REMOVABLE PROSTHODONTICS

SECTION EDITORS
LOUIS BLATTERFEIN S. HOWARD PAYNE GEORGE A. ZARB

An analysis of causes of fracture of

acrylic resin dentures
M.S. Beyli, Ph.D., Dr.Med. Dent., M.Sc., D. D. S.,* and J. A. von Fraunhofer, Ph.D., M.Sc. **
University of Istanbul, School of Dentistry, Istanbul, Turkey, and University of Louisville, School of Dentistry,
Louisville, Ky.

T he fracture of acrylic resin dentures is an unre-

solved problern in removable prosthodontics despite
maxillary denture, deformation causes extension at
the posterior palate and both extension and com-
numerous attempts to determine its causes. Despite pression at the anterior palate. There is no deforma-
the high frequency of denture fracture, there is tion in the anteroposterior plane, but the buccal
suprisingly little discussion of the subject in the flange tends to move away from the mucosa, and
literature. There is virtually no published data on there is compression at the labial flange. If the
the incidence of fracture except for that of Har- posterior teeth are set over the buccal slope of the
greaves who reported a survey performed at a dental ridge, there is rotation of the base around the crest of
school in Scotland. the ridge and consequent downward movement of
This lack of data is surprising until attempts are the posterior palatal contour at the midline.
made to elicit information on repairs as related to the In function, the strain of masticatory forces is
volume of dentures processed from dental laborato- carried by the part of the ridge closest to the point of
ries. In a survey performed by the authors in Lou- application due to the denture base elasticity.
isville, Kentu.cky, some 20 laboratories specializing Localized strain will traumatize the supporting tis-
in denture construction and repair were consulted sues and cause deformation and/or displacement of
for data on the incidence of fracture and repair. Of the denture base. It has been reported, for example,
the 20 laboratories, 14 provided useful information that the degree of mucosal ulceration is a function of
and only one laboratory indicated the number of denture base deformation, with tooth design being
dentures fabricated each week. Data compiled in this an additional factor. Denture base deformation is
survey are summarized in Table I, and it is clear that also considered to be a contributing factor in ridge
while specific data are unobtainable, certain general resorption, with acrylic resin bases exhibiting a
trends are apparent. Typically, the ratio of upper to lateral deformation some 8.5 times greater than that
lower denture fractures is about 2:1, with the most of metal bases., 6 Denture base deformation, howev-
common causes of fracture appearing to be poor fit er, is affected by the anatomy of the supporting
and lack of balanced occlusion. Fractures or repairs tissues, with high ridge bases exhibiting torsional
of removable partial dentures have not been deformation and compression (inward movement)
included since these most often involve replacement occurring with flat ridges.fi
of missing teeth or clasps. Nevertheless, the trend is Denture base deformation is also affected by
that about equal numbers of removable partial and occlusal design, with the horizontal deformation
complete dentures are repaired, although the nature increasing with cusp angle during mastication;
of the repairs obviously differ. occlusal surface area has little effect on deforma-
tion7. 8 Base deformation has been found to occur
DENTURE DEFORMATION IN FUNCTION during deglutition, with the duration of deformation
Deformation and/or movement of the denture being some 3.6 times longer than that during masti-
during function will affect both the supporting cation.
tissues and the denture base itself. Typically, in the
STRESS WITHIN THE DENTURE
Stress distribution within dentures has been stud-
*Associate Professor, Department of Removable Prosthodontics. ied by many investigators using a variety of tech-
**Professor of Biomaterials Science. niques and theoretic models. It has been established

238 SEPTEMBER 1981 VOLUME 46 NUMBER 3 0022-3913/81/090238 + 04$00.40/00 1981 The C. V. Mosby Co.
CAUSES OF FRACTURE

Table I. Data on denture repair survey

Laboratory Number of Ratio of

Code size* repairs per month uppersdowers Ratio of complete:partial Suggested cause of fracture

