Repairing Fracture of Complete Dentures

The midline fracture of the maxillary complete denture is the fracture most commonly
seen in dentures. This is largely because as the ridges resorb and remodel, the palatal
bone does not. This leads to a high-centering of the denture, where the denture
contacts primarily in the hard palate and secondarily contacts the residual ridge. This
results in a constant rocking effect which accelerates bone loss and causes a steady loss of
stability of the denture, in time leading to a stress fracture of the denture base.

The second most common fracture of a complete denture is the mandibular fracture. This
usually is the result of an accidental drop, although it can occur during function. When
function is the case, it usually involves a thin denture base, as is common in an immediate
complete denture and invariably is associated with a poor fit with the ridge. Often,
patients will resort to not wearing the lower complete denture due to the lack of support
that is common with lower complete dentures. They may place it in a drawer or on a shelf
and allow the denture base to dry out, becoming a distorted example of its former shape.
This not only makes it fit even less well, it also makes it more brittle and prone to
fracture. Soaking it in water will not return it to its original state, either.
When a patient shows up with a denture that has fractured, the first thing the dentist
should do is determine whether the denture is truly the patients own denture. Always fit
the pieces of the denture together with sticky wax and place it against the opposing
denture or a cast of the opposing teeth to ensure that the denture is correct for the patient.
It may be a mate to a second set of dentures that a patient has but never wears. The
patient may have worn out, lost, or broken the mate to the one he is wearing and hope
that the one he provides to the dentist can be adapted to fit his current denture. It is also
not uncommon for a patient to present with someone elses denture, either innocently
believing it is their own or as an elaborate scheme to get an new denture without paying
for it.
When a midline fracture of a maxillary complete denture occurs, the cause must be
determined. As with any fracture, this must be corrected if the repair is to be successful.
First, the pieces are assembled and tried against a cast of the opposing dentition. The

parts of the fractured denture are aligned and splinted into position using long shank
dental burs, coat hanger wires, plastic sticks, or large paper clips. These are tacked to
the teeth with sticky wax. Wooden sticks or toothpicks are not recommended for this use
as these can absorb water and warp.

All undesirable undercuts that are more than 10mm from the fracture site are blocked out
with wet tissue paper, putty, or wet pumice. About 2mm of the denture flange borders are
left uncovered and a base of quick-set plaster or stone is poured. The easiest method of
blocking out the ridge area away from the fracture site is to use polyvinylsiloxane putty.
The fast set plaster will not bond with this material and will need to have some sort of
mechanical retention provided. Pieces of paper clip cut and bent into a loop will do
nicely. They must be placed into the putty before it sets, and the loop section needs to
extend into the area that will be filled by the plaster. A generous area (about 8-10 mm)
close to the fracture site is left free of putty coverage.

After the plaster has set, the bracing rods and sticky wax are carefully removed. All
denture pieces from are removed from the stone matrix. They and the matrix are cleaned,
and re-assembled on the cast to ensure that they can be accurately positioned.

The approximating surfaces are beveled so that there is a 3 mm gap on the polished
surface and a 2mm gap on the cast side. This allows visual access to see that the acrylic
is filling the entire area. The pieces are replaced in position on the cast and checked for
accuracy. Remove enough acrylic from the polished surface side of the denture to allow
a gap of 8-10 mm. This process is called rabbeting and provides an increased surface
area that affords a stronger joint between the old and new acrylic. The rabbeting thins
the proximal surfaces of the dentures about half way through the polished side and adds
about 3 mm more width to the gap on each piece, totaling about 8mm on the polished
surface side between the pieces. Any small pieces are left out, and replaced entirely with
repair acrylic.

Separating medium is painted on the cast at least 10 mm to either side of the fracture line.
The parts are tacked with sticky wax into position on the cast base. The brush-bead
method is used to overfill the repair area with repair acrylic. In the lab exercise, red
DuralayR resin will be used so that the juncture can be easily seen. If this were done on a
patients denture, a repair acrylic matching the dentures original acrylic would be
chosen.
The entire assembly is placed in warm water in a pressure pot and allowed to cure for
about 10 minutes at 20 pounds/square inch pressure. After the acrylic has set for ten
minutes, the repaired denture is removed from the stone matrix and finished with
successively finer abrasives until a high shine is achieved. The tissue side is checked for
irregularities and these are repaired or smoothed. An inspection of the denture should
show a smooth line at the junction of the denture base acrylic and the repair acrylic. In

the case of the denture used in this example, the repair acrylic has permeated the crack in
the denture tooth. This tooth will be replaced in a subsequent procedure.

