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Ten patients with kennedy class I classification utilizing OT unilateral extracoronal attachment were randomly divided in two groups using split mouth research design. Group I (without bracing arm) and group II (with a bracing arm on a prepared ledge at the survey line of the abutments). Radiographic evaluation of the abutments was made at time of denture insertion, 6months, 12months, 18 months, and 30 months after denture insertion to measure the bone height changes around the abutments. The results obtained showed a statistically significant difference in bone loss around the abutment teeth between the two groups. In Conclusion patients rehabilitated with OT unilateral extracoronal attachment with a bracing arm showed less vertical bone loss around the abutments KEYWARDS: Splinted abutments, bracing arm, unilateral distal extension, attachments. (934) Hesham I AlmEldeen E.D.J. Vol. 63, No. 1 removable prosthesis with improved aesthetics, as elimination of the buccal or labial direct retainer or clasp arm is a key factor in establishing an esthetically acceptable design. Also less postoperative adjustments and better patient comfort are indication for the attachment RPD.(1,3) Attachments are mostly indicated in long edentulous spans, distal extension bases and nonparallel abutments. Many recent studies greatly recommended that when abutments were of adequate clinical crown height to receive attachment; multiple abutments were splinted anterior to the edentulous span to aid in better distribution of stresses.(1,5) Extensive dental crown preparation, financial burden, complex clinical and laboratory procedures and difficulty in performing repairs are negative aspects of removable dentures associated with attachments. (7) This study was carried out to evaluate the affect of using a reciprocal arm in unilateral attachment retained skeleton partial denture in distal extension cases. MATERIALS AND METHODS Ten patients were selected from the outpatient clinic, Prosthodontic department, Faculty of dentistry, Future University. The selected patients had the following criteria. All patients had Kennedy class I lower partially edentulous ridges with the first or second premolars were the last standing abutments. The remaining teeth had good periodontal condition, with no signs of attrition or gingival recession. Patients age ranged from 55-65 years. Patients with abnormal habits as bruxism or clenching were not included in the study. Preliminary impressions were made for the upper and lower arches using irreversible hydrocolloid impression material in properly selected and adjusted aluminum stock trays. The impressions were poured in dental stone to produce study casts. Study casts were mounted on a semiadjustable articulator (Easi Co, Ltd, Tokyo, Japan ) A face bow (Easi Co, Ltd, Tokyo, Japan) record was used to mount the upper cast. A provisional interocclusal wax record was made to mount the lower cast.. Preoperative panoramic radiograph was made to detect the presence of impacted teeth, remaining roots or any pathological conditions. Visual color determination of the abutment teeth using a shade guide was made before preparation. Two adjacent abutments on each side of the arch were prepared to receive two splinted ceramometallic crowns (Fig. 1). The finishing line was placed just below the free gingival margin. Gingival retraction was carried out using retraction cord introduced into the gingival crevice and left for five minutes before making the impression. An impression was made using silicone rubber impression material, and the prepared abutments were then protected with temporary crowns. The impression was poured in type IV improved stone and removable dies of the abutment teeth were obtained by sawing and then, wax patterns for the abutments were constructed. Unilateral OT attachment (Rhein 83 OT unilateral) was used in split mouth research design.Group I received (OT unilateral extracoronal attachment and wax pattern for the abutment were made without ledge, since the Fig (1) Intra-oral view, Kennedy class I lower partially edentulous ridge with prepared last two abutments. THE EFFECT OF RECIPROCAL ARM ON THE SUPPORTING STRUCTURES (935) abutments will not receive a bracing arm) and group II received a modified OT unilateral extracoronal attachment with a bracing arm and wax pattern for the abutment were made with a ledge to receive a bracing arm from the removable partial denture. In a split-mouth design. Then OT Unilateral attachment Kit were used (Fig 2), The male portions of the plastic pattern of the attachments were joined to the distal surface of the wax pattern of the last abutments 1mm away from the gingival margin. This was carried out with the aid of surveyor (fig 2). Spruing, investing, burn out and casting were carried out according to the manufacture’s instruction. The casting was sandblasted, finished and polished except the male portion of the attachment. The finished castings were tried in the patient’s mouth and checked for seating, retention and proper adaptation of the finishing line. Porcelain was then fired to the metallic crowns. Try in of the crowns were carried to check proper occlusion and contact with the adjacent teeth. (fig 3). Centric occluding relation were recorded . Setting up of cross linked acrylic resin teeth and then tryin were done. Denture processing was carried out. After deflasking, laboratory remounting was carried out to correct processing occlusal errors and dentures were then finished and polished. The porcelain crowns were finally cemented to the abutment teeth and the denture was inserted and used to fix the crowns accurately during cementation. In the recall visits, patients were evaluated radiographically to measure the bone height changes around the natural abutments at time of denture insertion, 6months, 12months, 18 monthss and 30 months. The Digora computerized system (Digora computerized system, Helsinki, Finland), the Rinn XCP periapical film holder (Rinn manufactures Co. Ligin, III, USA) and a specially constructed acrylic template were used for taking standardized and reproducible serial digital images for the natural abutments using the long cone paralleling technique.The digital images were analyzed to evaluate the marginal bone level distal to the last abutment at three different points with the same fixed landmarks. (8) Fig.(2) Ledge preparation on the second premolar for receiving the bracing arm only at one side. Fig. (3) Porcelain crown with the attachment also showing the prepared ledge on the right side of the cast for receiving the bracing arm. (936) Hesham I AlmEldeen E.D.J. Vol. 63, No. 1 The first a line (first line) was drawn horizontally and tangential to the apex of the root of the last abutment. The second and third vertical lines were drawn at equal distances from each other from the highest level of the alveolar crest to the horizontal line the first line and perpendicular on it. Fig. (4) The marginal bone height along each of the three lines was measured and the mean values of the three readings distal to the last abutment were recorded, tabulated and statistically analyzed.

THE EFFECT OF RECIPROCAL ARM ON THE SUPPORTING STRUCTURES OF THE ABUTMENTS IN CASES RETAINED BY UNILATERAL ATTACHMENT