1. Fabrication of a Co-Cr Precision Attachment in Association with a Zigomatic Implant Prepared and presented by Ruan S. de Jongh BTech: Dental Technology Student at Peninsula Technikon

2. Contents Patient history Background information Possible treatment plan Possible technical treatment plan Most suitable treatment option Treatment option of choice Laboratory procedures and final placement

3. Patient History 29 year old female 1974 – complained about swelling Tumour in right maxilla (Myxoma) Myxoma appeared 1 year earlier 2002 – Hemimaxillectomy From midline including 2.2 —1.8 Obturator made in 2002 by Ms Galloway 4 th year student in 2002 Started with this current case

4. Condition and background information Currently tumor is removed Patient’s maxillary right Tumour was benign Wearing obturator Patient in stable and ready for advancements.

5. Possible Treatment Plan Hollow-bulb obturator Already in existence Co-Cr precision attachment Osteotomy

6. Possible Technical Treatment Plan Cobalt chrome removable denture Surgery (R 14 000 = 3h) Anaesthetics = R 1 000 ph Specialist = R 1 000 ph Zigomatic implant ± R 8000 Fabrication of attachment bar ± R 1 000 Fabrication of Co-Cr appliance ± R 1 500 Total cost adding up to ± R16 500

7. Possible Technical Treatment Plan (continued) Private hospital Ward fee = R 500 p/day Total cost = R 205 Surgery = R 165 Ward fee = R 40 (1 month) I.D.S. pays for implant

8. Possible Technical Treatment Plan (continued) First visit Impression Surgery – placement of zigomatic implant Healing time (± 6 weeks) Second visit Impression with analog in place Construction of attachment bar

9. Possible Technical Treatment Plan (continued) Third visit Impression with attachment bar Co-Cr appliance is constructed Fourth visit Co-Cr appliance is placed With 1 st try-in Fifth visit Final placement of Co-Cr removable denture

10. Most Suitable Option Co-Cr precision attachment Implant support Improved stability compared to an obturator Patient is ideal candidate age benign tumour have retentive teeth

11. Treatment Option of Choice Cobalt-Chrome precision attachment Advantages Good aesthetics Very stable Reasonable cost Hygienic Superior strength 1 Disadvantages Movement during function Retention diminishes with use Fracture - porosity 1

12. Laboratory Procedures First Visit Cast of primary model Changes are notified 2

13. Laboratory Procedures (continued) Second Visit Final model cast with analogs Construction of Attachment Bar 2 Cast in Co-Cr Worked off and polished

14. Laboratory Procedures (continued) Second visit (continued) Plastic clips preferred (nylon)

15. Laboratory Procedures (continued) Third Visit Construction of Co-Cr Precision Attachment 1 Duplicated Co-Cr appliance constructed in wax Invested Cast Sprues removed Sandblasted Trimmed Polished

16. Laboratory Procedures (continued) Fourth Visit Placement of Co-Cr precision Attachment 1 st try-in OR Final placement

17. References 1.G. Jenkins, Precision attachments. Removable Partial Prostodontics, Ch 6, Moscow:Quintessence Publishing, 1999: 78-80. 2.University of Pennsylvania Health System. Advances in Head and Neck Reconstruction. 2002: 132-143 3.D. Henderson, Major and Minor Connectors, 6 th Ed. Removable Partial Dentures, Ch 4, Mosby Company, London. 1981: 20-39

18. Thank You! Special thanks to: Prof J.Morkel Dr P.van Zyl Ms Z.Nortje