The Journal of Contemporary Dental Practice

Register      Login



Volume / Issue

Online First

Related articles

VOLUME 24 , ISSUE 2 ( February, 2023 ) > List of Articles


Comparison between Distal Extension Attachment-retained Removable Partial Prostheses with Integrated and Conventional Reciprocation Designs: A Clinical Trial

Maria Raafat Reslan, Essam Osman, Lucette Segaan, Ibrahim Gamal El-Hussein

Keywords : Extracoronal attachment, Hybrid partial prosthesis, Integrated interlock designs, Parallel interlock designs, Removable partial dentures

Citation Information : Reslan MR, Osman E, Segaan L, El-Hussein IG. Comparison between Distal Extension Attachment-retained Removable Partial Prostheses with Integrated and Conventional Reciprocation Designs: A Clinical Trial. J Contemp Dent Pract 2023; 24 (2):89-96.

DOI: 10.5005/jp-journals-10024-3479

License: CC BY-NC 4.0

Published Online: 23-05-2023

Copyright Statement:  Copyright © 2023; The Author(s).


Aim: To compare marginal bone level (MBL) around the abutments in integrated and conventional reciprocation designs in attachment-retained removable partial prosthesis (A-RPP). Materials and methods: Around 14 participants were indiscriminately selected and separated into two groups. For every group, an A-RPP with one of the studied reciprocation types was fabricated and assessed. Group I received A-RPP with integrated reciprocation and group II received A-RPP with conventional reciprocation. MBL around the crowned primary and secondary abutments was assessed on the day of A-RPP insertion, at 6 and at 9 months of denture use. Results: Comparison of MBL values at the primary and secondary abutments within each group showed no statistical difference from time of delivery and throughout the study. After using the A-RPP for 6 and 9 months, group I revealed lower mean values of MBL than group II which were statistically significant. Conclusion: Distal extension A-RPP with integrated and conventional reciprocation designs were associated with raise in bone loss. Integrated reciprocation design revealed a lesser amount of bone loss than the conventional reciprocation design and therefore, it is considered as more preferable to be used. Clinical significance: Distal extension A-RPP with integrated reciprocation is superior in terms of periodontium preservation around abutment teeth as compared to distal extension A-RPD with conventional reciprocation.

