CLINICAL SCIENCE Titanium Palate Maxillary Overdenture: A Clinical Report Gene C. Stevenson, DDS,* and Mark E. Connelh, DDSf A clinical technique of using a cast titanium base in a maxillary overdenture for a patient with bruxism who has a history of repeated midline denture fractures is presented. The advantages of a metal palate and the favorable properties of titanium are discussed. This treatment provides the practitioner with a practical option for successfully treating difficult overdenture or conventional denture patients. J Prosthod 1:57-60. Copyright o 1992 by the American College of Prosthodontists.
INDEX WORDS: titanium. overdenture he unique biocompatible and hypoallergenic properties of titanium have led to a recent surge of popularity in the use of this metal in restorative dentistry. Titanium is light, strong, noncorrosive, has no metallic taste, and has low thermal conductivity. Titanium casting technology has overcome inherent casting problems and is reasonably economical and practical for applications in dentistry.'J In addition to its well-known use for many years in endosseous implant^,^,^ a number ofcomniercial dental laboratories are now providing titanium porcelain-fused-tometal restorations and removable partial denture frameworks.j" Reports of titanium use in metalbased complete dentures are limited. Japanese studies"" have shown that titanium-based complete dentures possessed superior properties in comparison with acrylic resin and cast base mctal alloy bases; titanium bases are lighter, stronger, and can be made thinner, and fit the palatal mucosa more intimately. A review of the literature revealed no published report citing the use of-titanium in an overdenture. This clinical report describes the treatment of a 70-year-old man with a titanium palate maxillary overdenture.
T
Front the Depaltment qRernouablc Prosthodontics, b'niniaersasz$OJ l k l c o ~ Health Sciencp Center at Hmrton, Dental Branch. *Pro,rfhndoaticRP.n'dmt. f h m i a t e PrqfiJsor and Chairman. Address re,bnnt requests to: Gene C. Stevenson, DDS, Departrneni qf Rmriouable Prosthorluntics, Uniomi!y of Texm Health Saence Centv a! Hot&m. Ilmtal Branch, P.0.Box 20068, Howlon, TX 77225. C o b ~ g h0 t 1992hy th American College ifProsthodontiJts 10.59-941X/9210101-001lS.5.00
Clinical Report The patient had five endodontically treated overdenture abutment teeth: Three in the maxilla (nos. 8, 11, and 15) and two in the mandible (nos. 22 and 27). The patient was a bruxer with active, strong and vigorous masticatory muscles and he showed an unusually extended range of mandibular motion whilc bruxing. The patient had worn a mandibular overdenturc for several years. It was originally fabricated to oppose natural maxillary dentition. A maxillary immediate overdcnturc was placed 1% years ago, prompted by thc extraction of multiple unrestorable maxillary teeth. O n his initial examination, the patient had been wearing his second maxillary overdenture and a new mandibular overdcnture for 1 year. The dentures were clinically acceptable, had adequate peripheral seal, sufficient retention and stability, correct vertical dimension of occlusion, and were in bilateral balanced occlusal scheme. However, the maxillary denture was a prosthodontic failure because of repeated anterior midline fractures. Both maxillary dcnturcs developed similar fractures within several days after placement. Despite repeated repairs of thc denture and occlusal adjustments, cracking and fracture continued to occur (Fig 1). Fractures of overdcnturc bases are often seen when the height and contours of the abutment roots are not continuously modified to keep pace with the changes in the soft tissue. The rate of fracture is exacerbated by parafunctional habits, such as bruxism, The root should be a rounded dome 1.0 to 2.0 mm in height.'*J3 Periodic evaluations should be made with pressure indicating paste to ensure that the denture base does not contact the roots except when functional occlusal loads are applied. If the
Journal ofPoJthodontm, 1701 I , A1o I (September),1992:pp 57-60
57
58
Cast Titanium Rase Maxillaly Omnienture
Stevenson and Conlwlh
Figure 1. Original maxillary overdenture. The patient’s
Figure 3. Completed rriaxillary overdenture, occlusal
bruxing habit overstressed the denture base, prducing rnidline fractures lingual to the anterior teeth. Fractures in the palate continued to reoccur in spite of repeated occlusal adjustments and numerous denture base resin repairs, including the use of a wire mesh.
surface. Labial and buccal borders are in denture base resin.
