Received Date : 08-Sep-2016

Accepted Article
Revised Date : 14-Nov-2016

Accepted Date : 23-Nov-2016

Article type : Review

Title: Reinforcement in removable prosthodontics: a literature review

Running head: Reinforcement in removable prosthodontics

Authors

Toshihito Takahashi, DDS, PhD, Department of Prosthodontics, Gerodontology and Oral

Rehabilitation, Osaka University Graduate School of Dentistry, Assistant Professor, Suita, Japan.

Tomoya Gonda, DDS, PhD, Department of Prosthodontics, Gerodontology and Oral Rehabilitation,

Osaka University Graduate School of Dentistry, Associate Professor, Suita, Japan.

Yoko Mizuno, DDS, PhD, Department of Prosthodontics, Gerodontology and Oral Rehabilitation,

Osaka University Graduate School of Dentistry, Clinical Staff, Suita, Japan.

Yozo Fujinami, DDS, PhD, Department of Prosthodontics, Gerodontology and Oral Rehabilitation,

Osaka University Graduate School of Dentistry, Resident, Suita, Japan.

Yoshinobu Maeda, DDS, PhD, Department of Prosthodontics, Gerodontology and Oral Rehabilitation,

Osaka University Graduate School of Dentistry, Professor, Suita, Japan.

This article has been accepted for publication and undergone full peer review but has not been
through the copyediting, typesetting, pagination and proofreading process, which may lead to
differences between this version and the Version of Record. Please cite this article as doi:
10.1111/joor.12464
This article is protected by copyright. All rights reserved.
 Corresponding author: Dr. T. Takahashi
Accepted Article
Department of Prosthodontics, Gerodontology and Oral Rehabilitation, Osaka University Graduate School

of Dentistry, Assistant Professor, 1-8 Yamadaoka, Suita, Osaka 565-0871, Japan.

E-mail: toshi-t@dent.osaka-u.ac.jp

Tel: +81-6-6879-2955; Fax: +81-6-6879-2957; E-mail: toshi-t@dent.osaka-u.ac.jp

Abstract

Background: Removable prothodontics are often associated with mechanical troubles in daily use, such as

fracture or deformation. These troubles render prostheses unusable and reduce wearers QOL. Various

reinforcements are used to prevent such problems, but consensus on reinforcement has not been

reached.

Objective: This review aimed to summarize the effects of reinforcement, and to propose favorable

reinforcement based on material, design, and position in the prostheses.

Methods: Initially, 139 articles were selected by electronic and manual searches. After exclusion of 99

articles based on the exclusion criteria, 40 articles were finally included in the review. Electronic searches

were performed for articles published from 2005 to 2015 in PubMed, EMBASE, Medline, and Cochrane

Library and manual searches were performed in 10 journals relevant to the topic of removable

prosthodontics.

Results: For in vitro studies, certain dental alloys and fibers were mainly used. Their forms were different,

including complicated forms in dental alloys and various forms in fibers. The materials were examined for

mechanical properties like fracture strength, flexural strength, and elastic modulus, and compared with one

another or without reinforcement. There were a few clinical studies and one longitudinal study.

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 Conclusion: Cast metal reinforcement seemed to be most favorable in terms of fracture toughness and
Accepted Article
stiffness. The most favorable forms differed depending on the prostheses, but placement around thin and

deformable areas was effective. However, randomized or longitudinal clinical reports and comparative

clinical studies on the use of reinforcement were still lacking and such studies are necessary in the future.

Keywords: review, reinforcement, removable denture, glass fiber, strength, stiffness

Background

In clinical practice, removable dental prostheses have been used for oral rehabilitation, and are essential

for patients to improve and maintain their quality of life. However, these requisite prostheses for daily life

often become unusable because of deformation or fracture, and wearers become disadvantaged. The

reasons for these complications were reported to include improper usage by wearers, accidents like

dropping or hitting, and insufficient strength (1), and various reinforcements have been embedded into

prostheses to increase their strength and prevent these problems. The reinforcements used in removable

dental prostheses, especially complete dentures, partial dentures, and implant or root overdentures, have

frequently been reported regarding their materials, designs, and positions among other factors, but their

variations were different and their reported effects were almost sufficiently high. Furthermore, the

necessity for reinforcement was advocated in clinical studies (2). However, the most effective

reinforcement is not apparent, and clinicians are confused about designing such reinforcement.

