SUBLINGUAL BAR VS.

LINGUAL BAR RPD

major connector designs were evaluated by the patients 4. Rudd KD, Morrow RM, Eissmann HF: Dental Laboratory
Procedures. Removable Partial Dentures, cd 1. St. Louis, 1981.
at the conclusion of the study. Eight of the 10 patients
The CV Mosby Co, vol 3, p 144.
preferred the lingual plate and nine of the 10 found both 5. Lavere AM, Krol AJ: Selection of a major connector for the distal
designs satisfactory. One patient indicated a strong extension-base removable partial denture. .J PROSTHET DENT
preference for the sublingual bar over the lingual plate 30:102, 1973.
and another found both designs equally acceptable. We 6. Potter RB, Appleby RC, Adam CD: Removable partial denture
design: A review and a challenge. J PROWHET DENT 17:63.
have concluded from the final data that the sublingual
1967.
bar compares favorably with the lingual plate in patient 7. Brantenburg RM, Tryde G: Connectors for mandibular partial
acceptance and should be considered as a viable design dentures: Use of the sublingual bar. J Oral Rehabil 4~389,
alternative when a lingual plate is not indicated. 1977.
8. Dewy .4, Bcrtrarn L: A clinical survey of removable partial
We wish to thank Colonel Richard Bauman for his assistance in drntures after 2 years usage. Acta Odortol Srand 28~583,
providing laboratory support for this study and Colonels Charles 1970.
Antonini and William C. Brokaw for their critical review of the 0. (:rcconi BT: I,ingual bar design. J PKOSTHLT DENT 29:635,
manuscript. 1977.
IO. Leupold RJ, Kratochvil FJ: An altered..cast procedure to
REFERENCES improve tissue support for removable partial dentures. J PROS-
1. Campbell LD: Subjective reactions to major connector designs for THET DENT 15:672. 1965.
removable partial dentures. J PROSTHET DENT 37:507, 1977.
2. Krol AJ: Removable Partial Denture Design, Outline Syllabus, Refmnt requests to:
ed 3. San Francisco, 1981, University of the Pacific Bookstore, p DR. CARL A. HANSEN
40. UNIVERSITY OF NEBRASKA MEDICAL CENTER
3. Henderson D: Ma.jor connectors-united it stands. Dent Clin COLLEGE OF DENTISTRY
North Am 17:661, 1973. LINCOLN, NE 68583

Diagnosing functional complete denture fractures

Robert L. Schneider, D.D.S., M.S.*
University of Iowa, College of Dentistry, Iowa City, Iowa

C omplete dentures often fracture during normal

masticatory function. However, an edentulous patient
can only exert occlusal forces of 15 to 25% that of dentate
patients.’ Theoretically, therefore, an edentulous patient
could not fracture a denture base that possessesa tensile
strength of 7000 to 9000 psi, a compressive strength of
11,000 psi, and an elastic modulus of 550,000 psi. This
article describes many of the causes of maxillary and
mandibular complete denture fracture, and discusses
methods to help prevent their recurrence.
MAXILLARY COMPLETE DENTURE
A common problem is the recurrent midline fracture
of a maxillary complete denture opposing natural denti-
tion or dentition that is restored with fixed partial
dentures.i Frequently, the opposing arches are restored
*Assistant Professor, Department of Removable
at different times by different dentists with little or no
consideration to the final oeclusal plane..
Uneven or deflective occlusal contacts will deform the
denture base and create lines of fatigue that result in
complete denture base fracture. Many authors empha-
size the importance of properly restoring the occlusal
plane.‘-’ They agree that recontouring the natural denti-
tion will provide a more favorable occlusal plane and
facilitate the development of balanced occlusion for the
maxillary complete denture, which will more evenly
distribute the forces of mastication to the denture base
and help prevent fracture.
The occlusal plane can best be evaluated on accurate,
mounted diagnostic casts. The proper plane can be
determined using several methods that include retromo-
lar pads, esthetics and phonetics, a curved occlusal
template, or the Broderick occlusal plane analyzer (Figs.
1 and 2).
Prosthodontics An acceptable occlusal plane can occasionally be

