17 TECHNIQUE TO MAKE - Aligarh Muslim University TO MAKE.pdfcobalt chromium metal.(fig:4)The denture...

ABSTRACT:The fracture of acrylic resin denture is an unresolved problem in removable

prosthodontics despite numerous attempts to determine causes. Midline fracture was the most

common problem of these 71% midline fracture seen in maxillary denture and in mandibular

denture its 29%. Fractures in Reinforcement has been attempted through the incorporation of

solid metal forms and various types of fibers in fracture-prone areas. Metals can be added in the

form of wire, plates, nets or fillers. The present case series deal with oral rehabilitation of

maxillary and mandibular arch by incorporating various reinforcement material in denture base

to combat the masticatory forces and improve the longevity of the prosthetic replacement at the

same time prevent resorption of the underlying residual ridge.

1 2 3Abbad Nikhil, Srivastava Rajeev, Choukse Vivek

Modern Dental College And Research Centre

INTRODUCTION: Patients who has become entirely

edentulous in one jaw and retaining either or all or some of

natural teeth in the others with several difficulties in

providing successful single complete denture is common1.

Fracture of an acrylic resin denture base can be a problem in

prosthodontics1,2,3. The material most commonly used for

the fabrication of dentures is the acrylic resin, poly methyl

methacrylate4,5. This material is not ideal in every respect

and it is the combination of properties rather than one single

desirable property that accounts for its popularity and

usage5,6. Causes of fractures include occlusal disharmony,

flexure and fatigue of the denture base as a result of alveolar

resorption and impact as a result of dropping the denture5,6,7.

Midline fracture was the most common type of fracture

during the period of study 195(61%)8.The midline fracture in

a denture is often a result of flexural fatigue 2,6. There are

many different approaches to solve the problems of repeated

denture fracture2,9,10,11. Through this case series denture

reinforced with metal, Denture reinforced with metal mesh

have been discuss although there are three routes which

improve the impact properties of PMMA alternative material

to PMMA; the chemical modification of PMMA such as by

the addition of a rubber graft copolymer; and the

reinforcement of PMMA with other materials such as carbon

fibers, glass fibers and ultra-high modulus polyethylene4,10.

Advantages of metal denture base: (1) They have excellent

strength to volume ratios and may be cast in thin sheets

maintaining rigidity and fracture resistance4.(2) Thinner

metallic denture base decrease interference with

phonation12.(3) They display desirable dimensional

characteristics and may be cast accurately4,9.(4) More

retentive12.(5) Deform less during lateral mandibular

function.(6) High thermal significant conductors12,13.

Disadvantages of metal denture base: (1) There is increased

cost, difficulty in fabrication, difficult to rebase4. (2) They

may be indicated when polymer-based systems fail to provide

acceptable physical properties.(3) Time consuming and

added steps needed.(4) Encroachment of interocclusal

space.(5) Weight of the denture may be inconvenient

initially4,12.

Indications of metal denture base: (1) Patients with atrophied

ridges.(2) Patient with compromised neuromuscular

coordination, who may drop their dentures.(3) Patients with

increased rate of residual ridge resorption. a. Like

postmenopausal women b. Diabetic patients.(4) Patients with

flabby tissues which may require soft liner.(5) Patients who

TECHNIQUE TO MAKE SINGLE COMPLETE DENTURES ROBUST: CASE SERIES

Journal of Dental Sciences

University

University Journal of Dental Sciences, An Official Publication of Aligarh Muslim University, Aligarh. India 78

University J Dent Scie 2017; No. 3, Vol. 2

Case Report

Keywords-

Residual ridge

resorption, metal denture

base, single complete

denture, metal reinforced

denture, metal mesh.

Source of support : Nil

Conflict of interest: None

are allergic to metal, with a history of denture

fractures4,12,13,14,15.

Materials used for metal denture base: Cr-Co – most retentive,

Ni – Cr, Titanium etc4,10,12,13,14,15..