Figure 2. Titanium casting fitted on the master cast. Retention beads enhance retention of acrylic resin to denture base. Adequate relief of the palatal base over each abut nient tooth allows for post placement adjus tm r nts to he made in denture base resin.
Figure 4. Completed maxillary overdenture, tissue sur-
denture “settlcs” and begins to bind on a root, a fulcrum is established and torquing of the dcnturc will then be inevitable. will o ~ c u r . ~Fractures ’J~ Flexural fatigue of a maxillary denture base caused by cyclic dcformation during function will result in a rnidline fracture of the base.l5,l6The area of the denture most subject to deformation is lingual to the incisors.l6Construction ofdentureswith metal
face. Note the presence of ac:r)-lic resin over the abutment teeth to facilitate postplacenient adjustments.
palates for patients with heavy occlusal loading can help reduce the incidence of midline fracture of denture bases.lj,’GSome dciitists regard the prognosis to be guarded for denture patients having such serious complications as bruxism or strong musculature due to the strcsses on thc supporting structures under the dentures.” However, lhe presence of overdenture abutment teeth in an arch will increase the stability and support of a complete denture and reduce the forces of occlusion to the supporting
59
September 1992, Volume I , Number 1
tissue.12,1",18 Successful management of such patients requires the construction of a denture possessing suffrcient strength and stabilized occlusion based on sound prosthodontic principles.15%1!'
Technique A preliminary impression of the maxilla was made with a stock tray and irreversible hydrocolloid. A custom acrylic resin tray was made from the preliminary cast and was border molded intraorally with modeling plastic. The final impression was made with Yermlastic polysulfide impression material (Kerr Manufacturing Co., Romulus, MI). The master cast was prepared and the posterior palatal seal area was identified and carved into the cast. The design ofthe metal base was drawn on the master cast. Relief and metal struts were planned over each abutment tooth to allow for denture base resin to be processed in these areas to facilitate any future adjustments over the abutment teeth. First, the titanium palate was fabricated and fitted to the master cast (Fig 2). The wax pattern was formed on a refractory cast, invested, and cast in pure titanium in a Castmatic-S titanium casting system (Iwatani Corp., Osaka, Japan).* This system uses an electric arc to melt the titanium in an argon gas atmosphere and forces the melt into the casting ring by means of positive pressure. Pure titanium dental castings have properties similar to type IV gold a1loys.l Retention beads were used to enhance retention of the acrylic resin to the metal base, To further enhance the adherence of the denture base resin to the metal, the retention areas of the casting werc Silicoated (silica coating, Kulzer Inc., Irvinc, CA) . Maxillomandibular records werc obtained, teeth selected, and a trial set-up was completed directly on the titanium base. The denture was processed in Lucitone 199 denture base resin (Dentsply International, Inc., York, PA) (Figs 3 and 4). A lingualized, bilateral balanced occlusal scheme was selected to provide stability of the denture. When the denture was placed, pressure indicating paste was used to cvaluate and corrcct the fi1.I"
maxillary overdenture. There has been no fracture recurrence in the palate since placement. With overdenture therapy, the advantages of retained teeth are increased support and stability for a complete denture, the maintenance of proprioceptive guidance by the periodontal ligaments, and the preservation of alveolar bone by retained roots."'.'" Meticulous home care and daily use of fluoride gel on the retained abutment teeth are necessary to reduce caries susceptibility. According t o Boucher,'2 the principal advantages of conventional maxillary metal denture bases are (1) better thermal conductivity, (2) increased tissue tolerance, (3) reduced bulk across the palate which creates more tongue space, and (4) increased accuracy of fit. Disadvantages are (1) increased restorative cost, (2) difficulty of rebasing, (3) less margin of error in the posterior palatal seal, and (4) increased weight for a maxillary denture. The use of titanium enhances all the advantages of metal denture bases and offsets or eliminates the disadvantages. Titanium-based dentures weigh substantially less than conventional resin dentures." Laboratory costs are only slightly greater than for conventional metal-based dentures. With new and improved techniques of bonding resins to metal, such as Kulzer's Silicoater s y ~ t e m , ~the ~ - ~Espe * RocatecSystem (Espe-Premier Sales Corporation, Norristown, PA)25,2fiand 4-META adhesive resin (Preat Corporation, San Mateo, CA)27,2tJ; relining, rebasing, and adding denture base material to metal bases are viable treatment options.*""I The metal-resin interface is chemically bonded and is impervious to separation and m i ~ r o l e a k a g e . ~ ~When , ~ ~ , "the ' technical factors listed above are considered in conjunction with the remarkable biocompatibility of the material, titanium represents state of the art in dental technology and may become the material of choice for metal denture bases.