THE JOURNAL OF PROSTHETIC DENTISTRY 809


Fig. 1. Occlusal plane analysis with curved template
before treatment.
Fig. 2. Occlusal plane analysis with curved template
after enameloplasty.
achieved by reducing cusp inclines to produce shallow
cusp angles thereby eliminating interferences by ex-
truded cusps and incisal edges. Occlusal tables on
mandibular restorations can be narrowed to reduce
occlusal forces. If extensive prosthodontic rehabilitation
is required in the mandibular arch, it is advisable to
complete the maxillary denture to the trial arrangement
phase. The final restoration of the mandibular arch can
be completed against the maxillary wax trial denture.
This will give the dentist and technician more flexibility
in developing a compatible, properly positioned occlusal
plane.
Cantilever fixed partial dentures can occasionally be
used in the mandibular arch opposing a maxillary
complete denture, due to the decrease in occlusal forces
generated by the complete denture. Double abutted fixed
partial dentures are functional and will eliminate
the need for a Kennedy Class I or II removable par-
tial denture if the premolars are used as the abutments
(Fig. 3).
810
SCHNEIDER
Fig. 3. Mandibular three-unit cantilever fixed partial
denture opposing maxillary complete denture.
Fig. 4. Mandibular onlay removable partial denture
used to restore occlusal plane.
An onlay removable partial denture can occasionally
restore a severely distorted mandibular occlusal plane.
This treatment is less expensive for the patient than a
fixed restoration. The onlay removable partial denture
requires the same mouth preparation as other types of
removable partial dentures in addition to some selective
enameloplasty. The mandibular cast is surveyed for
proper guide planes and retentive undercuts. It is
beneficial in developing an occlusal scheme if the on-
lay removable partial denture can be waxed to the max-
illary posterior denture tooth trial arrangement (Figs.
4 and 5).
It is difficult to develop balanced occlusion in Angle
Class II patients with a maxillary complete denture that
opposes a natural dentition. The occlusal forces exerted
in function may fracture the denture base because of
potential anterior tooth contacts. It may be necessary to
widen the occlusal table of the maxillary denture for
increased stabilization because of a discrepancy in max-
illary and mandibular arch widths (Figs. 6 and 7). This
DECEMBER 1985 VOLUME 54 NUMBER 6
DIAGNOSING FUNCTIONAL COMPLETE DENTURE FRACTURE

Fig. 5. Mandibular onlay removable partial denture Fig. 7. Posterior occlusal scheme developed for patient
and maxillary complete denture fabricated to proper in Fig. 6 using functionally generated path technique
occlusal plane. and cast metal occlusal surfaces.

Fig. 6. Maxillary complete denture fabricated for Fig. 8. Maxillary complete denture constructed with
patient with Class II jaw relationship. cast metal palate.

can be accomplished by the use of a functionally
generated path technique. * For protrusive balance a
lingual anterior ramp can be placed in the denture. It is
advisable to develop the anterior ramp in the mouth with
modeling plastic to determine the potential effect this
procedure may have on the patient’s speech. If speech is
significantly affected, this procedure may not be appro-
priate.
It has been reported that patients with a low Frank-
fort-mandibular plane angle (FMA) are able to exert
increased occlusal forces,9 which may contribute to
increased incidence of fracture. Patients with an
increased vertical dimension of occlusion are prone to
denture base fracture because of the excessivemasticato-
ry forces they are able to exert. It is advantageous when
constructing a maxillary complete denture opposing
natural dentition to fabricate a cast metal palate to
minimize denture base flexure (Fig. 8). The use of
acrylic resin denture teeth will strengthen the base by
connecting it into a solid unit.“’ Porcelain denture teeth
may weaken the denture base by introducing internal
stresses.”
Maxillary anatomic considerations that can contribute
to denture base fracture should also be evaluated. A
fulcrum can be created in the denture palate over a
palatal torus or prominent midpalatal suture (Fig. 9).
The fulcrum creates stresses that predispose to fracture
in the denture base. Judicious relief of these areas is
desirable at the insertion appointment. If a metal palate
is used, the final impression should be free of pressure in
these regions. The dentist may choose to place relief on
the master cast before the technician waxes and casts the
palate because the metal is difficult to adjust and
repolish.
A broad maxillary labial frenum that i.sattached close
to the crest of the ridge can present an area of potential
fracture for the complete denture. The large notch
required to provide the frenum relief during function