Case report 1: (Metal denture)

A 70-year-old male patient, reported to the Department of

Prosthodontics (Institute of dental sciences) with a chief

complaint of recurrent fracture of maxillary single complete

denture.

Intraoral examination revealed shallow palatal vault, high

frenal attachment on buccal side bilaterally and opposing

mandibular natural dentition with few edentulous area.

Missing 31,32,35,36,41,42,44,46.(Fig:1). Mucosa was

normal and opposing dentition required minor alterations.

Saliva was of medium consistency and patient was

cooperative and philosophical according to House

classification. His primary concern for the new denture was a

denture with increased strength. Appropriate treatment plan

was formulated taking into consideration. Considering all the

factors and history of denture fractures, metal denture base

was planned for the patient12,13,14,15.

Impression of the lower natural teeth was made with an

irreversible hydrocolloid material and the dental stone

diagnostic cast was poured. Preliminary impression of the

edentulous maxilla was made with impression compound and

plaster cast was poured for the fabrication of a customtray.

The peripheral tracing procedures were completed tray with

green stick impression compound and the secondary

impression was made with zinc oxide eugenol impression

material.(fig:2) Master cast was made with dental stone type

IIIand the mold of the same was made with reversible

hydrocolloid (agar) and a refractory cast was poured with

phosphate bonded investment material. On the refractory cast

the denture base pattern wax was adapted and sprues were

attached and invested. The denture base was casted with

cobalt chromium metal.(fig:4)The denture base covered the

palate and residual ridges and the posterior palatal seal area

for mechanical retention of acrylic resin and teeth to the

metal12,13,14,15.

The vertical dimension of occlusion was established and

occlusion rim on the maxillary denture base was constructed

and contoured for adequate lip support in the anterior region

to simulate the vertical and horizontal overlap of the anterior

teeth. The anterior region of the occlusal rim had the same

thickness as the incisal edges of the anterior teeth to allow for

this vertical overlap. After this with the face bow orientation

jaw relation recorded and transferred on the Hanau wide

articulator.(fig: 5). After this with the help of functional chew

in method the centric is recorded. Cast partial was planned for

lower arch after alginate impression mouth preparation was

done and putty light body final impression was made. The

final cast was duplicated in agar and refractory cast was

poured (fig:6)

Arrangement of the artificial teeth was carried out to revel the

necessary changes to be made on the lower teeth. Adjustment

in the artificial teeth were incorporated in the preference to

making changes to the natural teeth.(fig:7) A trial of waxed up

maxillary complete denture was made followed by

acrylization of complete denture with heat polymerized

acrylic resin.(fig:8) The interference in denture were

eliminated and denture given to the patient.(fig:9) Post

insertion instruction were given to the patient regarding its

maintenance and hygiene12,13,14,15.

Fig. 1 a)

b)

c)



Fig. 2 a) b)

Fig.3 c) d)

Fig. 4 a b) c)

d) e)

Fig. 5 a)

Fig. 6 a) b)

c) d)

Fig. 7 a)

b)

Fig. 8 a)

b)



Fig. 9 a) b)

Case report 2: (Metal mesh denture)