Conclusion A clinical technique for fabricating a titanium palate
Discussion
maxillary overdenture is described. This treatment does not require any changes in clinical techniques and provides the practitioner with a practical option for successfully treating difficult overdenture or conventional denture patients.
The patient readily accepted his new dentures and has been functioning well with the titanium-based
Acknowledgment
*l)c:ntistry Intrrn;itional, San Antonio, TX
Special thanks to Thomas L. Hurst, DDS, MS, Program Director, Postgraduate Prosthodontics, UTHSCH; Rich-
60
Ca\t 1i’tanzum Baw Maxlllaly Ouerdenturc
ard S. McGuckin, I>I>S,MSc, Associate Professor, UTHSCH; arid Bert ‘I. C:ecconi, DlIS, MS, Dentistry Internatiorlal, Sari Antollio, whose and tecflnical assistarlce ,
1
1
References K, Barghi N, T r a n (:: Dirricnsional changcs in castiitg titanium rrrriovablc partiiil tlcnturc frameworks. .J Prosthr~tI k n t 1!)91;65:30!)-315 2. Sznrgot KC:, Marker HC, M o s c r ,JH, ct al: The casting of tilariiurii for rcmovablc partial dentures. Qu’l Yearbook 1988; 12: 17 1-17fi 3 . Alhrcktsson T, Ziirb G, Worthington P,et al: The long-term 01 currvritly uscd dental implants: A rcvicw and proposed criteria of succcss. In1 .J Oral Maxillofac Implants I. Hlacktnan
1986;I :I 1-25 I. 1,cnroiis ,JE, Bitlw MW: 1’:ntlostcal implant biomatcri;rls and biomechanics, in McKinncy 1ZV (cd): Endoslral Ilcrital ImI Imiis, M O , MosbyYcar Hook, 1991, pp27-36 3 . Antoni W: Crramic blcnding with titaniuni-A work like (very other onc? Quintesscw Zahntcch 1990;16: 1443-14.56 ti. Kuppcr 11, Bachman K: Pun: titanium as alternate metal in rcstorativc dentistry. 2. ‘l’itanium ccraniics. Quintcsscnz Zahntcch 1089; 15: I09 I - 1O9H 7. Wi:bc:r 15: Tcchriology arid progress in rknial prosthodontics and ilcritd materials. I>tsch Zahnarztl Z 1989;44572-:,78 8. Ilcr 1 I: Crown and bridgcs nintlc of titanium. Tandlacgcblii-
0.
10.