S Approximately 20 2:l NAt Poor fit; poor occlusion

S 12 3:l NAt Poor fit; dropping
M 4-6 2-3:l Mainly complete Poor fit
M 60-80 1:l Mainly complete Poor fit
L 25-50 NAt 1:l Poor fit; material breakdown with age
L 20 Mainly uppers Mainly complete Poor fit; dropping
(5 fractures per 400 cases each week)
G M 24-32 1:l 1:l Dropping
H M Low 1:l NAt Poor fit
I L 100-125 1:l Mainly complete Poor fit
J M l-2 Mainly lowers Mainly partial Poor fit
K S 20 Mainly uppers 9:l Poor occlusion
L L NAt 1:l NAt Dropping
M S 12-16 Mainly lowers 1:l Dropping
N M 20 1:l 1:l Poor fit; dropping
0 M 40 9:l 1:l Poor fit; material breakdown

*S, 1 to 5 technicians; M, 5 to 10; L, more than 10. Approximate sizing only.

TNA: Not available.

that maxillary dentures are subjected to bending changes in the supporting tissues. iDuring service,
deformation, with tensile stresses occurring at the dentures absorb water and saliva; over the initial
labial aspect and lingually to the incisors on the 3-months immersion, there is a linear dimensional
polished surfaces. The area lingual to the incisors is change of about 0.3% in the flange-to-flange dimen-
the most heavily stressed and, clearly, the incisal sions. This will clearly affect deformation under
notch represents a point of weakness in that it might loading, while long-term water sorption will lower
act as a stress raiser and so contribute to midline the fatigue resistance of the acrylic resin.
fracture of maxillary dentures. Changes in the occlusal design have been shown to
Photoelastic stress analysis has indicated that affect base deformation and tooth wear. This ulti-
compressive stresses occur in the maxillary base mately leads to occlusal imbalance, and will have an
adjacent to the supporting tissues, with tensile effect on functional deformation. Wear of teeth can
stresses elsewhere, although the stress distribution occur when natural or porcelain teeth oppose acrylic
will be altered by changes in the denture design or resin teeth and in patients with heavy occlusion or
reinforcement of the base., I2 Detailed photostress abrasive diets. Such wear affects the occlusal balance
analysis indicated that compressive stresses occurred and predisposes the denture base to fracture. Long-
toward the tissue surface, with greater values term changes in the supporting tissues, notably
beneath the teeth and on the ridge than those toward resorption of the ridge,- will also affect deforma-
the palate., lR The stress distribution will be tion of the denture base during function.
affected by functional loading, with the lowest Midline fracture of a denture base is a flexural
stresses occurring at the maxillary midline and stress fatigue failure,2l resulting from cyclic d.eformation of
increasing from the anterior to the posterior region the base during function. Any factor that exacer-
over the ridge, with maximum stress occurring in the bates deformation of the base or alters its stress
molar region in centric occlusion. In protusion, distribution will predispose the denture to fracture.
stresses shift anteriorly. The findings suggest that Fracture, however, is the result of the initiation and
changes in the loading conditions or modification of propagation of a crack, and this requires the pre-
the occlusal scheme will alter the pattern of stress sence of a stress raiser or point of loca.iized stress.
distribution., I4 Sharp changes in contour, pin holes, inclusions,
deep scratches, and residual processing stresses may
MIDLINE FRACTURE OF DENTURES all cause stress intensification. A survey of denture
While denture bases deform under loading, this fractures, however, has indicated that most failures
deformation may be exacerbated by other factors occurred when there was deep notching at the
such as changes in the denture base, tooth wear, and midline labial frenum. This supports the contention

