TITANIUM COMPLETE DENTURE BASE IN A PATIENT WITH HEAVY BRUXISM: A CLINICAL REPORT

INTRODUCTION

Poly methyl methacrylate (PMMA) denture bases

have good mechanical, biological and aesthetic

properties. However, they may fail because of excessive

para functional and/or functional forces (in cases of

bruxism and/or complete dentures opposing natural

mandibular teeth). In such circumstances metals or

metal alloys can be used to strengthen the denture

bases.1 These thin metallic bases have several

advantages, besides rigidity and fracture resistance, like:

excellent strength to volume ratio, good adaptation to the

supporting tissues, enhanced control of denture plaque,

high thermal conductivity, high biocompatibility, no

dimensional changes in time through fluids absorption

and no interferences with phonation.2-5

A treatment approach in a bruxing complete denture

wearer is described.

CLINICAL REPORT

Bruxism is a para functional habit that can affect

complete denture wearers too. A 60 year old male patient

had been wearing dentures for four years. He was

grinding the acrylic resin artificial teeth both while being

awake and during sleep (Fig. 1.). The occlusal surfaces

are flattened and the patient is complaining of poor

masticatory efficiency (Fig. 2.). The maxillary complete

denture has recurrently fractured and was repaired

several times with autopolymerizing acrylic resin (Fig.

3.). Retention and stability of the old dentures were good.

Clinical functional analysis revealed no signs or

symptoms of temporomandibular disorders. The

supporting soft tissues of the edentulous maxilla had no

lesions or painful spots.

The patient was advised to remove his dentures during

the night. His diurnal bruxism was more difficult to

handle.

96

Journal of Experimental Medical & Surgical Research

Cercetãri Experimentale & Medico-Chirurgicale

Year XV · Nr.3/2008 · Pag. 96-99E x p e r i m e n t a l

M e d i c a l S u r g i c a l

R E S E A R C H

J O U R N A L o f

Correspondence to: Dr. Corina Mãrcãuþeanu , phone nr. 0741182478, e-mail: marca_cori@yahoo.com

SUMMARYBruxism is a parafunctional habit that can affect complete denture wearers too. The mostfrequent problem encountered by these patients is the repeated fracture of the maxillarycomplete denture caused by flexural fatigue. The situation of a heavy bruxer treated with atitanium maxillary denture base is described. Titanium bases are ideal for maxillary dentures subjected to severe mechanical stresses in bruxing patients. In addition the patient shouldavoid wearing dentures during sleep and the dentist can decrease awake bruxism bymaking the patient aware of it and by managing psychogenic stress.

Key Words: bruxism, complete denture, titanium

BAZÃ DIN TITAN LA UN PROTEZAT TOTAL CU BRUXISM SEVER: PREZENTARE DE CAZ

Rezumat:Bruxismul este un obicei parafuncþional care poate afecta ºi purtãtorii de proteze totale.Problema întâlnitã cel mai frecvent la aceºti pacienþi este fractura repetatã a protezei totalemaxilare datoritã oboselii la încovoiere. Articolul prezintã cazul unui bruxoman tratat cu oprotezã totalã cu baza din titan.

Corina Mãrcãuþeanu1,Luciana Goguþã2, Anca Jivãnescu2, Enikö Demjan1,D. Bratu 2

Received for publication: 20.03.2008

Revised: 05.06.2008

1 - Department of Occlusion and Temporomandibular Disorders, 2 -Department of Prosthodontics, Faculty of DentalMedicine, University of Medicine and Pharmacy „Victor Babeº” Timiºoara,

The diagnosis of diurnal bruxism was confirmed by the

increased masseter muscle electromyographic activity

during ten minutes of silent reading.6 The patient

developed heavy occlusal strains, which could explain

the maxillary denture fracture through flexural fatigue.7

He needed a reinforced denture base. A maxillary metal

base cast from titanium was chosen to enhance the

physical properties.

All stages in denture manufacturing were carried out in

accordance with standard practice. The metal framework

was cast using fourth degree titanium and the Titanplus

Unit (Seitelettronica, Manfredi, Italy).

97

Fig. 1. Excessive wear of acrylic resin complete denture teeth due toheavy bruxism.

Fig. 3. Fracture of maxillary poly methyl methacrylate denture base undersevere mechanical stress

Fig. 2. Wear facets on all denture teeth typical for horizontal parafunctionalmandibular movements.

A critical point of the metal dental base was the

interface between titanium and acrylic resin. Improper

positioning of metal-resin finish lines can affect phonetics

and its incorrect design will adversely influence the

mechanical behavior of the adjoining acrylic resin (Fig. 4.

and Fig. 5.).

The low density of titanium allowed a pre-clinical

radiographic quality control of the metallic base for the

detection of internal defects8.

Anatomic acrylic resin teeth have been selected to

prevent fast bone resorbtion of the residual ridges and to

avoid chipping/fracture that often appears in porcelain

artificial teeth (Fig. 6.). The anatomic design of the

occlusal surfaces raised some problems in the

accommodation of the bruxing patient with the new

dentures. He was accustomed with flattened occlusal

surfaces. To help him, the diurnal parafunctional activity

was reduced by education, voluntary avoidance,

relaxation and biofeedback techniques.

DISCUSSION

There are several methods to increase the resistance

to mechanical stress of a maxillary denture base. In a

patient with recurrent fractures of the denture the choice

must be made between a metal base (casted Cr-Co alloy

or titanium, galvanoformed pure gold) or a PMMA base

reinforced with wire netting, carbon fibre, glass fibre or

ultra-high modulus polyethylene. 3,4,9, 10 Why titanium

denture bases are rather used in heavy bruxers?

A titanium denture base is lighter than the one cast

from a Cr-Co alloy due to the low density of titanium (4,5

g cm-3).4,8 Its rigidity and mechanical resistance are much

better than those of a galvanoformed gold denture base.

The adaptation to supporting tissues of complete

dentures reinforced with metal wire (1.0 mm in diameter)

decreases in comparison with the unreinforced ones

regardless of the polymerization method.11

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Fig. 4. Maxillary denture framework cast in titanium. Thereis a shoulder between the palatal metallic sheet and thesurrounding net that provides sufficient bulk to the acrylicresin.

Fig. 5. Maxillary complete denture with titanium framework. The metallic net covers the residual ridge and the posteriorpalatal seal area. This design offers optimum retention forthe acrylic resin, a good marginal palatal seal and facilitatesdenture relining for the compensation of osseous resorption

Fig. 6. Stable centric stops and bilateral balanced occlusion obtained with anatomicacrylic resin teeth.

Carbon or glass fibers and ultra-high modulus

polyethylene are difficult to use from the point of view of

the dental technician because of their processing

characteristics.7 These reasons contributed to the

selection of the titanium denture base.

The main disadvantage of the titanium base is its high

cost, conditioned by the increased incidence of failures

as well as by the prolonged casting process.

CONCLUSIONS

Titanium bases are ideal for maxillary dentures

subjected to severe mechanical stresses in bruxing

patients. In addition the patient should avoid wearing

dentures during sleep and the dentist can decrease

awake bruxism by making the patient aware of it and by

managing psychogenic stress.

99

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