Meanwhile, the materials for prostheses have been improved in their mechanical properties to prevent

complications, and thus reinforcement may become unnecessary. Moreover, some authors reported that

reinforcement involved the addition of a foreign material to prostheses, and may thus be a risk factor for

fracture development, rather than fracture prevention (3).

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 Currently, reinforcement has two important purposes in a prosthesis. The initial purpose is to
Accepted Article
improve the strength and prevent fractures, and most previous studies were conducted with a focus on this

purpose. The second purpose is to improve the stiffness and prevent residual ridge resorption and

overloading to residual teeth or structures. Regarding the effect on the residual ridge, Maeda et al. (4)

reported that deformation of the denture base leads not only to denture base fractures, but also to ridge

resorption by compressive stress transmitted to the underlying bone, while Gonda et al. (5) reported a

finite element study on mandibular overdentures, and showed that rigid metal reinforcement reduced the

stress beneath the denture base, and could distribute the stress of the residual alveolar ridge area more

widely and evenly. For overload to residual teeth, it was reported that denture deformation causes stress

on the abutment teeth that can lead to loss of these teeth, and that a rigid major connector or

reinforcement was necessary to make the denture more rigid and prevent tooth loss.

Therefore, in this review, we focused on reinforcement in terms of improving the mechanical

properties of prostheses, not only for their strength, but also their stiffness. The purposes of this review

were to summarize: 1) what is already revealed and what is not yet revealed about reinforcement and 2)

what is the most favorable reinforcement to keep the initial status in the long term and maintain wearers

quality of life from recent reports.

Methods

Search strategy

Searches were performed both electronically and manually in articles published from 2005 to 2015.

Electronic searches were performed in the PubMed, EMBASE, Medline, and Cochrane Library databases

and manual searches were performed in the following 10 journals: Acta Odontologica Scandinavica;

Dental Materials; Dental Materials Journal; Gerodontology; International Journal of Prosthodontics;

Journal of Dental Research; Journal of Oral Rehabilitation; Journal of Prosthetic Dentistry; The

International Journal of Oral and Maxillofacial Implants; and Quintessence International. The key words for

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 the searches were as follows: reinforcement denture; reinforcement dental prosthesis; reinforce
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denture; reinforce dental prosthesis; strengthened denture; and strengthened dental prosthesis.

Inclusion and exclusion criteria

The inclusion criteria were: 1) type of study (clinical study, case report, or in vitro study); 2) availability of

full text; and 3) written in English. The exclusion criteria were: 1) reports about fixed dental prostheses,

core treatments after root canal treatment, or orthodontic treatments; 2) types of studies other than the

abovementioned types; and 3) reports about characteristics other than mechanical properties, such as

discoloring, water resorption, or surface morphology.

Screening and selection

The titles and abstracts of all reports were screened by one author (TT) and the full-text articles were

reviewed by four authors (TT, GT, MY, FY). After screening of the reports, more detailed searches were

conducted according to the inclusion and exclusion criteria described above.

Data extraction

After completion of the search strategies, the following information about reinforcement was extracted from

the selected reports: reinforcement material and form; position in prosthesis; prosthesis material; and

reinforcing effect compared with other reinforcements or without reinforcement.

