DENTURE BASE CONSIDERATIONS

&
STRESS-BREAKERS
IN
REMOVABLE PARTIAL DENTURES
RUCHI GOEL
JR Final Year
CONTENTS
Introduction
Function of denture base
Ideal denture base materials
Advantages of metal bases
Design of denture base
Methods of attaching denture base
Methods of attaching artificial teeth


CONTENTS (CONTD.)
Stress breakers
Definition
Concept
Mechanism of action
Type
Various attachments
Advantages and disadvantages
Conclusion and references.

DENTURE BASE
Denture base is the part of a denture that rests on
the foundation tissues and to which teeth are
attached.
Glossary of Prosthodontic Terms , J Prosthet Dent 2005;94(1):10-92
FUNCTIONS OF DENTURE BASE
1. Supports the artificial teeth mastication
2. Transfer the functional occlusal forces to the
supporting oral structures stability
3. Esthetic
4. Stimulation of the underlying tissues of the
residual ridge.




FUNCTIONS OF DENTURE BASE
(CONTD)
5. Prevent vertical and horizontal migration of
remaining natural teeth.
6. Provides support of the denture.
7. Prevents undesirable food traps maintains oral
cleanliness.

IDEAL DENTURE BASE
The requirements for an ideal denture base are as follows:
1. Accuracy of adaptation to the tissues, with low to
minimal volume change.
2. Dense, non- irritating surface capable of receiving and
maintaining a good finish.
3. Thermal conductivity.
4. Low specific gravity, lightness in mouth.


IDEAL DENTURE BASE(CONTD)
5. Sufficient strength; resistance to fracture or distortion.
6. Self- cleansing.
7. Esthetic acceptability
8. Potential for future relining
9. Low initial cost
Such an ideal denture base
material does not exist, nor is it likely to be
developed in near future.
However, any denture base, whether resin or metal
and regardless of method of fabrication should
come as close as possible to this ideal as possible.
DENTURE BASE MATERIAL
1. Acrylic resin
2. Metal
3. Combination
Acrylic resin : Polymethyl methacrylate
Poly vinyl resins
Polystyrenes
Metal base : Gold alloys
Co Cr alloys


Metal v/s Acrylic Base
Metal bases
Tooth -supported
partial dentures

Acrylic base
Distal extension
ridges as they can be
relined frequently
with greater ease

ACCURACY AND PERMANENCE OF FORM
Metal bases

Greater accuracy & better
duplication of finer details.

Greater intimacy of contact
provides for direct indirect
retention.

Absence of internal strains
& resistance to abrasion to
cleaning agents

Need for additional PPS is
eliminated.

Acrylic bases
Volumetric shrinkage &
distortion with less
accurate adaptation

Abrasion due to cleaning
agents and constant
brushing of tissue surface.

Need for additional
recording and depth of
PPS is necessary to aid in
retention.
COMPARATIVE TISSUE RESPONSE
Metal base
Inherent cleanliness
due to greater density
and bacteriostatic
activity contributed by
the ionization and
oxidation of metal

Maintaining health of
oral tissues.
Acrylic base
Porous surface of acrylic
resin tend to accumulate
mucinous deposits
containing food particles
as well as calcareous
deposits bacterial
colonization.

Unfavorable tissue
response.
THERMAL CONDUCTIVITY

Temperature changes are transmitted through the metal
bases thus maintaining the health of underlying tissues
via stimulation.
Moreover improving patient's acceptance by allaying the
feel of a foreign body.
Acrylic resins act as insulators thus depriving the tissues
of the natural feel.
WEIGHT AND BULK
Cast in much thinner sections than resin and still
have adequate strength and rigidity


Acrylic base - if extreme loss of residual ridge
bone occurs, in order to restore normal facial
contours & fill the buccal vestibule to prevent the
food being lost into the cheek & from going
beneath the denture.
Acrylic resin base

Where denture
contours may be
utilized for retention.
Restoration of facial
contours for esthetic
reasons ideal
polished surfaces.
Avoid accumulation
of food at denture
borders.
Frequent relining

Metal base

Patient's preference
Acrylic sensitivity
Reduce chances of
breakage
Thinner sections are
required to provide
tongue space