A completely edentulous 59 year old male good general

health, reported to the Department of Prosthodontics, Crown

and Bridge (Institute of dental sciences) with a history of

repeated fracture of Mandibular Denture. History revealed

that he was completely edentulous for last 7 years and was

wearing the present dentures for last 6 years. Since last 1 year

the lower denture had been repaired thrice with routine

Laboratory procedures. His primary concern for fabrication

of new dentures was dentures with increased strength. History

taking revealed a personality of philosophic type intraoral

examination revealed that ridge form of mandibular arch was

Class 3 -thin inverted 'V'(Fig:10). Appropriate treatment plan

was formulated taking into consideration, the repeated

episodes of fracture. Our objective was to enhance the

fracture resistance of the denture. Considering the availability

of the resources and keeping in mind the patient's concern

about the cost and function it was decided to fabricate a metal

mesh reinforced denture4,5. The step involved are primary

impression followed by final impression of lower arch by

light body (fig:12). Wax rim were made face bow was

recorded transfer to Hanau articulator. Arrangement of the

artificial teeth was carried out to revel the necessary changes

to be made on the upper teeth. Adjustment in the artificial

teeth were incorporated in the preference to making changes

to the natural teeth. Processing of denture include additional

step is incorporation of metal mesh during packing

stage.(fig:13,14).The interference in denture were eliminated

and denture given to the patient.(fig:15,16) Post insertion

instruction were given to the patient regarding its

maintenance and hygiene

Fig. 10 a) b)

Fig. 11 a) b)

Fig. 12 a) b)

Fig. 13 a) b)

Fig. 14 a) b)

Fig. 15 a) b)

Fig. 16 a) b)



Case report 3: (Metal mesh)

A 55 years old male, partially edentulous with good general

health, reported to the Department of Prosthodontics,Crown

and Bridge (Institute of dental science) with a history of

repeated fracture of Mandibular Denture. Intraoral

examination revealed highly resorbed mandibular ridgeand

opposing full complement of natural dentition. Mucosa was

normal and the opposing teeth required minor alterations.

Saliva was of medium consistency and patient was co-

operative and philosophical according to House

classification. Procedure for case 3 is same as in case 2

procedure4,5from (fig: 12,13,14)

Fig. 17 a) b)

c)

Fig. 18 a) b)

Fig. 19 a) b)

Fig. 20 a) b)

Fig. 21 a) b) c)

Fig. 22 a) b)

Fig. 23 a) b)

Case report 4:(Metal mesh)

A 45-year-old male reported to the Department of

Prosthodontics Crown and Bridge, (Institute of dental

science) with a chief complaint of inability to chew food due

to missing teeth in the maxillary and mandibular arches

(Figure.1). Detailed case history was recorded and no

significant medical concerns were observed. Similar

treatment plan as case 2and 3 were planned4,5 from (fig:

12,13,14)

Fig. 24 a) b)



Fig. 25 a) b)

Fig. 26 a) b) c)

Fig. 27 a) b)

Fig. 28 a) b)

Fig. 29 a) b)

CONCLUSION:

The problems involved in providing comport, function,

proper esthetics and retention is a vigorous challenge for

practicing dentist. The treatment modality of maxillary metal

base and opposing natural dentition provided great comfort to

the patient as the metal denture base was strong to resist

catastrophic failure solving patients chief complain of

recurrent fracture in addition the metal denture bases are good

thermal conductors and less bulky thus patientperceive

natural feeling from thin base which may also contribute to

additional denture stability. Metal mesh in the denture has an

added advantage as it increases the strength and durability of

the denture with patient satisfaction.

REFERENCES:

1. Beyli MS, Dent M and Fraunhofer V. An analysis of

causes of fracture of acrylic resin dentures J Prosthet

Dent 1981;46(3):238-241.

2. Polyzois GL, Andreopoulos AG and Lagouvardos

PE. Acrylic resin denture repair with adhesive resin

and metal wires: Effects on strength parameters J

Prosthet Dent 1996;75(4):381-387.

3. Vallittu PK. Dimensional accuracy and stability of

polymethyl metacrylate reinforced with metal wire

or continuous glass fiber 1996;759(6):617-621.

4. Jagger DC, Harrison A and Jandt KD. Review The

reinforcement of dentures 1999;26:185-194.

5. Naik S, Preetham P, Behera SS, Shreelok BS. Metal

mesh dentures: A Boon to conventional dentures.

Indian J Stomatol 2012;3(3):197-199.

6. Sheikh Ali M, Al zahrani SB. Causes of denture

fracture: A survey. Saudi Dental J 2006;18(3):149-

155.