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 Results
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Searches and selection

Initially, 139 articles were selected by both electronic and manual searches. Subsequently, 90, four, and

five articles were excluded based on the exclusion criteria 1, 2, and 3, respectively. Finally, a total of 40

articles were included this review (Fig. 1). The included articles consisted of one clinical report (6), three

case reports (79), and 36 in vitro reports. Within the included in vitro articles, 24 reports examined

standardized specimens (1033), 11 reports examined prosthesis-shaped specimens (12,15,3442) like

complete and partial removable dentures, two reports examined both standardized and prosthesis-shaped

specimens (12,15), and three reports used a finite element method (5,43,44). In terms of the investigated

items, 13 reports (11,13,14,18,20,22,2628,30,32,38,39), four reports (10,16,26,32), one report (23), nine

reports (15,17,2426,31,33,35,41), and one report (21) examined flexural strength, impact strength,

transverse strength, fracture strength, and shear bond strength, respectively. In the only clinical report (6),

the 5-year prognosis after repair of fractured dentures was examined. The examined materials for

prostheses were mainly auto-polymerized (7,12,15,17,18,27,30,32,34,36,37,40,42,50), heat-polymerized

(911,1317,2022,2429,3133,38,39,41,43), and light-polymerized (19,32,35) acrylic resin. These

kinds of acrylic resin are usually used in clinical practice as removable denture bases. When included

reports were categorized by evidence level according to GRADE and Shekelles system (51), most of them

were placed in category III and a few were in IV GRADE. Therefore, all of them were placed in category D

recommendation level, that is based on Shekelles system.

Regarding the types of prostheses, four reports examined overdentures including implant

overdentures (5,8,9,34), eight reports examined maxillary complete dentures (6,3641,44), and four

reports examined mandibular complete dentures (7,15,35,42). The two other reports examined telescope

dentures (43) and removable partial dentures (12).

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 Materials and forms
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The materials for reinforcement reported in the previous articles were mainly metals

(5,710,15,19,23,24,31,3437,40,42) and fibers (6,10,12,15,17,1922,2433,35,37,39,41,43,44), plus a

small number of others (11,13,14,18). Metal and fiber reinforcements appeared to already be applied in

clinical practice.

The methods for metal reinforcement of prostheses were cast metal and metal wire, and the

materials were mainly Co-Cr and Ni-Cr. With respect to their forms, various designs were made by wax-up

techniques for cast metal reinforcement and bending techniques for wire reinforcement. The former can be

made into more complex designs than the latter, but their procedures are more complicated and

time-consuming. Although both types of reinforcements were more effective than no reinforcement in

terms of improving various strength and stiffness properties, cast metal was more effective in direct

comparisons of these two metal reinforcements (37).

The reinforcing fibers were glass fibers (6,10,12,16,17,1922,2433,35,37,39,41), polyethylene

fibers (10,15,16,19,44), rayon fibers (26,29), polyester fibers (26,29), and nylon fibers (26,29) in order of

numbers of articles, and a predominant number of reports were about glass fibers. Their forms were

various, such as unidirectional or continuous (6,16,17,20,22,26,27,29,30,37,39,43), chopped or flaked

(1114,18,28,33), and mesh or woven (6,10,15,19,20,24,25,3133,41). In these studies, unidirectional

and mesh fibers were embedded into the denture base when polymerizing the denture and chopped or

flaked fibers were mixed with the resin polymer in advance and then mixed with the resin monomer. In this

manner, the reinforcing methods differed among the forms, but their reinforcing effects were all reported to

be beneficial compared with no reinforcement. However, when using chopped or flaked fibers, attention

should be paid to the ratio of fibers and it should be not allowed to exceed 20% (28,33). Reports on

differences in forms for the same kind of fiber were few (6,20,41), and most reports compared prostheses

with and without fiber reinforcement. From the results in a limited number of reports comparing the

reinforcing effects between the forms or materials of fibers, mesh form (6,20) type and polyethylene fibers

(16,19) seemed to be the most effective. There was also a report on the effect of their surface treatments,

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 in which silane-treated glass fibers were more effective than non-treated glass fibers (16). In clinical
Accepted Article
practice, glass fibers have already been used for reinforcement in various materials and are no longer

experimental materials (6). From the selected reports, most previous reports examined the various

strengths of prostheses with reinforcement, being focused on improving only the strength and not the

stiffness, and only two reports (15,27) examined the stiffness by measuring the elastic modulus.