THE JOURNAL OF PROSTHETIC DENTISTRY 811


Fig. 9. Maxillary torus in edentulous patient. Note area
of irritation on torus attributed to patient’s denture.
Fig. 10. Metal base for mandibular complete overden-
ture (occlusal view).
weakens the base. A frenectomy is indicated before
fabrication of the denture when there is a history of base
fracture or if fracture is anticipated.
Soft and hard tissue undercuts that are relieved in the
base to facilitate the path of insertion and removal can
result in a thin denture base that is susceptible to
fracture under function. This is a common occurrence
with pronounced labial undercuts and retention of roots
for overdenture abutments.
Occasionally the overdenture abutment is too promi-
nent and will result in inadequate thickness in the
denture base. A patient with an overdenture can exert
more occlusal force than 0~ who is edentulous. It is
advisable to consider the use of a metal base for more
favorable force distribution to the denture base and
abutment teeth.12
MANDIBULAR COMPLETE DENTURE
A mandibular complete denture opposing maxillary
natural teeth is usually contraindicated. Excessive occlu-
812
SCHNEIDER
Fig. 11. Tissue side of mandibular complete overden-
ture with metal base.
sal forces to the mandibular residual ridge are generated.
through the denture base and can result in more rapid
resorption and chronic sore mouth.
As previously discussed, analysis of the existing occlu-
sal plane and advanced planning of the new occlusal
scheme is of utmost importance. Opposing natural teeth
should be reshaped or restored appropriately to develop
an occlusion that will more evenly distribute functional
forces.
As in the maxillary arch, fracture is more likely to
occur in a complete denture opposed by natural denti-
tion. In instances of decreased interarch space, a metal
base will help prevent fracture of the denture in function
(Figs. 10 and 11).
Resilient denture base liners, which are used most
frequently in mandibular complete dentures, can con-
tribute to fracture. The dentist or the laboratory techni-
cian may excessively reduce the denture base to allow
room for the resilient liner, trying not to alter the desired
vertical dimension of occlusion, and provide optimum
thickness of the resilient material. Occasionally, the
mandibular denture will fracture in the midline because
of excessive relief, the use of porcelain teeth with a thin
denture base, or anterior occlusal contacts. Before a
resilient denture liner is placed, the existing prosthesis
should be evaluated for proper occlusion and sufficient
base thickness to prevent fracture.
Mandibular considerations that can contribute to the
denture base fracture are similar to the maxillary
considerations. Excessive relief over lingual tori can
weaken the denture base, and they should be removed
before making a denture. A broad labial frenum or one
that is attached close to the crest of the ridge may weaken
the denture and should be removed before the denture is
fabricated.
Excessive labial hard and soft tissue undercuts on
mandibular overdentures is a commonly observed prob-
DECEMBER 1985 VOLUME 54 NUMBER 6
DIAGNOSING FUNCTIONAL COMPLETE DENTURE FRACTURE

Fig. 12. Labial hard and soft tissue undercuts that can
result in excessive denture base relief and adversely Fig. 13. Pediatric dental patient with cctodermal dys-
affect retention and stability. plasia.

lem (Fig. 12). The denture base can fracture in the area
of the abutment tooth, most often the canines. If the
abutment is not sufficiently reduced incisogingivally,
fracture is likely to occur because of insufficient denture
base thickness.
Many of the labial undercuts associated with retention
of mandibular canines for overdenture abutments can be
eliminated before denture fabrication. In view of the
acceptance of dense particulate hydroxyapatite for use in
surgical augmentation of atrophic residual ridges, this
material can be an excellent adjunctive treatment to aid
in eliminating undesirable undercuts. When indicated,
small amounts of hydroxyapatite can be placed in the
labial undercut. This procedure results in a stronger Fig. 14. Complete overdentures fabricated for patient
denture base with less chance of fracture because exces- in Fig. 13 using high-impact acrylic resin and acrylic
sive relief to accommodate the path of insertion is resin denture teeth to increase base strength.
eliminated.
Metal bases for complete and removable partial
dentures have been used successfully. One concern of SUMMARY
many dentists is that resorption of the residual ridges can Many factors can contribute to the fracture of com-
result in a loose metal denture base that cannot be easily plete dentures. This article has identified some of these
or successfully relined. Recent advances in metal etching factors and presented some methods that can greatly
techniques have made it possible to reline a metal reduce or eliminate functional complete denture base
denture base using acrylic resin with predictable fractures when used with a thorough diagnosis and
results.13 treatment plan.
In many complete dentures opposing natural denti-
tion, it is beneficial to use a metal base or a high-impact REFERENCES
acrylic resin denture base to help prevent fracture.14 1. Manly RS, Vinton PA: A survey of the chewing ability of
denture wearers. J Dent Res 30~314, 1951.
High-impact acrylic resin for denture bases should be
2. Farmer JB: Preventive prosthodontics: Maxillary denture frac-
used in pediatric patients who manifest oral symptoms of ture. J PROSTHET DENT 50~172, 1983.
ectodermal dysplasia and are being treated with over- 3. Rudd KD, Morrow RM: Occlusion and t!le single denture, J
dentures (Figs. 13 and 14). Because of the expense PROSTHET DENT 30~4, 1973.
involved and the rapid growth potential of the child, 4. Ellinger WE, Rayson JH, Henderson .D: Single complete
dentures. J PROSTHET DENT 26~4, 1971.
metal bases are not indicated. This material may also be
5. Bruce RW: Complete dentures opposing natural teeth. J PROS-
indicated in the presence of decreased interarch space, a THET DENT 26:448, 1971.
single overdenture, and a patient who is known to be a 6. Wiland L: Dentures, inclined planes, and traumatic occlusion. J
clencher or bruxer. PROSTHET DENT 14~892, 1964.