Occasionally, teeth are knocked off a complete denture by a traumatic blow, or because
the denture tooth was not bonded adequately to the base. In the above case, tooth #9 was
fractured when the denture base fractured. In any case involving a broken tooth on a
broken denture, the denture base is repaired first, and then the tooth replacement is done
to preserve the relationship of the denture base pieces.

To replace a broken tooth, a notch is cut into the denture base acrylic palatal to the tooth.
A replacement tooth is placed in the area to be repaired and luted in place with sticky wax
on the lingual (palatal) surface. The labial margin of the tooth is not disturbed. The
surfaces of the tooth and parts of the denture that will be covered by the matrix are lightly
lubricated. A plaster matrix is made on the labial or buccal side of the tooth being
replaced. This should cover an area of about two teeth on either side of the missing tooth.

The tooth is replaced back into the prepared area and should fit perfectly into the
undisturbed labial area. Diatoric interlocks can be cut into the tooth to provide additional
mechanical retention. The replacement tooth is luted back into place in the matrix and

tacked in place to both proximal areas with sticky wax. If three teeth are missing, the
teeth adjacent to solid teeth are repaired first, and then the one in the middle is repaired.

The prepared areas of the denture are over-filled with autopolymerizing repair resin. The
denture and cast are immersed in warm water (115 oF) in a pressure pot for 10 minutes.
After the resin is totally cured, the denture is removed from the cast, all excess acrylic is
removed and it is polished to a high shine. Care must be taken to not polish the plastic
tooth.

If several teeth have fractured out, the denture areas palatal to or lingual to the de-bonded
or fractured teeth are reduced. Again, the labial or buccal areas of the denture are not
reduced, if possible. Teeth of the same shade, shape, and size as the original teeth are
carefully selected and. fixed in place with sticky wax and checked against a cast of the
opposing dentition or the opposing denture to ensure they do not interfere with the
occlusion. TriadR (uncured), clay, or PlayDoughR can be used to help hold the teeth in
place.

A matrix of quick setting plaster (best) or polyvinylsiloxane putty (Citrecon R, ReprosilR,

etc.) is made. It is removed from the denture after it sets, the teeth are cleaned, cut a
diatoric is cut in the lingual of each tooth, and they are attached them to the plaster matrix
with sticky wax in such a way that they do not interfere with the placement of the matrix
back on the denture. If a putty matrix is used, extreme care must be taken to not flex the
matrix or the sticky wax will break and the teeth will come loose.

Resin is applied by the brush-bead method and to slightly overfill the prepared area. The
repair cast and uncured denture resin are placed in a pressure pot that is half-filled with
warm water (115oF) for 10 minutes to cure. The brush is cleaned by dipping it in
monomer and drying it thoroughly on a paper towel to remove any residual acrylic which
would harden and ruin the brush.
The following pictures will demonstrate how to successfully repair a fracture of a
mandibular compete denture. This is the procedure you will complete in the lab exercise.
Red DuralayR resin will be used so that the juncture can be easily seen. If this were done
on a patients denture, a repair acrylic matching the dentures original acrylic would be
chosen. First, the broken pieces are approximated and fixed in position with a nonabsorbing splinting material (Wire, plastic, etc.) Sticky wax is used to lute these braces
to the denture base. The tissue surface must be checked to make sure that the pieces are in
close contact and that there is no wax or other debris on that surface.

Polyvinylsiloxane putty (Reprosil) is used to block out the area away from the fracture
site. About 10 mm. of the surface is left uncovered on the tissue side kept bare of any
putty. Pieces of paper clip are pressed into the putty while it is soft to provide retention of
the putty to the plaster base of the repair cast. A mounting plaster base is poured to
complete the repair cast. The splinting material and all the sticky wax from the denture

surface and the repair cast are removed. The denture pieces are removed from the cast
and the area under the fracture site is inspected for any defects. The denture pieces are
replaced on the cast and examined to ensure that they fit precisely back into place.

Approximately 1.5 mm. of acrylic is removed from the proximal surfaces of the fracture
line on the polished surface and 1 mm on the tissue side, forming a gap of 2 mm. on the
tissue surface and 3 mm. on the polished surface. The pieces are placed back on the cast
and these dimensions are verified. It is necessary that this amount of gap be present to
allow enough visual and working access so the repair acrylic can be placed and fill the
entire repair site. Enough acrylic is removed from the polished surface side of the denture
to allow a gap of 8-10 mm. This process is called rabbeting and provides an increased
surface area that affords a stronger joint between the old and new acrylic.