Reports on other reinforcing materials were few, but ZrO2 (11), mica (14), and aluminum borate

whiskers (18) were used. These materials were all powders and mixed with resin polymers in varying

proportions before polymerization. They were reported to have some efficacy, but were not sufficient to be

applied in clinical settings, and were no more than new attempts at the time.

When comparing the effects among reinforcing materials in terms of various strengths, one study

reported that metal reinforcement showed more improvement than fiber reinforcement (37), while others

reported that fiber reinforcement was superior to metal reinforcement (10,15,19). Thus, their effects

differed depending on experimental conditions like the size, morphology, and material of the specimens.

On the contrary, in comparisons of the effects in terms of elastic modulus, metal reinforcement, especially

cast metal reinforcement, led to smaller moduli than various fiber reinforcements and wire reinforcement

had almost equal or slightly lower moduli than fiber reinforcement. Nonetheless, their effects were

size-dependent, with increasing reinforcement sizes being associated with increasing beneficial effects.

However, there were no comparative studies directly comparing metal reinforcement to fiber reinforcement

or if one type of fiber (woven or continuous) was clearly superior to another. Therefore, it might be difficult

to know which approach is best.

Positions in prostheses

In the prosthesis-shaped specimen studies, the position of reinforcement was examined. The previous

studies were about complete dentures (both maxillary and mandibular), partial dentures, and tooth or

implant overdentures. For implant overdentures, one in vitro study (34) and one finite element study (5)

examined the rigidity of prostheses and two case reports examined the strength of prostheses (8,9).

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 Considering these studies, the reinforcing effect seemed to differ depending on the position regardless of
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the materials. From these studies, to improve the strength and rigidity of prostheses, the reinforcements in

addition to a metal framework in the denture base should run over the top of the residual ridge in complete

dentures (36,37), and run over the top of the coping or abutment in tooth and implant overdentures

(5,34,42).

Materials for prostheses

The materials used in the studies were all acrylic resin and differed in their polymerization methods, in

particular heat-, auto-, or light-polymerization. The materials were usually used in clinical practice and

selected in consideration of their advantages and disadvantages. In all studies, the reinforcements were

reported to be effective regardless of both reinforcement and prosthesis materials. Only four articles

(15,17,27,32) compared the prosthesis materials, and other articles were conducted with only one

material. From the results of the four studies (15,17,27,32), there was no difference in reinforcing effects

among the prosthesis materials regardless of the reinforcement material.

Discussion

In this literature review, the effects of reinforcement within different removable prostheses were

summarized from previous reports published in the decade from 2005 to 2015. There have been many

reports about such reinforcement, but they lack coherence and include only two reviews (3,45), one of

which was published more than 15 years ago. In the previous reviews (3,45), the following information

about reinforcement was already apparent: 1) cross-section forms of reinforcement should not be

rectangular, but instead should be convex or semicircular; 2) reinforcement should be placed in a direction

perpendicular to the stress-concentrating line; and 3) reinforcements should be positioned near the

surface, especially the tensile surface. However, new organized information has not published for about 15

years since the last review was documented while the materials or procedures have been further

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 developed. Therefore, reports published after 2005 were focused upon in this review to clarify the current
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trends.

There are two reasons why the reinforcement should be embedded into the prosthesis: one is to

improve the strength and prevent fracture of the prosthesis and the other is to make the prosthesis more

rigid and prevent deformation of the prosthesis. The former was examined by measuring different

strengths and using a finite element analysis and the latter was examined by measuring the flexural

modulus and using a strain gauge analysis, but the number of the former studies was much larger than the

number of the latter studies. This seemed to arise because the effects on improvement in strength to

prevent fracture were more frequently focused upon than improving rigidity to prevent deformation.