1 I. Ito M, Okuno 0 , Ai M, (:t al: Application of supcrplasric. titaniuin alloy for d c n ~ u r ch Part I . Adaptability o f the riturc basr. Kokubyo (hkkai Zasshi 1989;56:
(120-434
12. %arbG.4, Bolcntlcr (:I,, HickvyJC:, ct A: Houchcr’s Prosthodontic Trcatmcnt for l’:dcntuloris Patients (ccl 10). St I,ouis, MO, Mosby, I990;473:52 1.533 13. 1)cl:anco KIA:Ovcrtlcritures. Dent Clin NAm 1977;21:379-394 11. wf i r.t,e n AH, Captito AA: I.oad tranafc-r t o alveolar bon inllucnccd by abutment designs lor tooth-supliortcrl dcnturcs. J l’msthct Dent 197.5;33:137-148
Steuemon and Connelh
15. Farmer ,JH: Prcvcntivc prosthodontics: Maxillary denture fracturr.,J Prosthc,t Ucnt 1983;50:172-175 16. Hcyli MS, von 1:raunhofcr.JA: An analysis ofcausrs of lractiirc ofacryli(.resin tlenturcs.,J Prosthet Dent 1981; 17. Bruce 1 Z W C O I T I ~ ~dentures C ~ C opposing natural teeth. ,J Prosthct Dent 1971;26:448-455 18. I>odgr CA: Prevention o f complete denture problems by usc of“ovcrdctilurc.s.”,~Prosttiel T k n t 1973;30:8&(y3-’+1 1 19. Morrow RM: Rcmotc ovcrdcntiirc.s, i n Hrrwrr M, Morrow IihiI (cds): Ovcrdcnturcs (cd 2). St Imuis, MO, Mosby, 19N), pp 132- 168 20. Crum RJ: Rationalc [or thc: rrtcntion of tccth for ovcrdctil turcs, in Brcwcr AA, Morrow RM (eds): Ovrrdrnliir(’s( ( ~ 2). St Louis, MO, Mosby, 1980, pp 3-1 I 21. Toolson I,U, Smith DE: A livc-ycar longitudinal study of patients trcated with ovcrclcriturcs. ,J l’rosthct Dent 1983;49: 749-756 22. Bahannan SA, Chinclly ME, MucninghofTIA: Application of silica coating tcchnicluc l o r rc:uiovablc prosl tiot1oritic:s. A clinic:al rcport.J Prosthct D c n t 1991;65:1-3 23. ’l‘illcr HJ: Tlir K u l z r silicoatcr mcthotl. Evaluation from I h r scientific-materials Ycience vicwpoint. Zahntcchnik (Gcncvc) l986;,1.4:1.8-4.9 24. Nord IZS: Kulxcr’s silicoatcr: A new tcchrricluc for bonding mcthacrylatrs t o inctal. Trcntls T d i Contcmp I>cnt I.ab 19863332.38 25. Tiller HJ, Gobcl R, Mzgnus H, ct al: Sand blasting proccdiircs and its cflcct on the surface ~m)pcrticsof dental alloys. 11. Quintesserlz I985;36:2 1.5 1-2 158 26. Tillcr HJ,Magnus H, Gobcl R, ct al: Sanclblaating proccns and i l s usc in surlacc conditioning o f dental alloys. I. Quintc 1985;36:1927-1934 27. ~JacobsonTE: The significance o f adhesive dcriturr base resin. 1nt.J ~’rosthodont1989;2:163-172 28. ~JacobsonTE, (:hang ~ J C ,Krri PP, c t al: I3ontl strcngth of 4-META acrylic rrsin denture base t o cobalt chromium alloy.,] Prosthct Ilcnt I988;60:570-576 29. L y ~ HE: i Adding a pustcrior palatal seal to a rnctal-based prosthesis. h t , J Prosthodont I989;2:283-284 30. Zurasky~JE,l h k c ES: Irriprovcd adhcsion of d(mturr acrylic rcsins to base rnctal alloys.,J Prosthct Dent 1987;57:520-524 31. Garfield RE: An cfkctiv(: mrthod for relining metal-t pros:(hes(:swith acid-etch tcchniqucs.,J I’rosthct Dent 198 7 19-721 32. Cacg C, Lcinfcldcr KF, Lacc.licld WR, ct ill: Elfi.ctivcncss ofa method uscd in bonding rcsins t o metal. ,I I’rosthct Dcnt 1990;64:37-4 1
