Advertisement
Journal of Prosthetic Dentistry

Reinforcement of an interim fixed prosthesis with a denture metal mesh

Published:September 29, 2020DOI:https://doi.org/10.1016/j.prosdent.2020.07.016
      Long-term interim fixed prostheses play a critical role in the success of extensive prosthodontic rehabilitations. They allow assessment of esthetics, phonetics, masticatory function, newly established vertical dimension of occlusion, and proper occlusal scheme before fabrication of the definitive restorations. Furthermore, fixed interim restorations protect implants or tissue grafts during the osseointegration phase.
      • Frederick D.R.
      The provisional fixed partial denture.
      Fracture is the most common problem associated with interim fixed prostheses, especially in patients with parafunctional habits or in long span restorations. Repairing and replacing fractured interim restorations is inconvenient because of the additional cost and time associated with these complications.
      • Burns D.R.
      • Beck D.A.
      • Nelson S.K.
      A review of selected dental literature on contemporary provisional fixed prosthodontic treatment: Report of the Committee on Research in Fixed Prosthodontics of the Academy of Fixed Prosthodontics.
      Techniques and materials for reinforcement of interim restorations have been reported, including metal wires, stainless steel orthodontic bands,
      • Hazeiton L.R.
      • Brudvik J.S.
      A new procedure to reinforce fixed provisional restorations.
      lingually placed metal castings,
      • Bluche L.R.
      • Bluche P.F.
      • Morgano S.M.
      Provisional fixed prosthesis reinforced with a metal casting.
      and heat-processed acrylic resin with cast metal reinforcement,
      • Galindo D.
      • Soltys J.L.
      • Graser G.N.
      Long-term reinforced fixed provisional restorations.
      in addition to different types of fibers such as plasma-treated woven polyethylene
      • Ashkan Samadzadeh A.
      • Kugel G.
      • Hurley E.
      • Aboushala A.
      Fracture strengths of provisional restorations reinforced with plasma-treated woven polyethylene fiber.
      and silane-impregnated glass,
      • Hammond B.D.
      • Hodd J.A.
      Fiber-reinforced interim fixed dental prostheses: A clinical protocol.
      ,
      • Pfeiffer P.
      • Grube L.
      In vitro resistance of reinforced interim fixed partial dentures.
      and silica nanoparticles reinforcement.
      • Topouzia M.
      • Kontonasakia E.
      • Bikiarisb D.
      • Papadopoulouc L.
      • Konstantinos M.
      • Paraskevopoulosd K.M.
      • et al.
      Reinforcement of a PMMA resin for interim fixed prostheses with silica nanoparticles.
      However, they are relatively expensive and may require additional laboratory procedures that increase the complexity of fabricating the interim restoration.
      This article describes a straightforward, cost-effective, chairside technique for fabrication of reinforced interim fixed prosthesis with an embedded denture metal mesh, as used to increase the fracture resistance of maxillary complete dentures.
      • Im S.M.
      • Huh Y.H.
      • Cho L.R.
      • Park C.J.
      Comparison of the fracture resistances of glass fiber mesh-and metal mesh-reinforced maxillary complete denture under dynamic fatigue loading.
      The mesh is made of interlaced wire structure that provides resin interlocking and micromechanical retention; therefore, it can be used with different types of materials including polymethyl methacrylate (PMMA) and bis-acryl resins. In addition, it increases the fracture toughness of the prosthesis by resisting occlusal forces and crack propagation.
      • Im S.M.
      • Huh Y.H.
      • Cho L.R.
      • Park C.J.
      Comparison of the fracture resistances of glass fiber mesh-and metal mesh-reinforced maxillary complete denture under dynamic fatigue loading.
      Moreover, it prevents catastrophic failure and complete separation of segments, leaving a fractured restoration connected. This technique is indicated for posterior interim fixed prostheses, where esthetics are not of a major concern.
      The procedure is illustrated for a patient with a history of parafunctional habits and a complete-mouth rehabilitation with an increased occlusal vertical dimension. The complete-arch interim restorations were made in 3 segments. The posterior right segment was delivered as an interim fixed partial denture from second molar to first premolar with the second premolar as a pontic. The prepared abutment teeth provided 1.5 to 2.0 mm occlusal clearance (Fig. 1). The thickness of the metal mesh used is about 0.5 mm.
      Figure thumbnail gr1
      Figure 1Prepared abutment teeth providing 1.5-2.0 mm occlusal clearance at increased occlusal vertical dimension.
      Figure thumbnail gr2
      Figure 2A, Matrix made on duplicate cast of diagnostic waxing. B, Adjusted mesh placed into matrix. C, Mesh seated into single layer of bis-acryl resin in matrix. D, Matrix filled with bis-acryl resin.
      Figure thumbnail gr3
      Figure 3A, Finished and polished interim prosthesis. B, Cemented mesh-reinforced interim fixed prosthesis.

