Patients' Expectations of and Satisfaction with Implant-Supported Fixed Partial Dentures and Single Crowns

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Expectations and final evaluation of complete dentures by patients, dentist and dental technician

There is a poor association between the dentist's evaluation of denture quality and patients' satisfaction with their dentures. Possible differences between dental professionals and patients' expectations might help explain differences in outcome evaluations. This study compared scores given by a dentist, a dental technician and patients for their expectations before and their final evaluation after complete dentures treatment. Twenty completely edentulous patients, a prosthodontist and a dental technician provided scores for the expected aesthetic and functional results of their dentures based on a visual analogue scale at baseline. Post-treatment completion ratings were given after adjustments, by dentist and patients. The dental technician provided post-treatment completion ratings after completing the dentures. The patients had higher expectations than the dental technician and the dentist perceived for both aesthetic and function (P < 0.001). The patients also presented higher post-treatment completion ratings than the dental professionals perceived for final aesthetics (P = 0.016, Kendall's W = 0.207). and function (P = 0.002, Kendall's W = 0.303). Only the dentist presented a statistically significant difference between expectations (lower) and final (higher) outcomes for aesthetics (P = 0.017) and function (P = 0.003). There was no correlation between expectations and post-treatment completion ratings according to the patients' age. There was also no correlation between the patients' gender and expectation scores. Patients presented higher expectations regarding their dentures than dental professionals. The dentist believed that dentures would bring fewer benefits than patients did, but his perception of denture benefits post-treatment was significantly higher than his expectations.

Unrestricted linear dimensional changes of two hard chairside reline resins and one heat-curing acrylic resin

The selection and use of hard chairside reline resins must be made with regard to dimensional stability, which will influence the accuracy of fit of the denture base. This study compared the dimensional change of two hard chairside reline resins (Duraliner II and Kooliner) and one heat-curing denture base resin (Lucitone 550). A stainless steel mold with reference dimensions (AB, CD) was used to obtain the samples. The materials were processed according to the manufacturer's recommendations. Measurements of the dimensions were made after processing and after the samples had been stored in distilled water at 37° C for eight different periods of time. The data were recorded and then analyzed with analysis of variance. All materials showed shrinkage immediately after processing (p < 0.05). The only resin that exhibited shrinkage after 60 days of storage in water was Duraliner II; these changes could be clinically significant in regard of tissue fit.

Water sorption, solubility, and bond strength of two autopolymerizing acrylic resins and one heat-polymerizing acrylic resin.

STATEMENT OF PROBLEM: Because water sorption of autopolymerizing acrylic reline resins is accompanied by volumetric change, it is a physical property of importance. As residual monomer leaches into the oral fluids and causes tissue irritation, low solubility of these resins is desired. Another requirement is a satisfactory bond between the autopolymerizing acrylic resins and the denture base acrylic resin. PURPOSE: This study compared the water sorption, solubility, and the transverse bond strength of 2 autopolymerizing acrylic resins (Duraliner II and Kooliner) and 1 heat-polymerizing acrylic resin (Lucitone 550). MATERIAL AND METHODS: The water sorption and solubility test was performed as per International Standards Organization Specification No. 1567 for denture base polymers. Bond strengths between the autopolymerizing acrylic resins and the heat-polymerizing acrylic resin were determine with a 3-point loading test made on specimens immersed in distilled water at 37 degrees C for 50 hours and for 30 days. Visual inspection determined whether failures were adhesive or cohesive. RESULTS: Duraliner II acrylic resin showed significantly lower water sorption than Kooliner and Lucitone 550 acrylic resins. No difference was noted in the solubility of all materials. Kooliner acrylic resin demonstrated significantly lower transverse bond strength to denture base acrylic resin and failed adhesively. The failures seen with Duraliner II acrylic resin were primarily cohesive in nature. CONCLUSIONS: Autopolymerizing acrylic reline resins met water sorption and solubility requirements. However, Kooliner acrylic resin demonstrated significantly lower bond strength to denture base acrylic resin.

Effect of Surface Treatments on the Bond Strength between Composite Resin and Acrylic Resin Denture Teeth

Purpose: This investigation studied the effects of 3 surface treatments on the shear bond strength of a light-activated composite resin bonded to acrylic resin denture teeth. Materials and Methods: The occlusal surfaces of 30 acrylic resin denture teeth were ground flat with up to 400-grit silicon carbide paper. Three different surface treatments were evaluated: (1) the flat ground surfaces were primed with methyl methacrylate (MMA) monomer for 180 seconds; (2) light-cured adhesive resin was applied and light polymerized according to the manufacturer's instructions; and (3) treatment 1 followed by treatment 2. The composite resin was packed on the prepared surfaces using a split mold. The interface between tooth and composite was loaded at a cross-head speed of 0.5 mm/min until failure. Results: Analysis of variance indicated significant differences between the surface treatments. Results of mean comparisons using Tukey's test showed that significantly higher shear bond strengths were developed by bonding composite resin to the surfaces that were previously treated with MMA and then with the bonding agent when compared to the other treatments. Conclusion: Combined surface treatment of MMA monomer followed by application of light-cured adhesive resin provided the highest shear bond strength between composite resin and acrylic resin denture teeth.