INDEX WORDS: titanium. overdenture he unique biocompatible and hypoallergenic properties of titanium have led to a recent surge of popularity in the use of this metal in restorative dentistry. Titanium is light, strong, noncorrosive, has no metallic taste, and has low thermal conductivity. Titanium casting technology has overcome inherent casting problems and is reasonably economical and practical for applications in dentistry.'J In addition to its well-known use for many years in endosseous implant^,^,^ a number ofcomniercial dental laboratories are now providing titanium porcelain-fused-tometal restorations and removable partial denture frameworks.j" Reports of titanium use in metalbased complete dentures are limited. Japanese studies"" have shown that titanium-based complete dentures possessed superior properties in comparison with acrylic resin and cast base mctal alloy bases; titanium bases are lighter, stronger, and can be made thinner, and fit the palatal mucosa more intimately. A review of the literature revealed no published report citing the use of-titanium in an overdenture. This clinical report describes the treatment of a 70-year-old man with a titanium palate maxillary overdenture.
T
Front the Depaltment qRernouablc Prosthodontics, b'niniaersasz$OJ l k l c o ~ Health Sciencp Center at Hmrton, Dental Branch. *Pro,rfhndoaticRP.n'dmt. f h m i a t e PrqfiJsor and Chairman. Address re,bnnt requests to: Gene C. Stevenson, DDS, Departrneni qf Rmriouable Prosthorluntics, Uniomi!y of Texm Health Saence Centv a! Hot&m. Ilmtal Branch, P.0.Box 20068, Howlon, TX 77225. C o b ~ g h0 t 1992hy th American College ifProsthodontiJts 10.59-941X/9210101-001lS.5.00
Clinical Report The patient had five endodontically treated overdenture abutment teeth: Three in the maxilla (nos. 8, 11, and 15) and two in the mandible (nos. 22 and 27). The patient was a bruxer with active, strong and vigorous masticatory muscles and he showed an unusually extended range of mandibular motion whilc bruxing. The patient had worn a mandibular overdenturc for several years. It was originally fabricated to oppose natural maxillary dentition. A maxillary immediate overdcnturc was placed 1% years ago, prompted by thc extraction of multiple unrestorable maxillary teeth. O n his initial examination, the patient had been wearing his second maxillary overdenture and a new mandibular overdcnture for 1 year. The dentures were clinically acceptable, had adequate peripheral seal, sufficient retention and stability, correct vertical dimension of occlusion, and were in bilateral balanced occlusal scheme. However, the maxillary denture was a prosthodontic failure because of repeated anterior midline fractures. Both maxillary dcnturcs developed similar fractures within several days after placement. Despite repeated repairs of thc denture and occlusal adjustments, cracking and fracture continued to occur (Fig 1). Fractures of overdcnturc bases are often seen when the height and contours of the abutment roots are not continuously modified to keep pace with the changes in the soft tissue. The rate of fracture is exacerbated by parafunctional habits, such as bruxism, The root should be a rounded dome 1.0 to 2.0 mm in height.'*J3 Periodic evaluations should be made with pressure indicating paste to ensure that the denture base does not contact the roots except when functional occlusal loads are applied. If the
Journal ofPoJthodontm, 1701 I , A1o I (September),1992:pp 57-60
57
58
Cast Titanium Rase Maxillaly Omnienture
Stevenson and Conlwlh
Figure 1. Original maxillary overdenture. The patient’s
Figure 3. Completed rriaxillary overdenture, occlusal
bruxing habit overstressed the denture base, prducing rnidline fractures lingual to the anterior teeth. Fractures in the palate continued to reoccur in spite of repeated occlusal adjustments and numerous denture base resin repairs, including the use of a wire mesh.
surface. Labial and buccal borders are in denture base resin.