THE JOURNAL OF PROSTHETIC DENTISTRY 813

 SCHNEIDER

7. Meyer FS: Dentures-Causes of failures and remedies. J supported complete dentures: An approach to preventive prostho-
PRQSTHET DENT 1:672, 1951. dontics. J PR~STHET DENT !21:513, 1969.
8. Meyer FS: The generated path technique in reconstruction 13. Garfield RE: An effective method for relining metal-based
dentistry. Part I: Complete dentures. J PROSTHET DENT 9:354, prostheses with acid-etch techniques. J PR~STHET DENT 53:719,
1959. 1984.
9. DiPietro GJ, Moergeli JR: Significance of the Frankfort- 14. Johnson EP, Nicholls JI, Smith DE: Flexure fatigue of ten
mandibular plane angle to prosthodontics. J PROSTHET DENT commonly used denture base resins. J PR~STHET DENT 46:478,
36~624, 1976. 1981.
10. Halpern AR: The cast aluminum base. Part I: Rationale. J Reprint requests to:
PROSTHET DENT 43:605, 1980. DR. ROBERT L. SCHNEIDER
11. Phillips RW: The Science of Dental Materials, ed 7. Philadel- UNIVERSITY OF IOWA
phia, 1982, WB Saunders Co, p 203. COLLEGE OF DENTISTRY
12. Morrow RM, Feldmann EE, Rudd KD, Trovillon HM: Tooth- IOWA CITY, IA 52242

Vacuum treatment of tissue conditioners

Arthur Nimmo, D.D.S.,* Betty J. Fong, B.A.,** Charles I. Hoover, M.A.,*** and
Erne$t Newbrun, D.M.D., Ph.D.****
University of California, School of Dentistry, San Francisco, Calif.

1.issue-conditioning agents are used to improve the vacuum treatment affects microbial adherence to the
health of abused denture-bearing tissues’-3 and to make surface of the material.
functional impressions for reline procedures.‘-lo For both
of these uses, a uniform mix that incorporates minimal MATERIAL AND METHODS
air in the tissue conditioner is desirable. The incorpora- The tissue-conditioning agent used in this study was
tion of air produces voids in the material, and voids are Visco-gel (DeTrey, Weybridge, England). Visco-gel
undesirable for several reasons. When the material is was selected for testing for two reasons: (1) it is
used as a tissue-conditioning agent, voids may harbor transparent, which facilitated visual evaluation of voids,
debris, bacteria,“,‘* and oral yeasts’3,‘4 that will further and (2) it has been shown previously to have no effect on
irritate the tissue. When the material is used to make microbial growth.19e2o
functional impressions, voids can create inaccuracies in The tissue conditioner was measured in the propor-
the impression.‘5 tions suggested by the manufacturer. These were quan-
Vacuum treatment of tissue-conditioning agents may titated using an electronic scale as 3 gm powder to 2.28
offer a solution to the problem of voids in the material. gm liquid and were mixed in a small plastic cup for 30
Vacuum-mixing is widely used in dentistry to reduce the seconds. The control mix (atmospheric pressure [API
entrapment of air in gypsum produc@-‘* so the technol- group) consisted of three groups of six samples that were
ogy is available to most dentists. The purposes of this allowed to sit for 45 seconds at atmospheric pressure
study were to determine (1) if vacuum treatment reduces before pouring into a silicone mold 2 mm deep and 25
void formation in tissue-conditioning agents and (2) if mm in diameter. The vacuum-treated mix (VAC group)
consisted of three groups of six samples that were placed
in a vacuum (28 inches Hg) for 45 seconds and then
Presented at the International Association of Dental Research, Las
Vegas, Nev.
poured into the silicone mold. The vacuum apparatus
Supported by short term training Grant No. DE07103 from the consisted of a dessication jar connected to a porcelain
National Institute of Dental Research, National Institutes of oven vacuum pump (Mark IV Digital, J.M. Ney Co.,
Health, Bethesda, Md. Bloomfield, Conn.) with a vacuum gauge (Whip-Mix
*Associate Professor, Department of Removable Prosthcdontics, Tem- Corp., Louisville, KY.) in line.
ple University, School of Dentistry, Philadelphia Pa.
**Dental student; short-term research training Fellow. The mold was placed in water and incubated at 38” C
***Staff Research Associate. for 24 hours. The samples were removed from the mold
****Professor, Department of Stomatology. and evaluated using a ~10 stereoscopic microscope. All

814 DECEMBER 1985 VOLUME 54 NUMBER 6