Choice of material for denture base

Need of the situation

Metal resin bases : total metallic coverage with
resin borders to avoid the display of metal & add
buccal fullness
DESIGN OF THE DENTURE BASE
A time-honored principle: base should cover as
wide as area as the limiting structures will permit &
that the patient can comfortably tolerate

Supported by the Snow shoe principle : broader
coverage furnishes the best support with the least
load per unit area
TOOTH SUPPORTED V/S TOOTH - TISSUE
SUPPORTED
Tooth supported

Support of the
denture is obtained
from abutment teeth at
each end of edentulous
space.
Less chances of
relining
Metal bases can be
used.
Tooth - Tissue supported

Major part of support is
obtained from the Distal
extension denture base.
Changes are likely to
occur due to residual ridge
resorption need for
relining.
Resin bases are
preferred.
TOOTH SUPPORTED V/S TOOTH - TISSUE
SUPPORTED
EXTENSION OF TOOTH -SUPPORTED BASE

Maxillary as well as mandibular
- restricted to the edentulous span b/w
abutments without peripheral borders
extending into the vestibular fornix.
MAXILLARY DISTAL EXTENSION
Full coverage base extending to cover the tuberosity &
hamular notches
Posterior border: taper towards tissues; beveled
Termination on tissues that are resilient but not movable
Tissue surface should be lightly beaded if in metal & post -
dammed if in acrylic
Metal finished lines- sharp straight junction with no
overlapping of acrylic
Buccal flange should extend into vestibular fornix
Anterior border of labial flange taper posteriorly; beveled
2mm in thickness, rounded and smooth
Labial flange property contoured; festooning
EXTENSION OF MANDIBULAR DISTAL EXTENSION
BASE
T.Fischer and W.D. Sweeney total area of maxilla capable
of support 1.6 times mandible

Should extent to cover retromolar pads distally and laterally
to include the buccal shelf

Lingual flange : vertically downwards into alveolingual
sulcus.

Distolingual flange extended laterally into retromylohyoid
space; beveled.

Concave to allow adequate tongue space
Labial and buccal extensions : mucosal reflections.
METHODS OF ATTACHING DENTURE BASES
Resin bases are attached to partial denture
framework by minor connector designed such that
space exists b/w it & underlying tissues.




Relief of 20 gauge thickness over master cast
raised platform on investment cast on which the
pattern for minor connector frame is formed

After casting, the retentive frame is returned to
master cast where it stands away from the tissue
surface sufficiently to permit the flow of resin
beneath the surface
Minimum thickness of resin - l.5mm
- to allow relieving during adjustment & relining
- avoid weakening and subsequent fracture of
resin surrounding metal framework.
Investment cast on which pattern for minor connector is formed.

VARIOUS DESIGNS OF MINOR CONNECTORS USED
Latticework
Meshwork
Nail head Beaded
Open ladder- like framework (12 ~ l4 gauge half
round wax or 18 gauge round wax) extending
buccally as well as Iingually preferred to finer
latticework mesh pattern
- excellent attachment
- sufficient thickness of resin thereby minimizing
distortion due to release of internal strains &
fracture due to weakening
- avoid interference in artificial teeth placement


Open construction can be
used whenever multiple teeth
are to be replaced.
This form of minor connector
provides the strongest
attachment of acrylic resin to
the removable partial denture
framework.
It also facilitates relining and
rebasing of removable partial
dentures.
MESHWORK
A mesh minor connector may be compared
to a rigid metallic screen.
Channels that pass through the connector
are intended to permit acrylic resin
penetration.
Relief and border extension for a mesh minor
connector should be identical to open type.
The main drawback of a mesh minor
connector is the difficulty it presents during
the packing of acrylic resin.
Insufficient packing pressure may result in
inadequate resin penetration and a weak
attachment to the framework.
The smaller the openings in this minor
connector, the weaker the attachment.
Mesh construction also may interfere with the
arrangement of prosthetic teeth.
Mesh construction may be used whenever
multiple teeth are to be replaced.

BEAD, NAILHEAD, OR WIRE CONSTRUCTION
Bead, nailhead, or wire components are
often used in conjunction with metal denture
bases.
The metal bases are cast to fit directly
against the underlying soft tissues.
Hence, no relief is provided beneath these
minor connectors.
Resin is attached to the free surface of such
bases, and retention is gained by
encompassment of surface projections.
Bead, nailhead, and wire construction should
be limited to short-span, tooth-supported
applications in patients with well-healed
ridges.



