Journal of Oral Rehabilitation 2005 32; 772775
Immediate replacement removable partial dentures with
cobaltchromium frameworks: rationale, technology and a
case report
L. HASSAN, A. S. JUSZCZYK & R. K. F. CLARK
SUMMARY The advantages of removable partial den-
tures with cobaltchromium frameworks over those
made entirely of acrylic resin, in oral health and
hygiene, are well documented. However, in cases
where teeth are to be extracted for fitting the
removable partial denture, a difficulty arises
because of the need to test the fit of the removable
partial denture framework. The advent of two
modern technologies laser welding and metal
bonding agents make it possible to test the fit of
the major part of the framework prior to adding
additional metal components to support artificial
teeth. A case is described in which the four lower
Introduction
Removable partial dentures have been shown to have
the potential to damage the remaining oral structures
(13). However, this damage can be minimized if the
standard of oral hygiene is enhanced (4) and if the
removable partial denture is well supported and covers
as little of the gingival tissues as possible (5). These
requirements can best be met if the removable partial
denture has a cast metal framework.
Patients who require immediate replacement of un-
treatable teeth and who would benefit from an imme-
diate replacement denture with a cast metal framework
present a particular problem. Although the technology
involved in making cast metal removable partial denture
frameworks is tried and tested, it is still considered
necessary to test the fit of a metal framework before
adding the artificial teeth and completing the denture. In
the case of a denture that will replace teeth that are
extracted when the denture is fitted, there are additional
difficulties regarding the attachment of the artificial teeth
2005 Blackwell Publishing Ltd
GKT Dental Institute, Kings College, London, UK
incisors were extracted. The main part of the frame-
work was constructed and its fit tested. A second
casting was laser-welded to the lingual plate of the
first casting to support the artificial incisor teeth.
This technique avoids the need to make an acrylic
resin temporary denture but incurs the cost of the
additional technical work and so the advantages
may be considered to be economically neutral.
KEYWORDS: removable partial dentures, immediate
replacement dentures, cobaltchromium, laser
welding, bonding agents
Accepted for publication 5 December 2004
to the denture framework. The denture framework
cannot carry tags to support the artificial replacements
if its fit is to be tested before the teeth are extracted.
Two recent developments have provided a solution.
Laser welding allows metal components to be added to
the framework after its fit has been tested in the
patients mouth and metal bonding agents allow acrylic
resin to be bonded to the metal framework making a
stronger joint.
Previously, in dentistry, the most common proce-
dures for joining cobaltchromium alloy have been
soldering or brazing. Each of these techniques requires
an additional medium, usually gold or silver solder,
which has a lower melting point than the metal to be
soldered. They also require a gas torch or an electric
soldering unit for a heat source. The disadvantage of
these techniques are low tensile strength because of a
wide area of the melted filler metal, the heat affected
zone in which there is alteration in the grain size of the
soldered alloy, and also damage to any adjacent
material that has a lower melting point (6, 7). Laser
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 IMMEDIATE REPLACEMENT REMOVABLE PARTIAL DENTURES
technology has overcome these undesirable effects by
modifying the heat source (8). Laser welding has gained
popularity because of the joint strength and the very
narrow zone affected by heat, which causes very little
distortion to the work piece. The components being
joined can be aligned and welded on a cast made of
dental stone rather than refractory material.
A unique characteristic of the modern laser is that it
has a single-frequency light beam that can be focused
onto a fine focal point. The laser tip is contained in a
small glove box containing an argon gas source, which
enables the work to be completed in an inert atmo-
sphere. A stereomicroscope with lens crosshairs allows
precise alignment of the laser beam with the compo-
nents being welded together.
Bonding of resin to dental alloys has been improved
significantly over the last decade. The availability of
adhesive primers for base metals capable of bonding
chemically to casting dental alloy has simplified the
procedures for surface preparation of base metal alloys
(9).
Recently, several adhesive primers containing differ-
ent functional monomers for bonding base metals to
resin have become commercially available (10). In this
case Metal Primer II (MPII*), was used. It contains the
monomer methacryloyloxyalkyl thiophosphate deriv-
ative (MEPS). This monomer promotes the bonding of
acrylic resin to all types of metal.
