Reinforcement of a mandibular complete

denture with internal metal framework

J. Heath Balch, DDS,a Pamela D. Smith,b Mark A. Marin, CDT,c
and David R. Cagna, DMD, MSd
University of Tennessee Health Science Center, College of
Dentistry, Memphis Tenn
Metal framework reinforcement is used in complete dentures to improve the fracture resistance, dimensional stability,
accuracy, weight, and retention of a definitive prosthesis. A novel technique for suspending a metal framework within
the denture base of mandibular complete dentures is described. (J Prosthet Dent 2013;109:202-205)

Metal bases and frameworks have
been incorporated into complete
denture bases to improve fracture
resistance,1,2 dimensional stability,1,3
accuracy,3,4 weight,3,5 and reten-
tion.6,7 Grunewald3 used gold for the
framework to compensate for exces-
sive weight loss in atrophic eden-
tulous mandibles. Others have de-
scribed the use of chromium-cobalt
in contact with the soft tissues of the
denture foundation.8 Although this
approach permitted the reinforce-
ment of the prosthesis, postplace-
ment intaglio surface adjustments
were somewhat difficult.
Several authors have described
techniques for suspending reinforced
metal frameworks within denture
bases before processing resilient lin-
ing materials.9-11 The suspended
framework design described by Mor-
row et al9 used metal struts project-
ing laterally from the framework onto
the land area and tongue space of the
definitive cast. This technique permit-
ted the maintenance of a prescribed
amount of space for the resilient liner
between the definitive cast and the
metal framework and increased the
resultant strength of the prosthesis.
Wormley and Brunton12 incorporated
projections from their metal frame-
work design that extended laterally
beyond the denture’s cameo surface.
During the investment of the wax trial
denture, the projections were cap-
tured in gypsum, thus suspending
the framework in the denture base
during acrylic resin polymerization.
Hurtado13 suspended the reinforcing
framework by using cast stops de-
signed in similar fashion to the cast
stops integrated into the frameworks
of extension base partial removable
dental prostheses. Before introduc-
ing acrylic resin into the flask during
compression molding, the framework
was positioned against the definitive
casts and fixed with cyanoacrylate ad-
hesive. The techniques for reinforcing
internal prostheses described thus far
are either laboratory intensive or do
not permit acceptable framework sta-
bility during processing. Additionally,
available space14,15 for incorporating
the framework into the denture base
may be a concern.
This article describes a technique
to suspend a metal framework in-
ternally within the denture base of
mandibular complete dentures for in-
ternal prosthesis reinforcement. The
same process can be used for tooth-
supported and implant-supported
overdentures. This technique provides
fracture resistance and dimensional
stability for the prosthesis. Addition-
ally, this internally suspended metal
framework can be designed to accom-
modate attachments. Vertical posts
extending from the framework into
the definitive cast are used to provide
support and stability and to maintain
a prescribed space apical to the frame-
work during acrylic resin processing.
TECHNIQUE
1. Develop a wax trial denture by
using standard clinical and laboratory
complete denture processes.16 Verify
that appropriate and accurate hori-
zontal and vertical maxillomandibular
jaw relationships have been obtained
and that the patient is satisfied with
the related phonetics and esthetics.
Place the wax trial dentures on the
definitive casts and seal them to the
cast. Confirm that the planned occlu-
sal scheme has not been disrupted.
2. Separate the mandibular cast
from the articulator mounting. Du-

Presented at the International Academy of Gnathology, American Section, Congress XXV, San Antonio, Texas, September 2011.

a
Private practice, Knoxville, Tenn.
b
Dental Laboratory Technician, Memphis, Tenn.
c
Dental Laboratory Technician, San Antonio, Texas.
d
Associate Dean, Postgraduate Affairs; Professor and Director, Advanced Prosthodontics Program.
The Journal of Prosthetic Dentistry Balch et al
March 2013 203

1 Clear matrix indexed to land area of cast with denture 2 Framework design on duplicate definitive cast. Place
teeth in place. Matrix is made from stone duplicate of wax cross struts of minor connectors over holes in cast (red).
trial denture on definitive cast.