Methods of attaching artificial teeth
PORCELAIN & RESIN TEETH ATTACHED WITH RESIN

Porcelain teeth are mechanically retained.
Anterior : lingually placed retentive pins
Posterior : diatoric holes.

Resin teeth are chemically united with the acrylic
resin of denture base.
Metal bases : resin attachment is accomplished by
nail head, retention loops or diagonal spurs placed
at random.

Junction of resin to metal should be an undercut
finishing line so as to avoid separation and
seepage.
PORCELAIN OR RESIN TUBE TEETH AND FACINGS
Cemented directly to metal base
- tube teeth have hole on underside / side groove
may be present for cementation with resin.

Modification : ready -made resin teeth attached to
metal base with resin of same shade - pressing on
resin tooth.
TUBE TEETH
Disadvantages
Difficulty in obtaining satisfactory occlusion
Lack of adequate contours for functional
tongue & cheek contact
Unaesthetic display of metal at gingival
margins
RESIN TEETH PROCESSED DIRECTLY TO METAL
Advanced crosslinked copolymers allow teeth to
be processed in acrylic at an established occlusal
relationship therefore less occlusal adjustments are
needed
Sufficient hardness & abrasion resistance
Adv:
- occlusion can be created
- limited space
- occlusion can be reestablished
METAL TEETH
Cast as a part of framework
Indicated
- limited space available for the attachment of
artificial tooth
- usually when replacement of second molar is
desirable to prevent migration of the opposing
tooth
Disadvantage
- cast in chrome alloy which is difficult to adjust
RECENT ADVANCEMENTS DIRECT
CHEMICAL BONDING OF TEETH TO METAL
Roughed with abrasives.
Treated with a vaporized
silica coating.
Acrylic resin bonding agent
is applied
2. Tribochemical coating:
Fusing a microscopic layer of ceramic to the
metal by:

sandblasting the metal with
special silica particles (
ROCATEC PLUS).
silane agent is applied over it


How a distal extension base differs
from tooth borne partial denture?
SUPPORT OF DISTAL EXTENSION
DENTURE BASE
Distal extension base
- dual support mechanism
- abutment and residual ridge
- major part of it provided by edentulous ridge
Tooth - supported
- solely by abutment teeth
So in a free end partial denture clinician must decide
how the function and parafunction forces can be best
distributed b/w the edentulous and dentulous areas.
MOVEMENT OF DISTAL EXTENSION
BASE
CONDITIONS CONFRONTED BY DENTIST
Determine the selection of type of direct retainer system & load
distribution b/w abutment & ridge

1. Good PDL support with favorable ridge : any retainer with equal
distribution of load
2. Good PDL support with unfavorable ridge: >stress on abutment
3. Poor PDL support with favorable ridge : >stress on ridge therefore
a stress releasing type of retainer
4 Poor PDL & ridge support : stress releasing type of retainer to
preserve the remaining, teeth as long as possible
STRAIN ON ABUTMENT TEETH CAN BE
MINIMIZED
I. Functional basing
II. Broader coverage
III. Harmonious occlusion
IV. Correct choice of direct retainers
V. Stress-breakers


STRESS-BREAKERS
DEFINITION

A device which relieves the abutment teeth of all
or part of the occlusal forces. -- GPT.
A Stress-breakers is a device that allow
movement between the denture base and the
direct retainer which may be intracoronal or
extracoronal.
Also called "Stress director" or "Stress
equalizer".

CONCEPT
Concept of stress breakers came in existence in
relation to free- end partial dentures to reduce the
torque & load on abutment teeth
Designed to separate the action of retaining
elements from the movement of denture base by
allowing some movement b/w the two
As these devices transfer load from one structure
to another - "Load distributors" or Stress directors
(Menson-1972).
BROKEN STRESS PHILOSOPHY
Suggests that it is more appropriate to mechanically
isolate the abutment from extension base movement
during functional loading.

Mechanical device or attachments must be positioned
between abutments and extension bases within the RPD
framework.

Permit horizontal, vertical and/or rotational movement of
the extension base relative to abutment.