ALCOTE, a tin-foil substitute, is painted on the area under the site to be repaired. The
denture parts are replaced and luted in place with sticky wax. Rabbeting and beveling
noticeably increase the amount of visual and working access provided.

The method to be used to apply repair acrylic to the denture in this exercise is called the
brush-bead method. Dappen dishes containing monomer and polymer are arranged
close to the denture. The brush is first wetted in the liquid monomer. Then it is dipped
in the polymer powder. This will cause a small bead to form on the wetted end of the
brush. These beads are placed in the repair site to make the repair. The edges of each
fragment are wetted with monomer. A brush is moistened in monomer and dipped in
polymer. The wet polymer is brush-beaded onto the repair site. Additional acrylic is
added until the entire site is slightly over-filled.

Extra acrylic is added to overbuild the repair site area to assure that there is sufficient
thickness of high quality acrylic. Moisture from the water bath can cause a rough surface
to form. The repaired denture is removed from the repair cast and the tissue side is
inspected to verify that it has been repaired. The repair cast and denture in are placed in a
water bath to cure. The brush is dipped in monomer and dried thoroughly on a paper
towel to remove any residual acrylic to prevent ruining the brush. If this step is forgotten,
the acrylic will harden and the brush will be ruined.

The denture is removed from the cast and checked to make sure that the acrylic is of good
quality and covering all the desired areas. The dentures are fit together to ensure that
they occlude properly. If the occlusion is off, then the repair is not accurate. This is a
very good reason to make sure that the dentures are inspected to ensure that they fit
together before making the repair cast. The patient may be giving you a mismatched set.
After ensuring that the dentures fit together properly, the excess acrylic is removed with a
denture bur and abrasives and polishing agents are used to polish the repaired area, taking

care to not over-polish the area or the teeth. An unused, clean polishing wheel must be
used for each abrasive. If a repair is done properly with the correct acrylic it is almost
impossible to tell where the denture has been repaired.
One has to look closely to
discern the repair site because the repair acrylic blends together so precisely with the
original acrylic. This is how a repair should look!
Summary
Fractures occur on dentures most frequently when the residual ridge resorbs to the
point where the denture is unstable. The resultant rocking of the denture causes stress to
build up in the denture base as well as increasing the resorption rate of the supporting
bone. These stresses are released in the form of a fracture, and most frequently these
appear first as a midline fracture of the maxillary denture.
Occasionally, teeth are knocked off a denture by a traumatic blow, or because the
denture tooth was not bonded adequately to the base. This can occur with plastic teeth as
well as porcelain teeth, and fractures through the teeth themselves can occur in both
porcelain and acrylic teeth, although more often in porcelain teeth.
In any case involving a broken denture or debonded tooth, the parts are reassembled by
hand, held together temporarily with a sticky wax, and stone is poured into the base to
make a cast so that the fracture can be repaired with an autopolymerizing resin. When the
repair is complete, the cause of the fracture should be explored and eliminated if possible.
Most frequently, the fractured denture needs a new liner to compensate for the resorption
of the residual ridge, thus eliminating the most common cause of the fracture.
DENTURE FRACTURE & REPAIR
Technically Dentures can fracture in one of two ways:
By IMPACT where one hard blow results in instant breakage
By FATIGUE when the denture base is subjected to repeated stresses.
IMPACT FRACTURE
An impact fracture is usually caused by patient carelessness or accident.
FATIGUE FRACTURES
May be associated with
(1) The design of the denture
(2) Oral anatomy of the patient.
(3) Its use or abuse by the patient.
(4) Factors introduced in the laboratory.
(5) Previous repairs.
Denture Repair Instructions
Luther Ison
University of Minnesota School of Dentistry
Denture Fractures:

1- Relate dentures back together and lute with sticky wax or compound on the
polished side of denture.
2- Blockout undercuts on tissue side that are away from the fracture area
3- Pour plaster cast inside denture (tissue side). Fracture area must be filled with
plaster. Do not Vaseline denture prior to pouring.
4- When plaster is set, remove denture from cast. Use Brasseler bur to open up
fracture area on each piece, with polished side of denture opening up at least 5 mm
and tissue side of denture open 1-2 mm. Roughen and create as much surface area for
new acrylic to bond to old acrylic as practical. The more surface area to bond to, the
stronger the repair will be. If denture has repeatedly fractured, a half round
strengthener bar can be embedded in acrylic to strengthen. Bar must have rigidity, so
round wire will do no good. Wire mesh can also be used.
5- Coe Sep the cast where acrylic will be added. Lightly Vaseline tissue side of
denture adjacent to fracture area, being careful not to get Vaseline onto surfaces
where acrylic will be added. Place denture halves back on the repair cast and add new
acrylic. Rubber band denture onto cast.
6- While acrylic is still wet with monomer, place directly into warm water pressure
pot and raise pressure to 20-26 lbs. Acrylic will take 5-20 minutes to cure depending
on water temperature.
7- Remove from pressure pot. Remove denture from cast, finish, pumice and polish.
Check tissue side for defects and remove as necessary. Check tissue wide with PIP
paste upon insertion and adjust if necessary. Check occlusion and adjust if necessary.
Tooth Replacement:
1-Remove acrylic as necessary to position tooth, set tooth with baseplate wax and
festoon around new tooth.
2-Make plaster matrix covering buccal and occlusal portion of new tooth and adjacent
teeth.
3-Remove plaster matrix, steam and remove all wax, replace tooth back into matrix.
4-Lightly vaseline adjacent teeth in denture to keep repair excess repair acrylic from
sticking to them.
5-Mix acrylic in dappen dish and when doughy, add to denture where new tooth will
go.
6-Wet tooth with monomer and place tooth and matrix back onto denture.

7-Wrap with rubber band and insert into pressure pot. When cured, finish and polish.
Check occlusion upon insertion.
** If replacing anterior tooth, and occlusion is not a factor, you can sticky wax
tooth to the adjacent teeth and into position along incisal edge rather than
waxing in place and making plaster matrix.
Repairs & Additions to RPD's
Repair versus remake:
it depends upon the number of repairs because too many repairs => fatigue =>
fracture.
Before clinical decision to repair or remake the RPD's, some diagnostic
factors can be made, some of these are:
1. Patient's financial status.
2. Biologic age.
3. Frequency of appointments.
4. Medical status.
5. The degree of difficulty of the impression procedures: e.g. extraction from long
time leads to tongue enlargement, which causes difficulty in taking impression.
A RPD may break for one of the several reasons:
1.
Careless handling or abuse by the patient.
2.
Loss of adaptation of the prosthesis to teeth & associated tissue =>stress on the
metal framework and finally breakage.
3.
Failure during laboratory processing.
4.
Improper mouth preparation or impression procedures.
For example:
A. If the rest seat inadequate => decrease thickness of the metal => fracture.
B. If the metal too thick => affects the patient occlusion.
5.
Loss of abutment teeth.
6.
Excessive abrasion of the teeth, sometimes caused by bruxism & clenching
habits or due to abrasion of natural teeth against porcelain teeth.
Repairs & Additions to RPD's:
ISimple Repairs.
IIComplex Repairs.
I-

Simple repairs or Additions:

A.
B.

A)

Can usually be accomplished with or without impression.

Denture Base Repair.
Repair of Fractured denture Teeth.

Denture Base Repair:

Ranging from the complete loss of a denture base flange segment to the fracture
or loss of a portion of the denture base proper.
Broken flange.
Complete loss of a segment of the denture base flange repair requires using a
rebasing or relining impression procedure.
Most common areas of breakage: at the finish line(junction between acrylic and
metal) + junction between major and minor connector).
I. If the parts can be assembled:
No need to take impression.
Steps:
1.put sticky wax on the fracture line.
2.use matches to connect the teeth on both right and left sides together using
sticky wax.
3.pour a model.
4.block any tissue undercut.
5.when cast is hard, remove the wax then widen the area of the fracture line by
acrylic bur and make undercut.
6.apply self-cure acrylic resin using the sprinkle method.
7.PSI 30,120 degree F, 30 min in pressure cooking bath.
8.finishing and polishing.
II.
If some parts are missing:
1.take impression by green compound or impression plaster in the missing area.
2.pour the model then remove green compound by hot water so a space will be
created at that area.
3.fill the space by self-cure acrylic resin by sprinkle method.
4. OR fill the space by waxing up then flasking and heat cure acrylic resin.
N.B. If resorption occurs: when taking the impression use zinc oxide eugenol on
the fitting surface of the green compound.
III.
If the parts are present but can not be assembled:
Make an over all impression (pick up impression):
It is an impression using a stock tray while the denture is inside the mouth.
Before taking this impression assemble the parts by sticky wax.

B)

Repair of fractured denture teeth:

Porcelain
Acrylic resin

iDental porcelain denture teeth:

Held by mechanical means of retention.
Caused by continuous pressure.

If the denture tooth has lessened from the denture base & the diatoric hole
is still intact the denture porcelain tooth can be mechanically joined to the
denture base with new acrylic resin after making undercut lingually.