  1. Jeffrey A Dean, James E Jones, LaQuia A Walker Vinson, et al. McDonald and Avery's dentistry for the child and adolescent. 11th edition. Elsevier; 2022. pp. 1–715.
  2. Wills DJ, Manderson RD. Biomechanical aspects of the support of partial dentures. J Dent 1977;5(4):310–318. DOI: 10.1016/0300-5712(77)90123-3.
  3. Shahmiri R, Aarts JM, Bennani V, et al. Strain distribution in a Kennedy Class I implant assisted removable partial denture under various loading conditions. Int J Dent 2013;2013:351279. DOI: 10.1155/2013/351279.
  4. Schulze RK, Curić D, d'Hoedt B. B-mode versus A-mode ultrasonographic measurements of mucosal thickness in vivo. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2002;93(1):110–117. DOI: 10.1067/moe.2002.119465.
  5. Carr AB, Brown DT, McCracken WL. McCracken's removable partial prosthodontics, 12th edition. St. Louis Mo: Elsevier; 2011. pp. 560.
  6. Campbell SD, Cooper L, Craddock H, et al. Removable partial dentures: The clinical need for innovation. J Prosthet Dent 2017;118(3):273–280. DOI: 10.1016/j.prosdent.2017.01.008
  7. Budtz-Jørgensen E, Isidor F. A 5-year longitudinal study of cantilevered fixed partial dentures compared with removable partial dentures in a geriatric population. J Prosthet Dent 1990;64(1):42–47. DOI: 10.1016/0022-3913(90)90151-2.
  8. Decock V, De Nayer K, De Boever JA, et al. 18-year longitudinal study of cantilevered fixed restorations. Int J Prosthodont 1996;9(4):331–340. PMID: 8957871.
  9. Miura S, Kasahara S, Yamauchi S, et al. Three-dimensional finite element analysis of zirconia all-ceramic cantilevered fixed partial dentures with different framework designs. Eur J Oral Sci 2017;125(3):208–214. DOI: 10.1111/eos.12342.
  10. Wittneben JG, Joda T, Weber HP, et al. Screw retained vs. cement retained implant-supported fixed dental prosthesis. Periodontol 2000 2017;73(1):141–151. DOI: 10.1111/prd.12168.
  11. De Kok IJ, Cooper LF, Guckes AD, et al. Factors influencing removable partial denture patient-reported outcomes of quality of life and satisfaction: A systematic review. J Prosthodont 2017;26(1):5–18. DOI: 10.1111/jopr.12526.
  12. Swelem AA, Abdelnabi MH. Attachment-retained removable prostheses: Patient satisfaction and quality of life assessment. J Prosthet Dent 2021;125(4):636–644. DOI: 10.1016/j.prosdent.2020.07.006.
  13. Zlatarić DK, Celebić A. Treatment outcomes with removable partial dentures: A comparison between patient and prosthodontist assessments. Int J Prosthodont 2001;14(5):423–426. PMID: 12066636.
  14. Van Waas M, Meeuwissen J, Meuwissen R, et al. Relationship between wearing a removable partial denture and satisfaction in the elderly. Community Dent Oral Epidemiol 1994;22(5 Pt 1):315–318. DOI: 10.1111/j.1600-0528.1994.tb02059.x.
  15. Kaladevi M, Ramaprabha Balasubramaniam. Biomechanics in restorative dentistry. Int J Appl Dent Sci 2020;6(2):251–256. Available from:
  16. Li J, Wang H, Liu Z. The stress model of abutment tooth and periodontal tissues with unilateral mandibular dissociation and loss by precision extracoronal attachment. Saudi J Biol Sci 2019;26(8):2118–2121. DOI: 10.1016/j.sjbs.2019.09.022.
  17. Marie A, Keeling A, Hyde TP, et al. Deformation and retentive force following in vitro cyclic fatigue of cobalt-chrome and aryl ketone polymer (AKP) clasps. Dent Mater 2019;35(6):e113–e121. DOI: 10.1016/
  18. Helal MA, Baraka OA, Sanad ME, et al. Effects of long-term simulated RPD clasp attachment/detachment on retention loss and wear for two clasp types and three abutment material surfaces. J Prosthodont 2012;21(5):370–377. DOI: 10.1111/j.1532-849X.2012.00844.x.
  19. Meenakshi A, Gupta R, Bharti V, et al. An evaluation of retentive ability and deformation of acetal resin and cobalt-chromium clasps. J Clin Diagn Res 2016;10(1):ZC37–ZC41. DOI: 10.7860/JCDR/2016/15476.7078.
  20. Suvarna GS, Nadiger RK, Guttal SS, et al. Prosthetic rehabilitation of hypophosphatasia with precision attachment retained unconventional partial denture: A case report. J Clin Diagn Res 2014;8(12):ZD08–ZD10. DOI: 10.7860/JCDR/2014/9446.5250.
  21. Shende S, Bodele S, Kubasad G, et al. Cast partial denture with attachment: boon to preventive prosthodontics – A case report. Int J Adv Res (Indore) [Internet] 2017;5(6):290295. DOI:10.21474/IJAR01/4411.
  22. Davenport JC, Basker RM, Heath JR, et al. Bracing and reciprocation. Br Dent J 2001;190(1):10–14. DOI:
  23. Gupta S, Rani S, Sikri A, et al. Attachment retained cast partial denture: Conventional and contemporary treatment perspectives. Int J Oral Care Res 2016;4(4):312–316. DOI: 10.5005/jp-journals-10051-0071.
  24. Chaiyabutr Y, Brudvik JS. Removable partial denture design using milled abutment surfaces and minimal soft tissue coverage for periodontally compromised teeth: A clinical report. J Prosthet Dent 2008;99(4):263–266. DOI: 10.1016/S0022-3913(08)60058-X.
  25. Munot VK, Nayakar RP, Patil R. Prosthetic rehabilitation of mandibular defects with fixed-removable partial denture prosthesis using precision attachment: A twin case report. Contemp Clin Dent 2017;8(3):473–478. DOI: 10.4103/ccd.ccd_117_17.
  26. Schulz KF, Altman DG, Moher D. CONSORT 2010 statement: Updated guidelines for reporting parallel group randomised trials. J Pharmacol Pharmacother 2010;1(2):100–107. DOI: 10.4103/0976-500X.72352.
  27. Altay OT, Tsolka P, Preiskel HW. Abutment teeth with extracoronal attachments: The effects of splinting on tooth movement. Int J Prosthodont 1990;3(5):441–448. PMID: 2088381.
  28. Burns DR, Ward JE. Review of attachments for removable partial denture design: 1. Classification and selection. Int J Prosthodont 1990;3(1):98–102. PMID: 2196898.
  29. Geramy A, Adibrad M, Sahabi M. The effects of splinting periodontally compromised removable partial denture abutments on bone stresses: A three-dimensional finite element study. J Dent Sci 2010;5(1):1–7. DOI:
  30. Ku YC, Shen YF, Chan CP. Extracoronal resilient attachments in distal-extension removable partial dentures. Quintessence Int 2000;31(5):311–317. PMID: 11203941.
  31. Wang HY, Zhang YM, Yao D, et al. Effects of rigid and nonrigid extracoronal attachments on supporting tissues in extension base partial removable dental prostheses: A nonlinear finite element study. J Prosthet Dent 2011;105(5):338–346. DOI: 10.1016/S0022-3913(11)60066-8.
  32. Ben-Ur Z, Gorfil C, Shifman A. Designing clasps for the asymmetric distal extension removable partial denture. Int J Prosthodont 1996;9(4):374–378. PMID: 8957876.
  33. Hanna EAM, Hegazy SAF. Modified rotation joint connection unite versus double aker clasp used for bracing of maxillary unilateral free end removable partial dentures (in vitro analysis of stresses on principle abutments and edentulous ridge) [Internet]. 2010. Corpus ID: 33524662.
  34. Feinberg E. Diagnosing and prescribing therapeutic attachment-retained partial dentures. N Y State Dent J 1982;48(1):27–29. PMID: 7031533.
  35. Kumar AB, Walmsley AD. Treatment options for the free end saddle. Dent Update 2011;38(6):382–388. DOI: 10.12968/denu.2011.38.6.382.
  36. Zarb GA, Mackay HF. The partially edentulous patient. II. A rationale for treatment. Aust Dent J 1980;25(3):152–162. DOI: 10.1111/j.1834-7819.1980.tb03706.x.
  37. Vaidya S, Kapoor C, Bakshi Y, Bhalla S. Achieving an esthetic smile with fixed and removal prosthesis using extracoronal castable precision attachments. J Indian Prosthodont Soc. 2015;15(3):284–288. DOI: 10.4103/0972-4052.155048.
  38. El Charkawi HG, El Wakad MT. Effect of splinting on load distribution of extracoronal attachment with distal extension prosthesis in vitro. J Prosthet Dent 1996;76(3):315–320. DOI: 10.1016/s0022-3913(96)90178-x.
  39. Fleiner J, Hannig C, Schulze D, et al. Digital method for quantification of circumferential periodontal bone level using cone beam CT. Clin Oral Investig 2013;17(2):389–396. DOI: 10.1007/s00784-012-0715-3.
  40. Scarfe WC, Farman AG. What is cone-beam CT and how does it work?. Dent Clin North Am 2008;52(4):707–730. DOI: 10.1016/j.cden.2008.05.005.
  41. Saito M, Miura Y, Notani K, et al. Stress distribution of abutments and base displacement with precision attachment- and telescopic crown-retained removable partial dentures. J Oral Rehabil 2003;30(5): 482–487. DOI: 10.1046/j.1365-2842.2003.01092.x.
  42. Coye RB. Precision attachment removable partial dentures. W V Dent J 1993;67(1):6–14. PMID: 9518850.
  43. Brudvik JS, Shor A. The milled surface as a precision attachment. Dent Clin North Am 2004;48(3):685–708. DOI: 10.1016/j.cden.2004.03.005.
  44. Kolodney H Jr, Holder R Jr, Gray WC. A reliable index for correct positioning of precision attachments into an existing overdenture. J Prosthet Dent 1992;67(3):335–338. DOI: 10.1016/0022-3913(92)90242-3.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.