THE JOURNAL OF PROSTHETIC DENTISTRY 239

 BEYLI AND van FRAUNHOFER

that the incisal notch is the most important causative terms. Many midline fractures can be avoided by the
factor in midline fracture and that cracks initiate at application of established prosthodontic principles
the tip of the notch where there is high local stress in constructing and maintaining dentures. Improve-
concentration.. ments in the resins and processing techniques can
also reduce the incidence of midline fracture. The
PREVENTIOn; OF MIDLINE FRACTURE
most promising approach to preventing or reducing
Various approaches can help reduce the incidence the incidence of this problem appears to be reinforce-
of midline fracture of denture bases. A good process- ment in the anterior part of the palate of the
ing technique .which reduces or eliminates residual denture.
stress within the denture and avoids surface defects
and inclusions is essential. Using higher strength REFERENCES
polymers, notably impact-resistant materials, will 1. Hargreaves A. S.: The prevalence of fractured dentures, a
reduce the tendency to fracture. (Laboratories using survey. Br Dent J 126:451, 1969.
this type of material all reported a low incidence of 2. Kapur, K. K., Soman, S., and Stone, K.: The effect of
denture factors on masticatory performance. I: Influence of
fractures in the survey.) Constructing dentures with denture base extension. J PROSTHET DENT 15:54, 1965.
metal palates for patients with heavy occlusions has 3. Kapur, K. K., Soman, S., and Stone, K.: The effect of
the dual advantage of providing greater strength and denture factors on masticatory performance. II: Influence of
better thermal stimulation of the underlying muco- the polished surface contour of the denture base. J PROSTHET
DENT 15:231, 1965.
sa. Excessive wear of the teeth can predispose the
4. Schultz, A. W.: Comfort and chewing efficiency in dentures.
denture to fracture, but other factors are probably J PROSTHET DENT 1:38, 1951.
more significant. The use of occlusal checks and 5. Lambrecht, J. R., and Kydd, W. L.: A functional stress
inserts, which help reduce tooth wear, can have analysis of the maxillary complete denture base. J PROSTHET
deleterious effects on the opposing teeth as well as on DENT 12:865, 1962.
6. Koivuma, K. K.: On the properties of flexible dentures: A
the supporting tissues.
theoretical and experimental survey. Acta Odontol Stand
The incisal notch constitutes a point of weakness 16:159, 1958.
and a possible stress raiser and crack-initiation point. 7. Smith, D. E., Kydd, W. L., Wykhins, W. A., and Phillips,
Palatal relief in the anterior portion of the palate has L. A.: The mobility of artificial dentures during comminu-
been suggested as a means of reducing excess loads tion. J PROSTHET DENT 13:839, 1963.
over the median palatine suture.2 Avoiding deep 8. Boucher, C. 0.: Studies of the displacement of tissues under
dentures. J Am Dent Assoc 27:1476, 1940.
incisal spaces and increasing the bulk of base mate-
9. Kydd, W. L.: Comminuting efficiency of varied occlusal
rial in areas most subject to deformation (palatal to tooth form and the associated deformation of a complete
the incisors) reduces the possibility of midline frac- denture base. J Am Dent Assoc 61:465, 1960.
ture. Reducing the need for a deep frenal notch by a 10. Swoope, C. C., and Kydd, W. L.: The effect of cusp form and
frenectomy will be beneficial, although the area occlusal surface area on denture base deformation. J PROS-
THET DENT 16:34, 1966.
available where the base thickness can be increased is 11. Mathews, E., and Wain, E. A.: Stresses in denture bases. Br
limited. Increased base thickness in the anterior Dent J 100:167, 1956.
region beyond clinically acceptable limits reduces 12. Kubota, H.: The relation between the position of artificial
the tongue space and affects speech. Placing a thin teeth and the alveolar crest in dentures. Shiwa Gakuho
beading around a heavy labial frenum to improve 59:377, 1959.
13. Klotzer, V. W.: Spannungsoptische Festigkeitsuntersu-
the seal* has a strengthening effect and leads to chungen einiger Prosthesentypen. Dtsch Zahnaerztl Z
improved stress distribution. This approach is 19:375, 1964.
acceptable for labially inclined ridges but not for 14. Klotzer, V. W.: Uber polarizationsoptische Untersuchungen
those that are lingually inclined. Setting maxillary on Prosthesen Modellkorpen. Dtsch Zahnaerztl Z 21:894,
central incisors too far palatally should be avoided 1966.
15. Koran, A., and Craig, R. G.: Three-dimensional photoelastic
since, with c:orrect labial positioning, the amount of stress analysis of maxillary and mandibular dentures. J Oral
acrylic resin in the gingival portion of the midline Rehab 1:361, 1974.
and in areas lingual to it will be increased and thus 16. Tallgren, A.: Reduction in face height of edentulous and
strengthen the base at its weakest point. partially edentulous subjects during long-term denture wear:
A longitudinal roentgenographic and cephalometric study.
SUMMARY Acta Odontol Stand 24:195, 1966.
17. Craig, R. G., Farah, J. W., and El-Tahawi, H. M.: Three-
The causes of midline fracture of dentures are dimensional photoelastic stress analysis of maxillary com-
discussed in both clinical and materials science plete dentures. J PROSTHET DENT 31:122, 1974.