Case report
A 42-year-old female patient presented at the Depart-
ment of Prosthodontics at Guys Hospital. She was
concurrently receiving periodontal treatment but the
lower incisor teeth showed grade III mobility and were
considered to be unsavable. Conventional treatment
would have been to extract the incisors and insert a
transitional acrylic resin immediate replacement
removable partial denture. The periodontal condition
of her remaining teeth although unsatisfactory, was
improving under treatment. It was thought that the
hygiene benefits of a denture with a cobaltchromium
framework would supplement the periodontal therapy.
Diagnostic casts were made and mounted on a
Dentatus semi-adjustable articulator using a face bow
transfer record. The lower cast was surveyed and a
*GC Corp, Tokyo, Japan.
Dentatus, Hagersten, Sweden.
2005 Blackwell Publishing Ltd, Journal of Oral Rehabilitation 32; 772775
773
Fig. 1. Testing the fit of the first part of the cobalt chromium
framework in the patients mouth before extraction of the lower
incisor teeth. A second casting will be added to the lingual plate to
support artificial incisor teeth.
design formulated. The design incorporated a lingual
plate that would fit the lingual surface of the lower
incisors before they were extracted and would then
allow a second casting to be laser-welded once the fit of
the framework had been verified.
After preparation of the rest seats on the abutment
teeth, impressions were made with alginate impression
material using a custom acrylic resin tray. The metal
framework was cast and its fit tested in the patients
mouth (Fig. 1).
Using a duplicate of the master cast, the teeth
planned for extraction were removed and the ridge
area contoured in the conventional way. The metal
framework was placed on the duplicate master cast
and areas remote from the anterior saddle were
blocked out. A silicone mould was made in which a
second refractory cast was poured. A wax pattern was
made for the second casting comprising a shelf with
retention tags and proximal plates on the abutment
teeth to help stabilize the path of insertion. The
pattern was invested and cast.
Figure 2 shows the two separate castings prior to
them being assembled on the cast for laser welding
(Fig. 3). A neodymium : yttrium aluminium garnet
(Nd : YAG) solid-state laser (manufacturers details)
was set at output power levels of 200 V, 1 Hz, pulse
duration was 35 ms, weld overlap 80%. The focal point
of the laser beam was approximately 11 mm from the
surface of the framework.
Once the two castings were joined, the artificial teeth
were set on the metal framework and waxed up for
GC Europe N.V., Leuven, Belgium.
Heraeus Kulzer GmbH & Co KG, Hanau, Germany.
Bracon Ltd, Etchingham, UK.
774 L . H A S S A N et al.
Fig. 2. The two separate castings prior to positioning on the
modified cast.
Fig. 3. The incisor teeth have been removed from the cast, the
second casting has been laser-welded to the first casting.
finishing. The denture was processed conventionally
except that after the boiling out of the wax and
immediately before packing of the acrylic resin dough
an adhesive primer, Metal Primer II was applied to the
surface of the metal framework that would be in
contact with the acrylic resin. The teeth were extracted
and the denture fitted (Fig. 4).
Discussion
Occasionally, it is desirable to make immediate
replacement removable partial dentures with metal
frameworks. Traditionally, this has been difficult because
of the need to test the fit of the framework prior to
extracting the teeth. Recent technological advances in
laser welding and bonding of acrylic resin to metal have
2005 Blackwell Publishing Ltd, Journal of Oral Rehabilitation 32; 772775
Fig. 4. The denture has been completed, the incisor teeth have
been extracted and the denture fitted.
enabled a technique to be developed. It may be that
either one of the techniques could have been used alone,
but in this case it was felt that the bonding agent alone
would not be sufficiently strong in the long term and that
supporting metal components would be advantageous.
Use of a cast cobaltchromium framework allowed a
more hygienic design to be employed, thereby keeping
denture components away from the teeth and gingivae
as much as possible. The denture could also be
supported on the remaining teeth relieving load from
the area where teeth were extracted, improving com-
fort and in the long term, contributing to a reduction in
the rate of alveolar bone resorbtion. Nevertheless,
relining of the saddle over the extraction area will be
necessary in time.
This technique should be readily available as most
dental laboratories providing cobaltchromium
removable partial denture frameworks now have laser
welders, but there may be cost implications. A second
casting and the laser welding will add to the labor-
atory bill. However, this should be offset against the
cost of a transitional acrylic denture followed by a
new cobaltchromium definitive denture. The cost
could be reduced if instead of a second casting being
added to the main framework, tags made of nickel
chromium wire were used. There will also be the
cost of relining a single saddle but this should be
minimal.
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2005 Blackwell Publishing Ltd, Journal of Oral Rehabilitation 32; 772775