From the results of the specimen and prosthesis-shaped studies, various materials and designs

of reinforcement were examined and the results showed that all were effective. The prerequisites for

reinforcement to improve the mechanical properties should be considered the following points: 1) ease of

making and placing into the prosthesis; 2) sufficient rigidity to improve the mechanical properties; 3)

reasonable cost; 4) stable characteristics; and 5) sensuousness. In the decade from 2005 to 2015, glass

fibers were especially examined as reinforcement materials compared with other materials. Glass fibers

met the first, fourth, and fifth of the above conditions and were superior to metal in sensuousness.

However, they were inferior in rigidity and cost. Furthermore, their effects differed depending on their

position, shape, and material, and the selection of these factors is important to produce the maximum

reinforcing effect. Thinking about the reinforcement size, as the reinforcements increased in size, their

beneficial effects increased. When selecting the material and form of a reinforcement, these points should

be considered and ranked for their importance for each prosthesis and patient.

Materials for reinforcement

In terms of material, cast metal reinforcements, especially Co-Cr alloys, have the maximum effect in

improving both strength and rigidity and can be made into complex shapes, but require complicated

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 laboratory work and equipment. When selecting the material for reinforcement, the mechanical character
Accepted Article
of the material itself is important, and it should be sufficiently strong and rigid to make the prosthesis more

rigid. In this regard, cast metal reinforcements seemed to be superior to other materials. Meanwhile, the

major drawbacks of cast metal reinforcements were their color and adhesion to the prosthesis. A cast

metal reinforcement can be seen through the prosthesis in some situations, and is therefore not

recommended for use in anterior areas, where clear fiber reinforcement is more appropriate for an esthetic

choice, although fiber reinforcement is more expensive. When a reinforcement was placed into a

prosthesis regardless of the material, appropriate adhesive bonding procedures before placement, for

example sandblasting and priming for metals and silane-coupling procedures for glass fibers, were

necessary to produce the maximum effect of reinforcement (16,23). If these procedures are not conducted

sufficiently, the reinforcement will have the opposite effect and nothing will be gained by embedding.

Positions and forms of reinforcement

In terms of position and form, the reinforcement should be positioned in an area of stress and potential

deformation where the prosthesis is subject to fracturing. (40). These areas are specifically over the

residual ridge (1,46), implants (47,48), or roots (49), on the inflection point of the residual ridge. In

conclusion, the reinforcement should run over the residual ridge in a complete denture (40), run over the

top of the implants or roots in an overdenture (34, 42), and run across the residual ridge in a partial denture

(50). Regarding the cross-section form, a reinforcement should be positioned near the tensile surface, as

already clarified in previous reports (3,45). This result seemed to be derived from the character of the

denture base material, rather than that of the reinforcement material, given that the compressive strength

was stronger than the tensile strength.

To summarize this review, reinforcements within prostheses undoubtedly had some efficacy in improving

the mechanical properties, but the levels varied by material, form, and position of the reinforcement.

Considering these results, clinicians had better placed some kind of reinforcement in all removable

dental prostheses to prevent prosthetic and other complications. However, most previous studies were
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 carried out in terms of improving the strength, rather than the rigidity, and studies aimed at improving
Accepted Article
rigidity remained insufficient even in experimental model and specimen studies. Furthermore, clinical

studies about the effects of reinforcement on both prostheses and patients were very few, and in particular,

there were no randomized long-term clinical studies comparing prostheses with and without reinforcement.

Therefore, studies focused on the rigidity of prostheses with reinforcement and the effect on underlying

structures such as the residual ridge or implant and longitudinal clinical studies are necessary to ensure

the effect of reinforcement within dental prostheses.

Conclusions

From the results of this review on reports about reinforcement published in the decade from 2005 to 2015,

the following conclusions were drawn.

1. There have been many in vitro studies, but most of them were focused on improving the strength, rather

than the rigidity, of prostheses.

2. Cast metal reinforcement was most effective in improving the mechanical properties of prostheses, for

both strength and rigidity.

3. Glass fiber reinforcements were examined more frequently than other materials in the decade from

2005 to 2015 and were increasingly applied in clinical practice.

