Single complete dentures pose a great challenge to clinician. Chances of denture fracture are more when natural teeth are present in opposing arch. Heat cure acrylic resin cannot resist the heavy occlusal loads alone and it leads to denture fracture. This problem can be solved by use of innovative materials and appropriate techniques. Metal mesh reinforcement in denture provides satisfactory and economic solution for such cases. This case report describes a procedure of fabrication of metal mesh reinforced single maxillary denture, which is easy to fabricate and better in resisting masticatory loads of natural mandibular teeth.
Key words: Single denture, Metal mesh, Denture fracture.
The conventional acrylic resin denture fracture
is a challenging condition to prosthodontists.
Most common fractures are midline denture
fractures as reported in a recent dental survey.
Midline denture fractures 46.87% were seen in
maxillary complete dentures and 61% were seen
in mandibular dentures.1
The incidence of midline fractures increases in case of single maxillary
dentures opposing natural mandibular teeth.2
There are several factors contributing for denture fracture including flexural fatigue resulting from cyclic deformation and factors which alter the stress distribution of the base.3,4 To avoid such fractures, advancement in materials and techniques is prime requirement. Use of metal reinforced denture base,5 acrylic resin base reinforced with wire netting, carbon fibre, E glass fibre reinforced PMMA,6,7 lucitone 199, Trevalon high, Paladon ultra and visible light polymerized resin8 are different methods of increasing denture fracture resistance and decreasing chances of failure. Out of all these methods, metal mesh reinforcement is an economic and less time-consuming method, which significantly increases the denture strength.9 This case report describes a case of single maxillary denture fabrication reinforced by use of commercially available preformed metal mesh.
A 57-year-old male patient reported to Department of Prosthodontics and Crown & Bridge, with the chief complaint of difficulty in chewing due to missing upper and lower teeth. Patient had no significant medical history. Intraoral examination revealed completely edentulous maxillary arch (Fig.1) and kennedy’s class IV partially edentulous mandibular arch (Fig.2). Patient was explained about different treatment options-
Due to financial reasons, Patient was not willing to
go for implants and cast metal maxillary denture.
Metal mesh reinforced maxillary denture with
mandibular removable partial denture was
selected by patient. It was an economic option
with the benefit of increasing strength and fracture
resistance of denture.
Denture fracture results from two different types of
forces, namely impact and flexural fatigue. Impact
fracture occurs due to sudden blow to the denture
or accidental dropping of denture from hands or
mouth. Flexural fatigue occurs due to repeated
stress of lower dimension constantly, which
results in micro cracks formation in denture base.
Conventional denture base material Poly methyl
methacrylate (PMMA) shows poor mechanical
properties when put in an environment of heavy
occlusal loading and tends to fracture.10 Repeated
denture fracture is a problem for both patient and
Metal strengthener has a beneficial effect on the fracture resistance of the polymethyl methacrylate.12 Metal base and metal mesh reinforcement increases the strength of denture and reduces the micro crack propagation. Metal mesh is commercially available in both stainless steel and gold plated metal. They have a thickness of 0.4mm and their mesh design helps to produce a good resin bond. Metal mesh does not increase the denture weight and decreases the chances of fracture.13,14 Metal mesh is also economic to patient. Stock perforated trays, which are used for making alginate impression can be cut and modified to be inserted in denture. Modified portion of tray is used for reinforcing the denture.15
Using metal mesh has few disadvantages. It looks unaesthetic if it appears on labial portion of denture when patient smiles. It is prone to corrosion and has poor adhesion to acrylic denture base. In some cases patient may be allergic to metal contact. Some authors have proposed a technique of masking colour of metal mesh using self cure acrylic resin to avoid unaesthetic display of metal.16
Advancement in materials and techniques is required to completely fulfill the requirements of patient and clinician. Implant supported overdentures are newer treatment approach for single dentures.17 Due to financial reasons, not all patients can afford implant treatment. Metal mesh reinforcement is an economic and promising solution for such cases.
It is a challenge for prosthodontists to provide
successful treatment for patients presenting one
completely edentulous arch opposing natural
teeth in other arch. Such condition places more
amount of force on single denture. Metal mesh
reinforced dentures offer better strength and
fracture resistance. This is a viable treatment
option for all patients who suffer from repeated
denture fractures due to heavy occlusal loading.