international journal of research in dentistry oral

Dr. Manu Rathee et al. / IJRID Volume 4 Issue 4 Jul.-Aug. 2014 Available online at www.ordoneardentistrylibrary.org

ISSN 2249-488X

Case- report

INTERNATIONAL JOURNAL OF RESEARCH IN DENTISTRY ORAL REHABILITATION WITH METAL BASE COMPLETE DENTURE FOR PATIENT WITH ORAL LICHEN PLANUS Dr. Manu Rathee, Dr. Mohneesh Bhoria, Dr. Priyanka Boora Department of Prosthodontics, Post Graduate Institute of Dental Sciences Pt. B.D Sharma University of Health Sciences Rohtak, Haryana, India. Received: 17 June. 2014; Revised: 19 Jul 2014; Accepted: 26 Aug. 2014; Available online: 5 Sep 2014

ABSTRACT A little diverse approach from traditional modalities such astransforming conventional into unconventional approach is a characteristic feature of evergrowing prosthetic dentistry and by this approach patients’ problemscan be managed to a great extent,providing them physical as well as psychological boost and adding to the wellbeing and comfort of the patients.Several difficulties are encountered in providing a successful, single complete denture against natural dentition. This case report discusses successful rehabilitation of resorbed maxillary ridge opposing a full complement of natural teeth in a patient with Oral Lichen Planus, achieved through incorporation of metal denture base in place of the conventional material to prevent frequent denture fracture and alsoto provides relief in symptoms of Oral Lichen Planus. Keywords – Metal denture base; Oral Lichen Planus; Resorbed residual ridge

Introduction Since the introduction of acrylic resins as a denture base material in 1937, its use has become almost universal.[1] However,dimensional changes that occurs during the processing of these materials still continues to concern the dental practitioner seeking an accurate denture base.[2] Dimensional changes during processing have been reported as resulting from the resin itself as well as accompanying manipulative procedure.[3,4] Dimensional changes causes movement of artificial teeth position and increase the gap between the denture base and underlying mucosa resulting in illfitting denture.[5] Dentures are usually subjected to a combination of compressive, tensile, shearing loads and these forces are increased in ill-fitting dentures and these forces are traumatic to both soft and hard tissue of denture bearing surface.[6] PMMA denture bases have good mechanical, biological and esthetic properties but they may fail because of excessive masticatory or functional forces. In such circumstances metal denture base can be used.[7] Thin metallic base have several advantages like excellent strength, good adaptation to the supporting tissues, enhanced control of

denture plaque, high

biocompatibility,no dimensional change with time through fluid absorption.[8] Various studies have shown that metal dentures were perceived as more comfortable than acrylic resin denture reduces burning sensation, allergic reactions, eliminating microbial colonization, isfracture resistant, thin, comfortable to the patient and 117

Dr. Manu Rathee et al. / IJRID Volume 4 Issue 4 Jul.-Aug. 2014

Dr. Manu Rathee et al. / IJRID Volume 4 Issue 4 Jul.-Aug. 2014 gives them a feeling of chewing food naturally.[9,10] Acrylic denture base materials may serve as a reservoir for microorganisms like candida and bacteria.[11] Oral Lichen Planus (OLP) patients are advised to maintain a high standard of oral hygiene and mucosal trauma such as by illfitting denture or sharp cusps should be eliminated.[12] Metal denture base are more tissue tolerant and resistant to deformation than acrylic denture base. [13]

Metal denture base is effective in decreasing fungal growth in complete dentures and provides to be an

alternative dental service for edentulous patients.[14]

Case Report A 56-years-old male patient reported with the chief complaint of frequent fracture of maxillary complete denture and burning sensation in mouth.History revealed that the patient was a known case of OLP and was on medication.Intraoral examination revealed completely edentulous maxillary arch opposing mandibular natural teeth 31,32,36,37,41,41,43,44,47and porcelain fused to metal restoration crowns on 33,34,35,45,46.(Fig1)

Figure1. Intraoral pre-operative view of maxillary and mandibular arch. After thorough examination and meticulous investigations, a complete denture with metal denture base was planned for maxillary arch. Clinical Procedure Preliminary impressionfor maxillary arch was made using impression compound (DPI Pinnacle, Mumbai, India). The border molding of custom tray was carried out conventionally using low-fusing impression compound (DPI Pinnacle, Mumbai, India), and the final impression was recorded with zinc-oxide impression paste (DPI Pinnacle, Mumbai, India). The posterior palatal seal was established at the final impression stage, using low-fusing impression compound. Maxillomandibular relationships were recorded and mounting was done followed by teeth arrangement and try-in. For the construction of metal framework, refractory cast was obtained. Wax pattern was fabricated and external finish line was incorporatedfor resin metal junction. After investing procedure, casting process was completed using a Ni-Cr alloy (Bego, Germany) and metal frameworkwas finished and polished. (Fig 2, 3)

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Figure 2.Wax pattern for metal denture base with sprue former.

Figure 3. Finished metal denture base.

Using compression molding technique, investing and dewaxing procedure was carried out. Before packing, the metal framework was placed on the master cast and acrylization procedure was completed. The prosthesis was finished, polished and delivered. (Fig 5, 6) The regular follow up for one year has been uneventful.

Figure 4.Maxillary complete denture with metal denture base.

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Figure 5. Post operative extraoral view.