4. The most favorable form of reinforcement differed depending on the prosthesis, but the reinforcement

should be placed around the deformable and stress-concentrating area.

5. Longitudinal clinical reports about the effect of reinforcement on prostheses or patients were still lacking

and such future studies are required to ensure the effect of reinforcement.

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 Ethical approval
Accepted Article
Ethical approval is not applicable for this study.

Funding

This research was conducted with no funding.

Conflicts of interest

The authors have stated explicitly that there are no conflicts of interest in connection with this article.

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 47. Gonda T, Maeda Y, Walton JN, MacEntee MI. Fracture incidence in mandibular overdentures retained
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Table

Table 1. Studies on reinforcement in the decade from 2005 to 2015.

Investigation
Author and Type of Material of Form of ExperimentalMaterial of Brief of the
item and
year study reinforcement reinforcementsituation prosthesis results
method

maxillary 4 designs of cast

Takahashi T auto
cast metal implant reinforcement
et al. (2015) in vitro framework polymerized strain gauge
(Co-Cr) overdenture were compared
(34)
resin

(strain Cast

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 gauge reinforcement
Accepted Article analysis) over the residual

ridge and the top

of copings was

most favorable

design

Polyethylene

stainless fibers exhibit

Murthy HB steel heat better impact

mesh impact
et al. in vitro glass fiber specimen polymerized strength followed
woven strength
(2015)(10) polyethylene resin by glass fibers

fiber and stainless

steel mesh.

maxillary Reinforcement

Takahashi T complete auto with a palatal bar

cast metal
et al. (2015) in vitro framework denture polymerized strain or metal-based
(Co-Cr)
(36)
(strain gaugeresin palate could

analysis) reduce the strain.

The content (4%)

of the glass fiber

light
Yu S et al. glass fiber complete fracture mesh seemed
in vitro mesh polymerized
(2015) (35) metal denture resistance more important
resin
than the

structures.

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 The flexural
Accepted Article strength was
heat
Yu W et al.
flexural maximised when
in vitro ZrO2 flake specimen polymerized
(2014) (11) strength 2.0wt% ZrO2
resin
nanotubes were

added.

Bar-shaped

specimens can

be a reliable

method for
de Cruz specimen auto
impact evaluating
Perez LE et in vitro glass fiber flake complete polymerized
strength influencing
al. (2014) (12) denture resin
factors of

resistance to

impact of denture

base.

Reinforcement

adjacent to the

top of the coping

mandibular
and the medial
finite wire (Co-Cr) overdenture
Gonda T et part reduces the
element cast metal framework (finite
(5)
al. (2013)
stress beneath
analysis (Co-Cr) element
dentures and
analysis)
widely and evenly

distributes the

stress of the

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 residual alveolar
Accepted Article ridge.

Short ramie fiber

heat reinforced
Xu J et al.
flexural
in vitro ramie fiber chopped specimen polymerized denture base had
(2013) (13) strength
resin higher flexural

modulus.

20% mica
Mansour heat
flexural contains showed
MM et al. in vitro mica flake specimen polymerized
strength highest mica
(2013) (14) resin
microhardness.

All the denture

heat fracture load
specimens
specimen polymerized deflection
wire repaired with
Venkat R et wire mandibular resin flexural
in vitro polyethylen materials
al. (2013) (15) mesh complete auto strength
fiber demonstrated
denture polymerized elastic
higher fracture
resin modulus
load values.

A method for

fabricating and
mandibular auto internally a metal
Balch JH et case cast metal
framework complete polymerized case report framework in the
al. (2013) (7) report (Co-Cr)
denture resin
denture base of a

mandibular

complete

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 denture.
Accepted Article
The technique

presented

describes not

only the

reinforcement of

the denture base

with a metal

framework but
Ozcelik TB
case cast metal implant also the inclusion
et al. (2013) framework case report
report (Co-Cr) overdenture of the attachment
(8)

metal housing in

the framework

design to prevent

fractures that

could occur at the

sites close to the

implant

abutments.

