metal mess infused maxillary complete denture - a …

Official Journal of Indian Dental Association Tirunelveli Branch

METAL MESS INFUSED MAXILLARY COMPLETE

DENTURE - A CLINICAL CASE REPORT

Dr. Amalorpavam1*, Dr. Jithin2, Dr. T. Sreelal3, Dr. GiriChandramohan 4, Dr. Aparna Mohan 4

Present address: † ; ‡ ; § ; ¶

Access this article onlinehttps://www.jidati.com/Article IDJIDATI0101007

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Submitted: 05-Nov-2020Revised: 15-Dec-2020Accepted: 20-Jan-2021Published: 07-Mar-2021

Abstract

Single denture opposing a natural or restored dentition challenges the clinicianeven more than the completely edentulous patient does. This is due to thebiomechanical differences in the supporting tissues of the opposing arches. Soa proper evaluation, correction of the existing factors, and proper sequence ofdenture construction are necessary to give a more stable prosthesis. This casereport deals with the successful rehabilitation of the Maxillary edentulous archopposing natural teeth in the Mandibular arch. Incorporating metal mesh in theconventional Poly Methyl Methacrylate material of Maxillary denture to combatthe masticatory forces from natural dentition and improve the longevity of theprosthetic rehabilitation, at the same time improving the strength of the MaxillaryDenture.

Keywords: Single complete denture, Stability, Metal Mesh, Fractureresistance, Retention

INTRODUCTIONThe main aim of any Prosthetic rehabilitation is mainly based on the Devansprinciple "Perpetual Preservation Of That What Remains Rather Than MeticulousReplacement Of What Has Been Lost1." The single complete denture is a complexprosthesis that requires a complete understanding of the basics of prostheticrehabilitation of lost natural dentition2. Several difficulties are encounteredin providing a successful single complete denture treatment. Single completedentures have been frequently found to fracture under excessive masticatoryforces. Metal bases have been proved to be a valuable alternative for denturebases opposing natural dentition to strengthen bases and to prevent them3. Heatpolymerized dentures are the dominant material for the fabrication of denturebases. These heat polymerized denture base resins present acceptable physical,biologic and aesthetic characteristics at moderate expense4.

An ideal solution to strengthen the single complete denture bases is to providemetal reinforcement by fabrication of metal-based single complete denture dueto cost factor instead of using metal denture base we can go with metal messinfusion this improves the fracture resistance and also more cost-effective. Thebasic principles of retention, stability, and support should not be taken for granted,and steps must be completed so that all components are working in harmony forthe success of the maxillary denture5.

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The upper single denture can be functionally successful because of a large denture-bearing area offering stability.The tongue can develop habits for even more added stability. If the denture is made following the correctprosthodontic principles and the patient offers a good collaboration to provide comfort, function, stability,retention, and aesthetics This case report describes the step-by-step fabrication of metal mesh infused singlecomplete denture opposing natural dentition.

CLASSIFICATION OF SINGLE COMPLETE DENTUREClass I - Patients for whom minor, or no, tooth reduction is all that is needed to obtain balance.

Class II - Patients for whom minor additions to the height of the teeth are needed to obtain balance.Class III - Patients for whom both reductions and additions to teeth are required to obtain balance. The

treatment of these patients usually involves a change in the vertical dimension of occlusion.Class IV - Patients who present with occlusal discrepancies that require an addition to the width of the

occluding surface.Class V - Patients who present with combination syndrome.The Case report discussed in the article patient was categorized as Class I patient in whom minor, or no,

tooth reduction is all that is needed to obtain balance.

CASE REPORTCase Report a 45- year- old female patient reported with the chief complaint of repeated fracture of the maxillarydenture and for replacing the missing lower central incisors(Fig.1). Past medical history revealed that she wasdiabetic and hypertensive under medications for 4 years. Past dental history revealed that she had undergoneextractions of her lower anterior teeth 8 months back due to trauma and periodontitis associated with them.Intraoral examination revealed that her maxillary arch was edentulous and the mandibular arch was havingposterior teeth and missing mandibular central incisors Mandibular teeth were having less periodontal supportand the patient is not willing for the extraction of remaining natural teeth due to her systemic complications.A radiographic evaluation was done. The treatment plan decided for the patient was to provide her withmess infused single complete denture for the maxillary edentulous arch and removable partial denture forthe mandibular arch. Before the construction of the denture, it was desirable to complete all rehabilitationprocedures in the opposing dental arch.