      Technique

      • 1.
        Make a matrix for the quadrant to be treated with polyvinyl siloxane impression material (Aquasil Ultra Xtra and Reprosil Quixx Putty; Dentsply Sirona) with the putty and wash impression technique on a duplicate cast of the diagnostic waxing. Include the adjacent teeth in the impression to reposition the matrix accurately (Fig. 2A).
      • 3.
        Measure the mesiodistal and the buccolingual span length of the teeth to be restored. Cut a small piece of the stainless-steel wire mesh (Wire Mesh, Stainless Steel, Medium-Fine, 6" x 6"; Keystone Industries) with sharp scissors. Trim the mesh to fit into the occlusal portion of the matrix and to extend across the occlusal surfaces of all abutment teeth, including the pontic, thus reinforcing the entire span of the interim prosthesis (Fig. 2B).
      • 4.
        Block out undercuts on adjacent teeth with wax. Dispense a single layer of bis-acryl resin (Protemp Plus; 3M) into the matrix and then quickly seat the mesh into the bis-acryl resin (Fig. 2C). It is essential to have the mesh seated into the occlusal portion of the matrix to avoid the possibility of exposure on the buccal or lingual surfaces. If the mesh is attached intraorally to the occlusal surface of the abutment teeth, the matrix might displace the mesh during seating.
      • 5.
        Fill the remaining of the matrix with bis-acryl resin and seat it intraorally over the prepared teeth (Fig. 2D). Remove the matrix from the mouth after the initial polymerization and allow for complete polymerization following the manufacturer’s instructions.
      • 6.
        Finish and polish the interim prosthesis. If the metal edges are exposed in the interproximal embrasures of the prosthesis, trim the edges with an E-cutter carbide bur (H261E.11.023 HP; Brasseler USA), and then, overlay with flowable composite (Filtek Supreme Ultra; 3M) to mask the metal display (Fig. 3A).
      • 7.
        Cement the interim prosthesis with an interim luting agent (Cling2; Clinician’s Choice), following the conventional technique (Fig. 3B).

      References

        • Frederick D.R.
        The provisional fixed partial denture.
        J Prosthet Dent. 1975; 34: 520-525
        • Burns D.R.
        • Beck D.A.
        • Nelson S.K.
        A review of selected dental literature on contemporary provisional fixed prosthodontic treatment: Report of the Committee on Research in Fixed Prosthodontics of the Academy of Fixed Prosthodontics.
        J Prosthet Dent. 2003; 90: 474-497
        • Hazeiton L.R.
        • Brudvik J.S.
        A new procedure to reinforce fixed provisional restorations.
        J Prosthet Dent. 1995; 74: 110-113
        • Bluche L.R.
        • Bluche P.F.
        • Morgano S.M.
        Provisional fixed prosthesis reinforced with a metal casting.
        J Prosthet Dent. 1997; 77: 634-635
        • Galindo D.
        • Soltys J.L.
        • Graser G.N.
        Long-term reinforced fixed provisional restorations.
        J Prosthet Dent. 1998; 79: 698-701
        • Ashkan Samadzadeh A.
        • Kugel G.
        • Hurley E.
        • Aboushala A.
        Fracture strengths of provisional restorations reinforced with plasma-treated woven polyethylene fiber.
        J Prosthet Dent. 1997; 78: 447-450
        • Hammond B.D.
        • Hodd J.A.
        Fiber-reinforced interim fixed dental prostheses: A clinical protocol.
        J Prosthet Dent. 2016; 116: 496-500
        • Pfeiffer P.
        • Grube L.
        In vitro resistance of reinforced interim fixed partial dentures.
        J Prosthet Dent. 2003; 89: 170-174
        • Topouzia M.
        • Kontonasakia E.
        • Bikiarisb D.
        • Papadopoulouc L.
        • Konstantinos M.
        • Paraskevopoulosd K.M.
        • et al.
        Reinforcement of a PMMA resin for interim fixed prostheses with silica nanoparticles.
        J Mech Behav Biomed Mater. 2017; 69: 213-222
        • Im S.M.
        • Huh Y.H.
        • Cho L.R.
        • Park C.J.
        Comparison of the fracture resistances of glass fiber mesh-and metal mesh-reinforced maxillary complete denture under dynamic fatigue loading.
        J Adv Prosthodont. 2017; 9: 22-30