosthodontic techniques have been inadequate to fulfill their satisfaction. In an attempt to alleviate their problems, a variety of materials and methods have been tried such as springs, suction cups, adhesives, attachments, implants and magnets. As a mature retentive technique and a better alternative to conventional methods, magnetic attachments are applied in various types of 1 prosthesis . Magnet retained overdenture is one such method which fulfills dentist and patient needs. This innovative method was initiated way back from 1950 with the invention of Alnico bar magnets and later on progressed with the introduction of Platinum-Cobalt, Cobalt-Samarium and the recently introduced 3,7 Neodymium- Iron- Boron magnets . Even though they are smaller in dimension and have excellent retentive force, they are costly when imported to India. This article presents a clinical case report of fabrication of maxillary overdenture retained by magnets .The method is new and innovative and also economical and time saving Introduction A 60 year old male patient reported to dental clinic willing to replace missing natural teeth. Clinical examination revealed completely edentulous mandibular arch and partially edentulous maxillary arch with few remaining natural teeth which are periodontally weak. After adjuvant radiographic evaluation, hopeless teeth were removed. Periodontally favorable maxillary right central incisor and maxillary right second premolar were left intact which later on serve as overdenture abutments. Magnet retained overdenture were prepared as two components namely root component and denture component. a) Preparation of Root component Conventional Dental magnets (Ali brother Electronics, Ritchie Street, Chennai, India) were used for this study. All magnets used for this study are circular in shape and measure 3mm wide and 2 mm thick. Intentional root canal treatment was performed on the retained maxillary right central incisor and second premolar. Later on both the teeth were decoronated about 1mm from free gingival margin using carborundum disc. The surface of the section was smoothened and rounded to eliminate sharp margins. The temporary filling material and gutta percha was removed from the pulp chamber and part of root canal and a cavity was prepared to a depth of 2 to 3 mm and width slightly more than 3 mm with a fissure bur. Retention grooves are then cut in the buccal and lingual axio-pulpal line angles with an inverted cone bur. The extension of cavity depends on the size of tooth and enough tooth structure should be left to prevent lateral perforation or weakening and breakage of the cavity walls. Impression of the prepared cavities was made with an elastomeric impression material (Impregnum soft, 3M ESPE, St Paul, MN, USA) and poured in dental stone (Gold Stone, Asian Chemicals, Rajkot, India). JIADS VOL -1Issue 1 Jan-March,2010 |52| The cast prepared from this impression was used for cutting and fitting the magnets to the prepared cavities. Then magnets were cut to required size using high speed hand piece and diamond burs. Care should be taken not to overheat the magnets during cutting procedures because this may damage their physical properties. Each magnet was cut approximately to fit the prepared cavity and fit was verified. Magnets were held by a strip of stainless steel matrix band material (Matrix Band no-8, Khusboo & Co, Aligarh, India). The projecting edges of matrix band material serve as stops to ensure that the magnet is held flush with root face during trial fitting and cementation procedures. Now magnets are ready to be cemented into their respective cavities. Prepared cavities are isolated, dried and magnets were cemented (Fig 1) with an adhesive resin (RelyX U100, 3M ESPE, St Paul, MN, USA). Excess cement was removed, sharp dentin edges rounded and finally smoothened and polished. b) Preparation of Denture component Preliminary impression of maxillary and mandibular arches were made using impression compound (Aslate, Asian Acrylates, Mumbai, India) and cast prepared in dental plaster (Kalabhai Karson Pvt Ltd, Mumbai, India). Acrylic custom tray (DPI-RR Cold Cure, DPI,Mumbai,India) with wax spacer (Modelling Wax No 2, Hindustan Dental Products, Hyderabad, India) was fabricated. An additional wax spacer to the dimension of denture magnet, about 3mm x 2 mm was placed over the root face on preliminary cast. Border moulding was done with low fusing compound (DPI Pinnacle Tracing Stick, DPI, Mumbai, India), wax spacer removed, relief holes given and tray kept ready for definitive impression. Denture component magnet was placed facing the cemented root component magnet and definitive impression of maxillary and mandibular arches were made using Zinc oxide Eugenol impression paste (DPI Impression Paste, DPI, Mumbai). Set impression was removed from patient's mouth and inspected for defects (Fig 2). The denture magnet which gets embedded within the impression was removed and master cast prepared in dental stone. Complete denture was then fabricated by conventional material and methods (DPI Heat Cure, DPI, Mumbai). Finished complete denture was tried in patient's mouth and kept ready for insertion. The tissue surface of mandibular complete denture which contains the cavity corresponding to the denture magnet was slightly enlarged and undercut created with inverted cone bur to