PROCEDUREDuring the first visit primary impressions of the maxillary and mandibular arches were made. Maxillary andMandibular arch impression was made with elastomeric impression material (Zhermak, Italy). After makingprimary impressions, the impressions were poured in dental plaster and dental stone respectively. At the secondvisit, modeling wax was adapted for a spacer and auto-polymerizing acrylic resin was mixed and adaptedfinally custom tray was fabricated. On this custom tray, border moulding was done followed by the secondaryimpression for better retention and stability. The master cast was then duplicated with agar-agar (reversiblehydrocolloid) to get a working cast. The master cast was obtained Occlusal rims were constructed. Jaw relation(Fig 2) and mounting were done in the mean value articulator. Teeth selection is done according to the patientfacial form following appointments Anterior and Posterior was tried in the patient’s mouth. The denture try-inwas carried out and the patient’s consent was obtained. (Fig.3). On the working cast of the maxillary edentulousarch, the pattern of the metal mesh framework was adapted(Fig.4,5&6). The metal mesh was kept short ofthe posterior palatal seal area for ease to relieve the area if required. The metal mesh was then transferred tothe master cast. The conventional procedures of flasking, dewaxing, packing (Fig.7), curing, finishing, and



Figure 1. Preoperative Figure 2. Maxillomandibular relation

Figure 3. Wax Tryin- Frontal view Figure 4. Wax Tryin- Left Lateral view

polishing of heat cure dentures were carried out (Fig.8). Dentures were inserted and delivered to the patient(Fig.9). Post Insertions and Homecare instructions were given to the patient.

DISCUSSIONThe most important clinical situation involving a single denture is that of a completely edentulous maxillarydenture opposing the natural teeth in the mandibular arch. When a complete denture is opposed by naturalteeth, it will require some degree of contouring to provide a harmonious occlusion. The reasons for suchalteration are mainly due to unfavourable inclination of the occlusal plane, malpositioned individual teeth whichhave assumed positions resulting in excessively steep cuspal inclinations, and wide buccolingual width of thenatural teeth7. To overcome these problems, two things are necessary. First, full use must be made of everyfactor which favours success, and no minor error or imperfection which might perhaps have been tolerated inconventional complete denture construction should be accepted. Second, the forces to which the denture issubject must be reduced as much as possible by appropriate preparation or restoration of the remaining naturalteeth to provide an acceptable occluding surface8. The midline fracture in a denture is often a result of flexuralfatigue. Though poly MethylMetha Acrylate denture bases have good mechanical, biological, and estheticproperties, the impact and fatigue strength of PMMA is not entirely satisfactory, thus may fail when there isexcessive parafunctional or functional forces9,10

CONCLUSIONThe single denture treatment requires the same chair time as that needed for the construction of two completedentures. The most visible adverse sequelae of single denture treatment are the wearing of the natural teeth anddenture fracture. Both are presented in this case, the first one by using acrylic artificial teeth and the secondone by using metal mesh infused complete denture. This case report shows metal mesh infused maxillarysingle complete denture opposing natural dentition provided great comfort to the patient as the metal mesh wasstrong to resist catastrophic failure and flexural fatigue if PMMA was to be used as a denture base. The metal



Figure 5. Wax Tryin- Right Lateral View Figure 6. Metal Mess adapted to workingcast

Figure 7. Packing and Trail & Closure doneFigure 8. Metal Mess infused complete

denture

Figure 9. Postoperative



mesh is cost-effective and less bulky compared to the metal denture bases. Careful preparation of the patient isimportant. It provides the new complete denture patient with the opportunity to adapt to a complete dentureand allows the dentist to evaluate his patient physically and emotionally before fabrication of the final completedenture11.

References[1] Zarb GA, Bolender CL, Hickey JC, Carlsson GE. Boucher’s prosthetic treatment for edentulous patients. 11th ed St.

Louis: CV Mosby, 1990:503.

[2] Sharry JJ. Complete denture prosthodontics 3rd edition McGraw-Hill Book Company, New York, 1974, 1-378.

[3] Winkler S. second edition Ishiyaku Euroamerica; St. Louis: Essentials of Complete Denture Prosthodontics, 1994.

[4] Ellinger, C. W., Rayson, J. H., & Henderson, D. (1971). Single complete dentures. The Journal of Prosthetic Dentistry,26(1), 4–10.

[5] Patrick A. Mattie and Rodney D. Phoenix. A precise design and fabrication method for metal base maxillary completedentures. J Prosthet Dent 1996;76:496-9

[6] Carl F. Driscoll, Radi M. Masri. Single maxillary complete denture. Dent Clin N Am 2004;48:567- 583.

[7] Ellinger CW., Jack H. Rayson, Davis Henderson. Single complete denture. J Prosthet Dent, 1971;26(1):4-10.

[8] Anderson, R. Storer. Immediate and Replacements Dentures, Blackwell Scientific Publications, Oxford, 1966; 4.

[9] Ohkube C., Kurtz K .S., Suzuki Y., Hanatani S., AbeM., Hosoi T. comparative study of maxillary complete denturesconstructed of metal base and metal structure framework. Journal of oral rehabilitation, 2001;28: 1 49-56.

[10] Schneider RL, Stokes JL, Laduke D. Design and fabrication technique for metal palates in maxillary completedentures. J Dent Technol.2000; 17(7):8-11.

[11] Koper, A. (1987). The maxillary complete denture opposing natural teeth: Problems and some solutions. The Journalof Prosthetic Dentistry, 57(6), 704–707.


metal mess infused maxillary complete denture - a …

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