Discussion Complete dentures made in conventional manner prove to be satisfactory in most of the patients, but in compromised patients conventional method has certain disadvantages.Hence, using new techniques, a manifestation of new vision in prosthesis construction,based on same old fundamentals i.e. unconventional approach can solve theproblem.The fracture of complete denture is a common occurrence. Occlusal problems and denture-base fractureswhich are commonlyseen in the single complete denture, can be the result of one or all of the following: (1) occlusal stress on the maxillary denture and the underlying edentulous tissue from teeth and musculature accustomed to opposing natural teeth, (2) the position of the mandibular teeth, which may not be properly aligned for the bilateral balance needed for stability, and (3) flexure of the denture base. The use of metal denture base help prevent denture-base fracture.[15]In the present case, history of frequent fracture of maxillary acrylic denture led to the decision in favour of a metal denture base.

Oral Lichen Planus is a common mucocutaneous disorder of stratified squamous epithelium. It is of multifactorial origin,sometimes induced by drugs or dental materials but often idiopathic. Oral Lichen Planus can be complicated by Candidasis and is considered as oral carriage of candida species and may account for soreness and pain in some symptomatic patients. Trauma, though not an exact etiological factor in Oral Lichen Planus, but may be a mechanism by which other etiological factors may exert their effects. Mechanical trauma or irritants such as rough surfaces are often present in Oral Lichen Planus.[10]

Metal bases for complete dentures have been used successfully andhave manyadvantages. Various studies have shown that metal dentures were perceived as more comfortable than acrylic resin dentures, reduces burning sensation, allergic reactions, eliminating microbial colonization, isfracture resistant, thin, excellent strength, good adaptation to the supporting tissues, enhanced control of

denture plaque, high biocompatibility,no

dimensional change with time through fluid absorption comfortable to the patient and gives them a feeling of chewing food naturally.[7-9] Due to all these advantages, it was decided to fabricate denture with metal base. 120



A butt joint, internal and external finish line, was created palatal to the crest at the junction of acrylic and metal that enhances the strength of the metal acrylic junction creating a smooth joining of acrylicwith metal and avoiding any step formation, thus making it comfortable for the patient. The metal denture base fabrication has certain disadvantagesincluding high cost as compared to acrylic resins, difficult refitting of the denture and the technique is more time-consuming than those for making plastic base dentures. However, the advantagesseem to outweigh the disadvantages. Metal denture base helps significantly in solving patients’ long term problem of frequent denture fracture and provides a symptomatic relief to Oral Lichen Planus patients. Conclusion The metal denture base can be used successfully in patients with a history of frequent denture fracture, patient with completely edentulous arch opposing natural teeth and patient with Oral Lichen Planus. Metal denture base decreases the amount of bone resorption, increases stability, retention, provides a close adaption to the underlying tissue, eliminates the acrylic denture-induced allergic reactions, avoids microbial colonization, decreases the fungal growth that usually occurs under acrylic denture bases and provides symptomatic relief in patients of OLP. REFERENCES 1. Craig RG. Restorative Dental Materials, 8th ed. St. Louis: Mosby Inc; 1989. p.509. 2. Baemmert RJ, Lang BR, Barco MT Jr, Billy EJ. Effect of denture teeth on the dimensional accuracy of acrylic resin denture bases. Int J Prosthodont 1990;3:528-37. 3. Jackson AD, Grisius RJ, Fenster RK, Lang BR. The dimensional accuracy of two denture base processing methods. Int J Prosthodont 1989;2:421-8. 4. Takamata T, Setcos JC, Phillips RW, Boone ME. Adaptation of acrylic resin dentures as influenced by the activation mode of polymerization. J Am Dent Assoc 1989;119:271-6. 5. Garfunkel E. Evaluation of dimensional changes in complete dentures processed by injection-pressing and the pack-and press technique. J Prosthet Dent 1983;50:757-61. 6. Zappini A, Kammann, Wachter W. Comparison of fracture tests of denture base materials. J Prosthet Dent 2003;90:578-85. 7. Ohkubo C, Kurtz KS, Suzuki Y, Hanatani S, Abe M, Hosoi T. Comparative study of maxillary complete dentures constructed of metal base and metal structure framework. Journal of Oral Rehabilitation 2001;28:149–56.

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Dr. Manu Rathee et al. / IJRID Volume 4 Issue 4 Jul.-Aug. 2014 8. Corina M, Luciana G,Anca J, Eniko D, Bratu D. Titanium complete denture base in a patient with heavy bruxism: a clinical report.Journal of Experimental Medical & Surgical Research.2008;(3):96-99. 9. Hummel SK, Marker VA, Buschang P, DeVengencie J. A pilot study to evaluate different palate materials for maxillary complete dentures with xerostomic patients.J Prosthodont1999;8(1):10-7. 10. Scullyl C et al. Update On Oral Lichen Planus: Etiopathogenesis And Management. Critical Reviews in Oral Biology & Medicine. 1998;9(1):86-122. 11. Awad AK, Jassim RK.The effect of plasma on transverse strength, surfaceroughness and Candida adhesion of two types of acrylicdenture base materials (Heat cure and light cure). J Bagh College Dentistry 2012;24( 2):10-17. 12. Kalla R, Kumar S, Rao H. Total Rehabilitation Of Poor Edentulous Arches With Metal Denture Bases And Finger Prosthesis. International Journal of Prosthetic Dentistry2013:4(1):31-35. 13. Perezous LF et al. The effect of complete dentures with a metal palate on candida speciesgrowth in HIVinfected patients.J Prosthodont. 2006;15(5):306-15. 14. Rai N, Pal B, Shivashankar M, Jagadeesh, Kashinatha H M.Single metal base complete denture – a case report. Journal of Dentistry and Oral Biosciences 2012;3(1):14-17.

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