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TRANSCRIPT
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.
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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: [email protected]
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).
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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.
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