3 Use of standard drill press to prepare three 1.4-mm 4 Three parallel and evenly spaced post patterns placed
diameter, 3-mm deep, widely spaced, parallel holes in in corresponding holes in definitive cast.
definitive cast through crest of edentulous ridge.

plicate the wax trial denture and cast
with reversible hydrocolloid (Instaloid
Duplicating Material All-Purpose;
CMP Industries, LLC, Albany, NY) or
another laboratory duplicating pro-
cess. Be careful to duplicate the cast’s
land area and tongue space accurately.
3. Form a clear acrylic resin ma-
trix (1-mm thick Biocryl; Great Lakes
Orthodontics, Tonawanda, NY) on
the duplicate cast by using a pres-
sure forming (Biostar VI; Great Lakes
Orthodontics) or vacuum forming
(Sta-Vac II; Buffalo Dental Mfg Co,
Syosset, NY) process. Remove and
trim the matrix ensuring that contact
with the land area of the definitive
cast is maintained. Remove the den-
ture teeth from the wax trial denture
and insert them into the matrix. Posi-
tion the matrix on the definitive cast
Balch et al
to visualize the relative relationship
between the edentulous ridge and the
denture teeth (Fig. 1). Though less
satisfactory, alternatively use a stone
or putty matrix that captures the den-
ture teeth and indexes the land area
of the cast.
4. Duplicate the edentulous de-
finitive cast to serve as a design cast
for framework fabrication. Draw the
framework design (Fig. 2) on this cast
giving due consideration to frenal at-
tachments, undercut areas, and avail-
able space. Use the clear acrylic resin
matrix to aid in determining available
space when designing the framework.
5. Drill at least three 3-mm deep,
widely spaced, parallel holes in the
definitive cast through the crest of
the edentulous ridge with a 1.4-mm
diameter twist drill (ParaPost XP End-
odontic Post System, Casting Tech-
nique - Purple; Coltène Whaledent Inc,
Mahwah, NJ). The use of an adjustable
survey table to orient and secure the
definitive cast on the work platform
of a standard drill press will ensure the
creation of parallel holes (Fig. 3).
6. Prepare individual post pat-
terns for each of the holes drilled
in the definitive cast. Section a 1.4-
mm diameter, smooth, parallel-sided
post casting pattern (ParaPost XP
Endodontic Post System, Casting
Technique - Purple; Coltène Whale-
dent Inc) 6 to 8 mm long and flatten
or nail head one end of each pattern
with a heated waxing instrument.
Insert the unaltered end of the pat-
terns into the holes in the definitive
cast (Fig. 4). Note that these post
patterns will eventually be incorpo-
204 Volume 109 Issue 3

5 Refractory cast with post patterns. Note elevated 6 Clear matrix positioned on refractory cast to evaluate re-
relief from crest of ridge. Framework design has been storative space and modify tooth or wax pattern as needed.
transferred to refractory cast so that wax pattern can be Sufficient retentive and supportive elements have been in-
developed. corporated in framework design, respecting available space.

7 Framework is returned to definitive cast. Metal posts
accurately fit into holes prepared on definitive cast. Metal
posts elevate framework 1 mm above crest of ridge and
maintain framework’s location within denture base and
stability of framework during final denture fabrication.
8 Denture processed unilaterally to demonstrate frame-
work suspension within acrylic resin. Metal posts can be
finished level with acrylic resin as shown here or recessed
and backfilled with autopolymerizing denture base repair
resin.