240 SEPTEMBER 1981 VOLUME 46 NUMBER 3

CAUSES OF FRACTURE
18. Woelfel, J. B., and Paffenbarger, G. C.: Methods of evaluat-
ing the clinical effects of warping of a denture: Report of a
case. J Am Dent Assoc 59:250, 1959.
19. Campbell, R. L.: A comparative study of the resorption of
the alveolar ridges in denture wearers and nondenture
wearers. J Am Dent Assoc 60:143, 1960.
20. Jozefowicz, W.: The influence of wearing dentures on
residual ridges. J PROSTHETDENT 24:137, 1970.
21. Tallgren, A.: The continuing reduction of the residual
alveolar ridges in complete denture wearers: A mixed
longitudinal study covering 25 years. J PROSTHET DENT
27:120, 1972.
IADR PROSTHODONTIC ABSTRACT
Effect of occlusal adjustment on bruxism as monitored
recordings
J. 0. Bailey, Jr., and J. D. Rugh
University of Texas, Dental School, San Antonio, Texas
Although occlusal adjustment is routinely advo-
cated as a treatment for bruxism, little investigative
work has been done to study the effect of this
treatment. Nocturnal masseter EMG recordings in
the natural environment have been utilized to study
the effects of stress, occlusal splints, and drugs on
bruxism. This method was used in this study to
evaluate the effects of occlusal adjustment on noctur-
nal bruxism
Nine patients seeking treatment for bruxism and/or
its suspected sequelae were monitored before, during,
and after occlusal adjustment. Unilateral masseter
Reprinted from the Journal of Dental Research (59 (Special IssueA),
1980(Abst No. 199)] with permission of the author and the editor.
THE JOURNAL OF PROSTHETIC DENTISTRY
22. Boucher, C. O., Hickey, J. C., and Zar b, G. A.: Prosthodon-
tic Treatment for Edentulous Patients, ed 7. St Louis, 1975,
The C. V. hlosby Co. p 116.
Reprint requeststo:
DR. J. A. vm FRAUNHOFER
UNIVERSITY OF LOUlSVILLE
SCHOOL OF DENTISTRY
L~ISVILLE, KY 40232
by nocturnal EMG
EMG activity greater than 20 uv ptp was cumulative-
ly integrated and stpred during each nights sleep
period. After base line data were established, occlusal
adjustment was performed in two appointments, 1
week apart. Following treatment, additional data
were recorded for two weeks.
Under the assumption that masseter EMG activity
is a measure of bruxism, no consistent effects from
occlusal adjustment were noted. Six subjects showed
no effect, two showed an increase, and one subject
showed a decrease in EMG activity. A tentative
conclusion may be reached that the after, reported
positive effects of occlusal adjustment on l:he symp-
toms attributed to bruxism do not come from a
reduction in the bruxism itself.
241