freely accommodate the magnet. Denture magnet was placed facing the root magnet. Autopolymerising acrylic resin (DPI-RR Cold Cure) was mixed and placed into the cavity and complete denture inserted into patient's mouth and patient asked to occlude with minimal force. Complete denture was later removed from mouth, excess acrylic flash trimmed and removed (Fig 3). Finally finished and polished prosthesis was inserted into patient's mouth (Fig 4). Regular post insertion instructions and advises were given to the patient. Fig 2- Definitive Impression with embedded denture magnet Fig 4- Prosthesis delivered Fig 3- Processed denture component magnet Fig 1- Cemented root component magnet K.Balu An Innovative Method for magnet retained over denture JIADS VOL -1Issue 1 Jan-March,2010 |53| Discussion In this article, fabrication of overdenture using magnets was discussed. Basically there are two types of magnetic systems namely open field 1,4,8 and closed field systems . Open field system involves two cylindrical magnets, one embedded in the denture and the other cemented to the root canal treated teeth which was decoronated at the gingival margin where as in the closed field system, the magnetic assembly consists of magnet with protective stainless steel end plates embedded in the denture and a ferromagnetic alloy (detachable keeper) cemented into the root. The main advantage of this system over the conventional magnetic systems was that of time 8-14 saving, simple and very economical method .The procedure of crown decoronation, preparation of cavity to accommodate magnets, making impression of the prepared cavity, preparing working casts, modifying and cementing root component magnet and making definitive complete denture impression can be completed in one appointment on a short time span. More over by placing denture component magnet over root magnet while making definitive impression creates an exact negative depression on the tissue surface of complete denture. These procedures eliminate the chance of alignment error between the approximating surfaces of both the magnets. But a word of caution needs to be mentioned while fixing denture magnets with auto- polymerizing acrylic resin. The force needed to separate magnets was designated as breakaway load 13,14 expressed in terms of grams . The value of breakaway load is inversely proportional to the distance of separation and inclination between the magnets. Patient was instructed to apply minimal occlusal or bite force while fixing denture magnet as more pressure would displace magnets inwards which in turn decrease the breakaway force when the denture was later on inserted in patient's mouth. This was justified by the fact of REAL-EFF (resiliency and like effect). To summarize, it would be fair to explain that this complete overdenture would be more retentive in patient's mouth as soon as it is inserted. These magnets are wholly biocompatible in the human body and by itself exert no deleterious effects in human tissue. Inert magnetic field is harmless to human body. This can also be safely used for patients with cardiac pacemaker but magnets must not be brought closer 16. than 1 cm during trial procedures But we need to mention some drawbacks of this concept. Since the concept of open field magnetic system was involved in this case report, the magnets surfaces were exposed to oral fluids leading to tarnish and corrosion. This may lead to a gradual decrease in retentive force upon usage. Even so upon failure, a new similar pair of magnetic system can be incorporated without disturbing the denture component. But the most challenging drawback was that even though studies have proved that they are biocompatible, some open field uncoated magnets 2 exhibit significant cytotoxic effects which may be attributed due to the release of corrosion by products from them. Hence magnets should be replaced as 2,6,7 early as signs of corrosion develop . Extensive research will hopefully provide a permanent magnet which will be resistant to the adverse environment of the oral cavity and allow the full potential of prosthesis retained by magnets to be realized. Conclusion The concept of overdenture retained by magnets was detailed in this study. This method offers various advantages and convenience over their conventional counterparts in spite of certain drawbacks. Extensive research is going on around the world especially in the US and Japan pertaining to magnets sizes which are getting reduced, attractive forces becoming higher, better encapsulation, newer alloys, laser welding of protective end plates and so on. Hope such research would bring in a universally acceptable system. References 1. Akaltan F, Can G. Retentive characteristics of different dental magnetic systems. J Prosthet Dent. 1995 Oct; 74(4) : 422-7 2. Barnothy MF, Biological effects of magnetic fields, New York Plenum Press,1964,PP 29-306 3. Boice GW. Kraunt RA. Maxillary denture retention using rare earth magnets and endosteal implants. Int J.Oral Implantol. 1991; 7(2):23-7 4. Bormes T. Magnets myth and magic Trends Tech. Contemp Dent Lab 1998 Apr; 5(3): 42-7 5. Davis DM, Packer ME, Mandibular Overdentures stabilized by Astra Tech implants with either ball attachments or magnets; 5 year results. Int J Prosthodont. 1999 May-Jun; 1993: 222-9 6. Drago CJ. 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