Cast
maxillary cobalt-chromium
cast metal
Takahashi T complete auto
reinforcement
(Co-Cr)
et al. in vitro continuous denture polymerized strain could mostly
glass fiber
(37)
(2013) (strain gaugeresin reduce the strain
metal wire
analysis)
of a maxillary

complete

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 denture.
Accepted Article
Reinforcement

with the fiber is

an effective

glass fiber method to

Mowade TK polyethylene heat increase the

impact
et al. (2012) in vitro fiber continuous specimen polymerized impact strength
strength
(16)
polypropylene resin of denture base.

fiber And the surface

treatment further

increases the

impact strength.

heat Glass fiber

polymerized reinforcement
resin
Farina AP et Vickers increased the
in vitro glass fiber continuous specimen
al. (2012) (17) auto hardness Vickers hardness

of both types of
polymerized

resin resin.

30 dentures with

E-glass fiber

Goguta LM maxillary reinforcement

clinical woven clinical
et al. (2012) E-glass fiber complete
study unidirectional study follow-up period:
(6)
denture
5 years

4 partial fractures

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 Silanized
Accepted Article aluminum borate

whiskers
flexural
improved the
strength
alluminum auto flexural strength,
Zhang X et surface
in vitro borate flake specimen polymerized surface
al. (2012) (18) hardness
whisker resin hardness, and
thermal
thermal stability
stability
of PMMA. And

optimal amount

was 5 wt%.

Glass fibers,

woven

polyethylene
stainless
braids, and
steel
fatigue polyaramid fibers
Rached RN glass fiber light
mesh failure withstood the
et al. (2011) in vitro polyethylene specimen polymerized
woven flexural fatigue regime
(19)
fiber resin
strength and increased
polyaramid
the flexural
fiber
strength of

implant

overdenture.

Location of the
Yoshida K et maxillary heat
in vitro wire (Co-Cr) wire flexural load
metal
al. (2011) (38) complete polymerized
reinforcement

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 denture resin affected the
Accepted Article fracture

resistance of the

maxillary

complete

dentures.

Reinforcement of

denture base

resin with

heat pre-impregnated
Ladha K et glass fiber woven flexural
in vitro specimen polymerized glass fibers may
al. (2011) (20) nylon fiber unidirectional strength
resin be a useful

means of

strengthening

denture bases.

All reinforced

dentures had

higher flexural

load at the
Takahashi Y maxillary heat
flexural proportional limit
et al. (2011) in vitro E-glass fiber continuous complete polymerized
strength and lower flexural
(39)
denture resin
deflection than

the denture

without

reinforcement.

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 Cast
Accepted Article cobalt-chromium

reinforcement

reduces strain
maxillary
and could
Takahashi T complete auto
cast metal contribute to
et al. (2011) in vitro framework denture polymerized strain
(Co-Cr) fracture
(40)
(strain gaugeresin
avoidance
analysis)
deformation in

maxillary

complete

dentures.

3D FEA exhibit

the effectiveness

maxillary of

complete high-performance
finite
Cheng YY et polyethylene denture polyethylene
element lamella
al. (2010) (44) fiber (finite reinforcement
analysis
element together with

analysis) fiber positions on

enhancement of

denture strength.

By using this
Orenstein IH heat
case cast metal implant technique
et al. (2010) framework polymerized case report
report (Co-Cr) overdenture
(9) existing denture
resin
can be converted

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 into cast
Accepted Article metal-reinforced

implant-retained

overdenture

prosthesis, with

only one

additional office

visit required.

Soft liner

exhibited

stronger bond to

net

Hatamleh heat fiber-reinforced

woven
shear bond
MM et al. in vitro glass fiber specimen polymerized surfaces when
net strength
(2010) (21) resin compared to

smooth and

rough acrylic

interfaces after

thermocycling.

The use of glass

Gharehchahi heat fiber improved

flexural
J et al. in vitro glass fiber continuous specimen polymerized the flexural
strength
(2010) (22) resin strength in acrylic

bases.