7. Rodrigues AH. Metal reinforcement for implant

supported mandibular overdentures. J Prosthet Dent

2000;83(5):511-513.

8. Khasawneh SF. A clinical study of complete denture

fractures at four military hospitals in Jordan. JRMS

2003;10(3):27-31.

9. Jameson WS. Fabrication and use of a metal

reinforcing frame in a fracture prone mandibular

complete denture. 2000;83(4):476-480.

10. Bashi TK,Al-nema LM. Evaluation of some

mechanical properties of reinforced acrylic resin

denture basematerial( An in vitro study). Al

Rafidian Dent J 2009;9(1):57-62.

11. Murthy HB et al. Effect of reinforcement using



stainless steel mesh, glass fibers and polyethylene

on the impact strength of heat cure denture base

resin-An in vitro study. J Inter Oral Health

2015;7(6):71-79.

12. Rathod N, Pawar S,Naitam D and Pasam N. Metal

denture base an approach to overcome the failure of

acrylic denture bases . IJRID 2015;5(2):69-72.

13. Prasad A, Prasad K and Hegde C. Management of

completely edentulous maxillary arch opposing

natural dentition- A case report. NUJHS

2012;2(3):39-42.

14. Memon S, Patel JR, Sethuraman R and Patel RS.

Management of single mandibular complete denture

with custom metal mesh- A case report .EJDTR

2013;2;137-139.

15. Kaira LS,Singh R. Single complete denture in

mandibular arch opposing natural dentition – A case

report. NUJHS 2013;3(1):72-75.

Figures Legends:

Figure 1: (a) maxillary edentulous arch (b) mandibular

edentulous arch (c) inter arch

Figure 2: (a) pre-operative frontal view (b) lateral view

Figure 3: (a) alginate lower impression (b) upper final

impression with zinc oxide eugenol

Figure 4: (a) wax spacer adapted on refractory maxillary cast

(b) sprue attached to the cast (c) obtained metal framework (d)

adapted metal mesh on the cast (e) occlusal wax rim on cast

Figure 5: (a) facebow record on the patient (b) facebow

transfer on Hanau articulator

Figure 6: (a) block out mandibular cast (b) duplication of cast

(c) duplication by agar (d) Refractory mandibular cast

Figure 7: (a) right side occlusion (b) left side occlusion

Figure 8: (a) maxillary flasking (b) mandibular flasking

Figure 9: (a) post-operative frontal view (b) smile at rest

position

Figure 10: (a) maxillary arch (b) mandibular arch


Figure 12: (a) alginate maxillary impression (b) elastomeric

mandibular final impression

Figure 13: (a) flasking of mandibular denture (b) metal mesh

for mandibular

Figure 14: (a) metal mesh adapted on mandibular cast

(b)intaglio surface of denture

Figure 15: (a) right side occlusion (b) left side occlusion

Figure 16: (a) post-operative (b) smile at rest position

Figure 17: (a) maxillary arch (b) mandibular arch (c) interarch


Figure 19: diagnostic cast

Figure 20: facebow record

Figure 21: (a) frontal view of occlusion (b) right side

occlusion (c) left side occlusion

Figure 22: flasking of mandibular denture

Figure 23: (a) post-operative view (b) smile at rest position

Figure 24: (a) maxillary arch (b) mandibular arch


Figure 26: (a) right side occlusion (b) left side occlusion (c)

frontal view occlusion

Figure 27: (a) flasking of maxillary denture (b) metal mesh

adapted on cast

Figure 28: (a) maxillary denture (b)intaglio surface

Figure 29: (a) post-operative frontal view (b) lateral view

CORRESPONDING AUTHOR:

Dr. Abbad Nikhil Bharat

Modern Dental College And Research Centre

Email address: [email protected]

Mobile No.: 9713435111



17 TECHNIQUE TO MAKE - Aligarh Muslim University TO MAKE.pdfcobalt chromium metal.(fig:4)The denture...

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