Figure 2. Titanium casting fitted on the master cast. Retention beads enhance retention of acrylic resin to denture base. Adequate relief of the palatal base over each abut nient tooth allows for post placement adjus tm r nts to he made in denture base resin.
Figure 4. Completed maxillary overdenture, tissue sur-
denture “settlcs” and begins to bind on a root, a fulcrum is established and torquing of the dcnturc will then be inevitable. will o ~ c u r . ~Fractures ’J~ Flexural fatigue of a maxillary denture base caused by cyclic dcformation during function will result in a rnidline fracture of the base.l5,l6The area of the denture most subject to deformation is lingual to the incisors.l6Construction ofdentureswith metal
face. Note the presence of ac:r)-lic resin over the abutment teeth to facilitate postplacenient adjustments.
palates for patients with heavy occlusal loading can help reduce the incidence of midline fracture of denture bases.lj,’GSome dciitists regard the prognosis to be guarded for denture patients having such serious complications as bruxism or strong musculature due to the strcsses on thc supporting structures under the dentures.” However, lhe presence of overdenture abutment teeth in an arch will increase the stability and support of a complete denture and reduce the forces of occlusion to the supporting
59
September 1992, Volume I , Number 1
tissue.12,1",18 Successful management of such patients requires the construction of a denture possessing suffrcient strength and stabilized occlusion based on sound prosthodontic principles.15%1!'
Technique A preliminary impression of the maxilla was made with a stock tray and irreversible hydrocolloid. A custom acrylic resin tray was made from the preliminary cast and was border molded intraorally with modeling plastic. The final impression was made with Yermlastic polysulfide impression material (Kerr Manufacturing Co., Romulus, MI). The master cast was prepared and the posterior palatal seal area was identified and carved into the cast. The design ofthe metal base was drawn on the master cast. Relief and metal struts were planned over each abutment tooth to allow for denture base resin to be processed in these areas to facilitate any future adjustments over the abutment teeth. First, the titanium palate was fabricated and fitted to the master cast (Fig 2). The wax pattern was formed on a refractory cast, invested, and cast in pure titanium in a Castmatic-S titanium casting system (Iwatani Corp., Osaka, Japan).* This system uses an electric arc to melt the titanium in an argon gas atmosphere and forces the melt into the casting ring by means of positive pressure. Pure titanium dental castings have properties similar to type IV gold a1loys.l Retention beads were used to enhance retention of the acrylic resin to the metal base, To further enhance the adherence of the denture base resin to the metal, the retention areas of the casting werc Silicoated (silica coating, Kulzer Inc., Irvinc, CA) . Maxillomandibular records werc obtained, teeth selected, and a trial set-up was completed directly on the titanium base. The denture was processed in Lucitone 199 denture base resin (Dentsply International, Inc., York, PA) (Figs 3 and 4). A lingualized, bilateral balanced occlusal scheme was selected to provide stability of the denture. When the denture was placed, pressure indicating paste was used to cvaluate and corrcct the fi1.I"
maxillary overdenture. There has been no fracture recurrence in the palate since placement. With overdenture therapy, the advantages of retained teeth are increased support and stability for a complete denture, the maintenance of proprioceptive guidance by the periodontal ligaments, and the preservation of alveolar bone by retained roots."'.'" Meticulous home care and daily use of fluoride gel on the retained abutment teeth are necessary to reduce caries susceptibility. According t o Boucher,'2 the principal advantages of conventional maxillary metal denture bases are (1) better thermal conductivity, (2) increased tissue tolerance, (3) reduced bulk across the palate which creates more tongue space, and (4) increased accuracy of fit. Disadvantages are (1) increased restorative cost, (2) difficulty of rebasing, (3) less margin of error in the posterior palatal seal, and (4) increased weight for a maxillary denture. The use of titanium enhances all the advantages of metal denture bases and offsets or eliminates the disadvantages. Titanium-based dentures weigh substantially less than conventional resin dentures." Laboratory costs are only slightly greater than for conventional metal-based dentures. With new and improved techniques of bonding resins to metal, such as Kulzer's Silicoater s y ~ t e m , ~the ~ - ~Espe * RocatecSystem (Espe-Premier Sales Corporation, Norristown, PA)25,2fiand 4-META adhesive resin (Preat Corporation, San Mateo, CA)27,2tJ; relining, rebasing, and adding denture base material to metal bases are viable treatment options.*""I The metal-resin interface is chemically bonded and is impervious to separation and m i ~ r o l e a k a g e . ~ ~When , ~ ~ , "the ' technical factors listed above are considered in conjunction with the remarkable biocompatibility of the material, titanium represents state of the art in dental technology and may become the material of choice for metal denture bases.