AIM
To direct occlusal forces in the long axis, of
the abutment teeth.
To prevent harmful forces being applied to
the remaining natural teeth.
To share the forces as evenly as possible
between the natural teeth and distal
extension area according to the ability of
these different tissue to accept the forces.
MECHANISM OF ACTION
In a tooth tissue supported partial denture, when an
occlusal load is applied, the denture tends to rock due to
the difference in the compressibility of the abutment and
soft tissues.
A stress breaker is a hinge like joint placed with in the
denture framework, which allows the two parts of the
framework on either side of the joint to move freely.
TYPES
TYPE I TYPE II
With movable joints b/w
Direct Retainers and
denture base that permit
vertical movement, or
hinge-type or a
combination.
Devices with hinges,
sleeves, cylinders or ball
and socket joint.
E.g. Dalbo attachment,
Crismani attachment, ASC
52 attachment.

Flexible connection b/w the
Direct Retainers and denture
base is provided.
Wrought wire connectors
Divided or split major
connectors
Movable joints b/w two major
connectors.

INTRACORONAL ATTACHMENT
Introduced in the late
19
th
century by Dr.
Herman E.S. Chayes.

Consists of
matrix/keyway and
patrix.

These two components
interlock in a sliding
joint configuration.

CRISMANI COMBINED ATTACHMENT
Female section is housed within the abutment
intracoronal retainer.
Hinge connector located within the male section
embedded in the denture.
Allow for vertical movement of the base by hinge
action.
Spring mechanism help return base to original
position when out of occlusal contact.
EXTRACORONAL RESILIENT ATTACHMENT
Introduced in the early 1900s by Henry P Boos and
modified by F. Ewing Roach.
Provides rigid, movable or resilient connection between
the abutment and the denture base.
Sliding joint.
Alternatives to intracoronal attachments
- Short clinical crowns.
- High pulp horns
EXTRACORONAL ATTACHMENTS(CONTD.)
Dalbo: Most Popular
Resilient hinge type of
extracoronal attachment
Both rotational and
vertical movement
ASC-52
Universal resilience
Extracoronal slide
attachment with a
spring activated
universal joint hinge
& adjustable retention
Smallest of the stress
directors
EXTRACORONAL ATTACHMENTS
Hinge type attachment
EXTRACORONAL ATTACHMENTS(CONTD.)
Stud attachment
Bar and clip attachment
TYPE II
Movable joint b/w two
major connectors- dual
casting technique
Eg. Double lingual bar
of wrought metal; one
supporting the clasps
and other components
whereas the others
supporting and
connecting distal
extensions
Split major connector
- Made flexible, by
separating portion of
its length either by
saw cut or casting to
thin shim

ADVANTAGES OF STRESS DIRECTORS
Vertical forces acting on the abutment teeth are
minimized and alveolar support of abutment teeth is
preserved.
Intermittent pressure of denture bases massage the
mucosa thus providing physiologic stimulation,
which prevents the bone resorption and eliminates
need for relining.
Minimal requirement of direct retention.
Weak abutment is well splinted even during the
movement of the denture base.
DISADVANTAGES OF STRESS DIRECTORS
Design is complicated and expensive.
The assembly is very weak and tends to
fracture very easily.
Difficult to repair.
Precise and structurally demanding tooth
preparation
Reduced stability against horizontal forces.
Effectiveness of the indirect retainers is
reduced or eliminated all together.

CONCLUSION

The controversy of whether to employ a stress-
director in distal extension RPD has not been
resolved. Successful prostheses can be fabricated
by both methods.
However the key to success lies in intelligent
treatment planning and meticulous restorative
procedures.
Routine recall and maintenance is perhaps the most
important consideration for the longevity of the
prostheses & maintenance of the health of the
supporting oral structures
W.L. McCracken:
Unless a partial denture is made
with adequate abutment support, with optimal base
support, and with harmonious and functional occlusion,
it should be clear to all concerned that such a denture
should be considered only a temporary treatment
Prieskel concludes
"It seems more important to concentrate
on the production of stable prostheses
than to enter the controversy over
broken stress and rigid connectors "
REFERENCES
McCrakens removable partial denture. 12th
edition.
Clinical removable partial prosthodontics.
3rd ed. by Stewart.
Precision attachments in dentistry. H.W.
Preiskel. 3 rd ed.
Removable partial prosthodontics by
Grasso and Miller. 3rd ed.