Nagata K et finite glass fiber continuous telescope heat Change in the

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 al. (2009) element denture polymerized fracture pass by
Accepted Article
(43)
analysis (finite resin the fiberglass

element increased the

analysis) fracture

resistance.

The metal

strengtheners

with sufficient
transverse
auto length may
Shimizu H et strength
in vitro wire (Co-Cr) wire specimen polymerized provide a
al. (2008) (50) (after
resin preventive
repairing)
denture design

against the

acrylic fractures.

Young's modulus

glass fiber and maximum

rayon fiber flexural load suggests

Dogan OM heat
polyester strength that
et al. (2008) in vitro continuous specimen polymerized
fiber fracture reinforcement
(26)
resin
nylon 6 fiber strength makes resin

nylon 6,6 fiber resistant to

fracture.

Kostoulas IE heat The group

glass fiber fracture
et al. (2008) in vitro woven, wire specimen polymerized
reinforced with
metal wire strength
(24)
resin full lengths of

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 metal wire
Accepted Article offered the best

potential for

reinforcement.

Prepolymerized

fibers improved

the overall
heat
mechanical
polymerized flexural
Bertassoni properties of
resin strength
LE et al. in vitro glass fiber continuous specimen reinforced
auto elastic
(2008) (27) autopolymerized
polymerized modulus
acrylic resins
resin
more than

postpolymerized

fibers.

Most effective

fracture repair method

Kostoulas IE heat
strength was the use of
et al. (2008) in vitro glass fiber woven specimen polymerized
(after autopolymerized
(25)
resin
repairing) resin reinforced

with glass fibers.

mandibular Cast metal

wire
Gonda T et overdenture autopolymerized reinforcement
in vitro cast metal framework strain
(42)
al. (2007) (strain gaugeresin
that covers both
(Co-Cr)
analysis) the midline and

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 the coping top
Accepted Article significantly

reduced the

strain on the

overdenture.

glass fiber E-glass fiber

rayon fiber reinforcement

Dogan OM heat
polyester impact produced
et al. (2007) in vitro continuous specimen polymerized
fiber strength relatively stable,
(29)
resin
nylon 6 fiber high values for

nylon 6,6 fiber each length

Plasma treatment

with

ethylenediamine

monomer was an

effective

Cokeliler D alternative
autopolymerized flexural
et al. (2007) in vitro E-glass fiber continuous specimen method of
resin strength
(30)
increasing the

flexural strength

of denture base

polymers through

fiber

reinforcement

Nakamura Min vitro glass fiber short rod specimen heat flexural Flexural moduli of

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 et al. (2007) polymerized strength acrylic resin at
Accepted Article
(28)
resin fiber contents

exceeding 20%

were significantly

greater than

those without

short-rod glass

fibers.

The applied

glass-fiber

reinforcement

Hedzelek W maxillary heat increased the

bundle fracture
et al. (2007) in vitro glass fiber complete polymerized mechanical
mesh strength
(41)
denture resin strength of the

acrylic resin

palatal denture

bases.

Specimens

reinforced with

stainless steel
heat wires or Co-Cr-Ni
Minami H et glass fiber woven fracture
in vitro specimen polymerized
wires resulted in
al. (2005) (31) metal wire wire strength
resin significantly

higher loads to

fracture as

compared to

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 specimens
Accepted Article without

reinforcement.

The significant

improvement in

fracture
heat
Franklin P et fracture toughness of a
in vitro glass fiber flake specimen polymerized
al. (2005)(33) strength denture base
resin
using glass flake

is an extremely

promising result.

auto

polymerized

resin
flexural Flexural strength
heat
Kanie T et strength was significantly
in vitro glass fiber sheet specimen polymerized
al. (2005) (32) impact increased by the
resin
strength reinforcement.
light

polymerized

resin

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Accepted Article
Figure legend

Figure 1. Flow chart of the systematic review.

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