When the denture tooth is fractured, remove the remnants of the pins by
applying direct heat or using acrylic bur then make undercut lingually in the
acrylic part. Put resin then attach the tooth with it pins. A new denture tooth
must be selected (shade & mold).
N.B. the undercut is always placed opposite to the pins.
iiAcrylic resin denture teeth:
Held by chemical means.
Causes of removal:
1.trauma of occlusion.
2.presence of separating media.
3.remnants of wax.

If an acrylic resin denture tooth is dislodged from a new RPD, the cause
may lie with the formation of an incomplete chemical bond between the
acrylic resin denture tooth & the acrylic denture base.

In these instances, the denture tooth is removed & the area is mechanically
cleaned.

A box like area is removed from the acrylic resin denture base lingual to
the dislodged denture tooth.

The denture tooth is replaced, secured to the adjacent teeth with sticky
wax & processed with autopolymerizing acrylic resin.

Check occlusion in centric & eccentric positions.

To ensure proper placement of the tooth use plaster key or index.

II-

Complex Repair:

A)

A.
Repair or replacement of a clasp assembly or any part.
B.
Repair of a major connector or minor connector.
C.
Repair of the RPD after the loss of an abutment tooth.
All complex repairs require the use of proper impression procedures by the
dentist.

Repair of a broken clasp assembly:

I.e. fracture of one or more clasp arms, the occlusal rest on the area between the
minor connector & the major connector.
Reasons for broken clasp arms:
a.
Repeated flexure into & out of too severe an undercut.
b.
Structure failure of the clasp arm:
Improperly formed e.g. during waxing =>overheating of the wax
=>loss of the uniform taper and fracture.
Careless finishing & polishing
Careless contouring of wrought wire clasp arm
c.
Careless handling by the patient.
Repair can be done by either of 2 techniques:
A. By embedding an 18 gauge wrought wire (PGP) into the denture base of the RPD.

Steps:
1.make undercut.
2.take a wrought wire and attach it to the denture using self-cure acrylic resin.
OR
B.

Constructing a new clasp assembly & soldering on welding it to the existing

framework.
Steps:
1.take over all impression.
2.pour the model.
3.put platinum foil matrix on the area of soldering then put the RPD.
4.over the RPD put gold flux (solder) then adapt the wire in the proper place.
5.use electric solder to fuse the platinum + gold, so the wrought wire will be
attached.
N.B. to repair the arm follow the same steps but increase the thickness of the
wrought wire.

B)

Repair of a broken occlusal rest:

Always occur where it crosses the marginal ridge.

Causes:
Improperly prepared occlusal rest seats.
Before repair, a proper occlusal clearance should be made between the opposing
dentition & the marginal ridge of the occlusal rest seat.
The proper interocclusal clearance should be at least 1.5 mm.
Alginate impression is made with the prosthesis in place; the impression is boxed
& poured in soldering investment (cast).
A platinum foil matrix is placed over the impression of the newly prepared rest
seat on the soldering investment cast.
An appropriate wire or dental gold solder is used to reconstruct the occlusal rest &
solder it to the minor connector.

C) Repair of a major or minor connectors:

In that case the best thing is to remake a new denture.
Causes:
Distortion occurs from abuse by the patient.
Weakened by adjustment to avoid or eliminate tissue impingement.

In such situations, either a new restoration must be made or that part must be
replaced by casting a new section & there reassembling the denture by soldering.

[reconstruction technique , making a new master cast, remove the defective

elements, waxing, casting & soldering on welding the new portion ]
D) Repair of the RPD after tooth extraction:
If the extracted tooth is the abutment:

After extraction, patient's oral hygiene & condition of the remaining dentition
should be evaluated.

Loss of abutment tooth, the adjacent tooth is usually selected, as a retaining

abutment & it generally require modification or a restoration.

Any new restoration should be made to conform to the original path of

placement, with proximal guiding plane, rest seats, suitable retentive area.

After mouth preparation, over all impression with RPD in place (Alginate
impression) pouring in stone, the old clasp assembly is removed & a new clasp
assembly is waxed, cast & filled to RPD.

In the place of the missed tooth (previous abutment) put artificial tooth and
acrylic resin.
If the extracted tooth is not involved in support:

Take over all impression

Pour the model.

Attach the missed tooth by self-cure acrylic resin.

N.B.:
IF THE MISSED TOOTH WAS VERY FAR FROM THE RPD
FRAMEWORK..THEN A REMAKE IS REQUIRED.