rated into the framework pattern in
preparation for casting.
7. Provide a dental laboratory
technician with the design cast, de-
finitive cast, modified post patterns,
clear matrix with denture teeth, and
properly executed work authoriza-
tion. Prepare the work authorization
to prescribe at least 1-mm relief under
the framework’s strut or mesh acrylic
resin retentive elements.
8. Apply 20 gauge (1-mm thick)
relief wax sheet material (20-gauge
Adhesive Coated Pressure Sensitive
Relief Wax; Lincoln Dental Supply,
Cherry Hill, NJ) over the edentulous
ridge. Position the modified post pat-
terns through the relief wax and into
The Journal of Prosthetic Dentistry
the holes prepared in the cast. Pick up
the nail-headed post patterns, extend-
ing from the definitive cast through
the relief wax, in the impression mate-
rial used for cast duplication. Trans-
fer the post patterns to the refractory
cast (Fig. 5).
9. Complete the framework wax-
ing by incorporating the post patterns
within the framework pattern. Use the
clear denture tooth matrix to adjust the
ridge lap portion of the teeth and/or al-
ter the framework as needed to manage
available space (Fig. 6). Incorporate
sufficient retentive and supportive ele-
ments in the framework design.
10. Invest, burn out, cast, recover,
fit, and finish the framework. Re-
turn the framework to the definitive
cast. Note that the accurate fit of the
framework’s metal posts in the holes
prepared in the cast is critical to the
location of the framework within the
denture base and its stability dur-
ing final denture fabrication (Fig. 7).
Replace the denture teeth over the
framework onto the definitive cast by
using the clear matrix to guide den-
ture tooth positions. Rewax the den-
ture base contours.
11. Return the definitive cast to
the articulator. Refine the tooth posi-
tions to reestablish the desired occlu-
sal scheme. Refine the denture base
contour waxing and invest the den-
ture. Note that if adhesive bonding is
Balch et al
March 2013
desired (Rocatec Universal Bonding
System; 3M/ESPE, St Paul, Minn), the
framework is easily retrieved from the
flasked definitive cast after wax elimi-
nation for required metal preparation.
12. After denture processing, ac-
complish laboratory remount pro-
cedures and recover the denture
from the definitive cast. Remove the
metal support posts from the frame-
work with a metal cutting bur (H129.
UM.104.023; Komet USA, Rock Hill,
SC). Finish this metal flush with the
acrylic resin intaglio surface or recess
the metal into the denture base and
backfill with autopolymerizing denture
base repair resin (Lucitone 199 Repair
Resin; Dentsply Intl, Inc, York, Pa). Fin-
ish and polish the denture in prepara-
tion for clinical placement (Fig. 8).
DISCUSSION
The internally suspended metal
framework as described here is indi-
cated for mandibular complete den-
ture reinforcement when adequate re-
storative space is available to permit
1-mm relief of the framework from
the definitive cast. One study dem-
onstrated that mandibular complete
denture fractures decreased following
internal metal reinforcement as long
as adequate bulk of acrylic resin was
present.17 If sections of the denture
above the internally suspended frame-
work are too thin for adequate thick-
ness of acrylic resin, then the man-
dibular complete denture’s cameo
surface can be modified and finished
in metal so that strength is not com-
promised. The internally suspended
framework is also indicated when
Balch et al
edentulous ridge contours are irregu-
lar or significantly compromised, be-
cause all denture base adjustments
remain in acrylic resin rather than
metal. This framework design has the
added advantages of retrievability
from the flask for metal bond proce-
dures before compression molding
and good framework stability during
processing. Additionally, the internal-
ly suspended metal framework is in-
dicated for implant overdentures and
can be readily designed to accommo-
date individual attachments or bar
attachments. A disadvantage to this
or any complete denture reinforcing
framework is the added expense of
the prosthesis for the patient.
SUMMARY
This article details a method for
fabricating and internally suspend-
ing a metal framework in the denture
base of a conventional mandibular
complete denture. Procedures for
flasking and processing the defini-
tive prosthesis are similar to those
for nonreinforced complete dentures.
Metal-resin bonding procedures are
easily incorporated into the described
technique if desired. The processes
described are readily adapted to
natural tooth- or implant-supported
overdentures when indicated.
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Corresponding author:
Dr J. Heath Balch
1060 Highland Place Way, Suite 102
Knoxville, TN 37919
E-mail: jbalch1@gmail.com
Copyright © 2013 by the Editorial Council for
The Journal of Prosthetic Dentistry.