Conclusion A clinical technique for fabricating a titanium palate
Discussion
maxillary overdenture is described. This treatment does not require any changes in clinical techniques and provides the practitioner with a practical option for successfully treating difficult overdenture or conventional denture patients.
The patient readily accepted his new dentures and has been functioning well with the titanium-based
Acknowledgment
*l)c:ntistry Intrrn;itional, San Antonio, TX
Special thanks to Thomas L. Hurst, DDS, MS, Program Director, Postgraduate Prosthodontics, UTHSCH; Rich-
60
Ca\t 1i’tanzum Baw Maxlllaly Ouerdenturc
ard S. McGuckin, I>I>S,MSc, Associate Professor, UTHSCH; arid Bert ‘I. C:ecconi, DlIS, MS, Dentistry Internatiorlal, Sari Antollio, whose and tecflnical assistarlce ,
1
1
References K, Barghi N, T r a n (:: Dirricnsional changcs in castiitg titanium rrrriovablc partiiil tlcnturc frameworks. .J Prosthr~tI k n t 1!)91;65:30!)-315 2. Sznrgot KC:, Marker HC, M o s c r ,JH, ct al: The casting of tilariiurii for rcmovablc partial dentures. Qu’l Yearbook 1988; 12: 17 1-17fi 3 . Alhrcktsson T, Ziirb G, Worthington P,et al: The long-term 01 currvritly uscd dental implants: A rcvicw and proposed criteria of succcss. In1 .J Oral Maxillofac Implants I. Hlacktnan
1986;I :I 1-25 I. 1,cnroiis ,JE, Bitlw MW: 1’:ntlostcal implant biomatcri;rls and biomechanics, in McKinncy 1ZV (cd): Endoslral Ilcrital ImI Imiis, M O , MosbyYcar Hook, 1991, pp27-36 3 . Antoni W: Crramic blcnding with titaniuni-A work like (very other onc? Quintesscw Zahntcch 1990;16: 1443-14.56 ti. Kuppcr 11, Bachman K: Pun: titanium as alternate metal in rcstorativc dentistry. 2. ‘l’itanium ccraniics. Quintcsscnz Zahntcch 1089; 15: I09 I - 1O9H 7. Wi:bc:r 15: Tcchriology arid progress in rknial prosthodontics and ilcritd materials. I>tsch Zahnarztl Z 1989;44572-:,78 8. Ilcr 1 I: Crown and bridgcs nintlc of titanium. Tandlacgcblii-
0.
10.
1 I. Ito M, Okuno 0 , Ai M, (:t al: Application of supcrplasric. titaniuin alloy for d c n ~ u r ch Part I . Adaptability o f the riturc basr. Kokubyo (hkkai Zasshi 1989;56:
(120-434
12. %arbG.4, Bolcntlcr (:I,, HickvyJC:, ct A: Houchcr’s Prosthodontic Trcatmcnt for l’:dcntuloris Patients (ccl 10). St I,ouis, MO, Mosby, I990;473:52 1.533 13. 1)cl:anco KIA:Ovcrtlcritures. Dent Clin NAm 1977;21:379-394 11. wf i r.t,e n AH, Captito AA: I.oad tranafc-r t o alveolar bon inllucnccd by abutment designs lor tooth-supliortcrl dcnturcs. J l’msthct Dent 197.5;33:137-148
Steuemon and Connelh
15. Farmer ,JH: Prcvcntivc prosthodontics: Maxillary denture fracturr.,J Prosthc,t Ucnt 1983;50:172-175 16. Hcyli MS, von 1:raunhofcr.JA: An analysis ofcausrs of lractiirc ofacryli(.resin tlenturcs.,J Prosthet Dent 1981; 17. Bruce 1 Z W C O I T I ~ ~dentures C ~ C opposing natural teeth. ,J Prosthct Dent 1971;26:448-455 18. I>odgr CA: Prevention o f complete denture problems by usc of“ovcrdctilurc.s.”,~Prosttiel T k n t 1973;30:8&(y3-’+1 1 19. Morrow RM: Rcmotc ovcrdcntiirc.s, i n Hrrwrr M, Morrow IihiI (cds): Ovcrdcnturcs (cd 2). St Imuis, MO, Mosby, 19N), pp 132- 168 20. Crum RJ: Rationalc [or thc: rrtcntion of tccth for ovcrdctil turcs, in Brcwcr AA, Morrow RM (eds): Ovrrdrnliir(’s( ( ~ 2). St Louis, MO, Mosby, 1980, pp 3-1 I 21. Toolson I,U, Smith DE: A livc-ycar longitudinal study of patients trcated with ovcrclcriturcs. ,J l’rosthct Dent 1983;49: 749-756 22. Bahannan SA, Chinclly ME, MucninghofTIA: Application of silica coating tcchnicluc l o r rc:uiovablc prosl tiot1oritic:s. A clinic:al rcport.J Prosthct D c n t 1991;65:1-3 23. ’l‘illcr HJ: Tlir K u l z r silicoatcr mcthotl. Evaluation from I h r scientific-materials Ycience vicwpoint. Zahntcchnik (Gcncvc) l986;,1.4:1.8-4.9 24. Nord IZS: Kulxcr’s silicoatcr: A new tcchrricluc for bonding mcthacrylatrs t o inctal. Trcntls T d i Contcmp I>cnt I.ab 19863332.38 25. Tiller HJ, Gobcl R, Mzgnus H, ct al: Sand blasting proccdiircs and its cflcct on the surface ~m)pcrticsof dental alloys. 11. Quintesserlz I985;36:2 1.5 1-2 158 26. Tillcr HJ,Magnus H, Gobcl R, ct al: Sanclblaating proccns and i l s usc in surlacc conditioning o f dental alloys. I. Quintc 1985;36:1927-1934 27. ~JacobsonTE: The significance o f adhesive dcriturr base resin. 1nt.J ~’rosthodont1989;2:163-172 28. ~JacobsonTE, (:hang ~ J C ,Krri PP, c t al: I3ontl strcngth of 4-META acrylic rrsin denture base t o cobalt chromium alloy.,] Prosthct Ilcnt I988;60:570-576 29. L y ~ HE: i Adding a pustcrior palatal seal to a rnctal-based prosthesis. h t , J Prosthodont I989;2:283-284 30. Zurasky~JE,l h k c ES: Irriprovcd adhcsion of d(mturr acrylic rcsins to base rnctal alloys.,J Prosthct Dent 1987;57:520-524 31. Garfield RE: An cfkctiv(: mrthod for relining metal-t pros:(hes(:swith acid-etch tcchniqucs.,J I’rosthct Dent 198 7 19-721 32. Cacg C, Lcinfcldcr KF, Lacc.licld WR, ct ill: Elfi.ctivcncss ofa method uscd in bonding rcsins t o metal. ,I I’rosthct Dcnt 1990;64:37-4 1