Effect of microwave treatments on dimensional accuracy of maxillary acrylic resin denture base

Microwave energy has been used as an alternative method for disinfection and sterilization of dental prostheses. This study evaluated the influence of microwave treatment on dimensional accuracy along the posterior palatal border of maxillary acrylic resin denture bases processed by water-bath curing. Thirty maxillary acrylic bases (3-mm-thick) were made on cast models with Clássico acrylic resin using routine technique. After polymerization and cooling, the sets were deflasked and the bases were stored in water for 30 days. Thereafter, the specimens were assigned to 3 groups (n=10), as follows: group I (control) was not submitted to any disinfection cycle; group II was submitted to microwave disinfection for 3 min at 500 W; and in group III microwaving was done for 10 min at 604 W. The acrylic bases were fixed on their respective casts with instant adhesive (Super Bonder®) and the base/cast sets were sectioned transversally in the posterior palatal zone. The existence of gaps between the casts and acrylic bases was assessed using a profile projector at 5 points. No statistically significant differences were observed between the control group and group II. However, group III differed statistically from the others (p<0.05). Treatment in microwave oven at 604 W for 10 min produced the greatest discrepancies in the adaptation of maxillary acrylic resin denture bases to the stone casts.

Intercommissural width in 4 racial groups as a guide for the selection of maxillary anterior teeth in complete dentures

Purpose: To determine whether intercommissural width is a reliable guide for the selection of maxillary denture teeth width. Materials and Methods: Casts were made of 160 subjects from 4 different racial groups. Locations of intercommissural width landmarks (the corners of the mouth) were made on the subjects and transferred to the casts. The distances between the corners of the mouth and the distal of the canines were measured on the casts and compared. Results: A weak correlation was found between the distal of the canines and the distance between the corners of the mouth in the 4 racial groups. Conclusion: The use of the corners of the mouth for the selection of artificial teeth is generally inaccurate.

Effect of disinfectants on the hardness and roughness of reline acrylic resins

Purpose: Potential effects on hardness and roughness of a necessary and effective disinfecting regimen (1% sodium hypocholorite and 4% chlorhexidine) were investigated for two hard chairside reline resins versus a heat-polymerizing denture base acrylic resin. Materials and Methods: Two standard hard chairside reliners (Kooliner and Duraliner II), one heat-treated chairside reliner (Duraliner II +10 minutes in water at 55°C), and one standard denture base material (Lucitone 550) were exposed to two disinfecting solutions (1% sodium hypochlorite; 4% chlorhexidine gluconate), and tested for two surface properties [Vickers hardness number (VHN, kg/mm2); Roughness (Ra, μm)] for different times and conditions (1 hour after production, after 48 hours at 37 ± 2°C in water, after two disinfection cycles, after 7 days in disinfection solutions, after 7 days in water only). For each experimental condition, eight specimens were made from each material. Data were analyzed by analysis of variance followed by Tukey's test, and Student's t-test (p= 0.05). Results: For Kooliner (from 6.2 ± 0.3 to 6.5 ± 0.5 VHN) and Lucitone 550 (from 16.5 ± 0.4 to 18.4 ± 1.7 VHN), no significant changes in hardness were observed either after the disinfection or after 7 days of immersion, regardless of the disinfectant solution used. For Duraliner II (from 4.0 ± 0.1 to 4.2 ± 0.1 VHN), with and without heat treatment, a small but significant increase in hardness was observed for the specimens immersed in the disinfectant solutions for 7 days (from 4.3 ± 0.2 to 4.8 ± 0.5 VHN). All materials showed no significant change in roughness (Kooliner: from 0.13 ± 0.05 to 0.48 ± 0.24 μm; Duraliner II, with and without heat treatment: from 0.15 ± 0.04 to 0.29 ± 0.07 μm; Lucitone 550: from 0.44 ± 0.19 to 0.49 ± 0.15 μm) after disinfection and after storage in water for 7 days. Conclusions: The disinfectant solutions, 1% sodium hypochlorite and 4% chlorhexidine gluconate, caused no apparent damage on hardness and roughness of the materials evaluated. Copyright © 2006 by The American College of Prosthodontists.

Effect of post-polymerization heat treatments on the cytotoxicity of two denture base acrylic resins

Introduction: Most denture base acrylic resins have polymethylmethacrylate in their composition. Several authors have discussed the polymerization process involved in converting monomer into polymer because adequate polymerization is a crucial factor in optimizing the physical properties and biocompatibility of denture base acrylic resins. To ensure the safety of these materials, in vitro cytotoxicity assays have been developed as preliminary screening tests to evaluate material biocompatibility. 3H-thymidine incorporation test, which measures the number of cells synthesizing DNA, is one of the biological assays suggested for cytotoxicity testing. Aim: The purpose of this study was to investigate, using 3H-thymidine incorporation test, the effect of microwave and water-bath post-polymerization heat treatments on the cytotoxicity of two denture base acrylic resins. Materials and Methods: Nine disc-shaped specimens (10 x 1 mm) of each denture base resin (Lucitone 550 and QC 20) were prepared according to the manufacturers' recommendations and stored in distilled water at 37°C for 48 h. The specimens were assigned to 3 groups: 1) post-polymerization in a microwave oven for 3 min at 500 W; 2) post-polymerization in water-bath at 55°C for 60 min; and 3) without post-polymerization. For preparation of eluates, 3 discs were placed into a sterile glass vial with 9 mL of Eagle's medium and incubated at 37°C for 24 h. The cytotoxic effect of the eluates was evaluated by 3H-thymidine incorporation. Results: The results showed that the components leached from the resins were cytotoxic to L929 cells, except for the specimens heat treated in water bath (p<0.05). Compared to the group with no heat treatment, water-bath decreased the cytotoxicity of the denture base acrylic resins. Conclusion: The in vitro cytotoxicity of the tested denture base materials was not influenced by microwave post-polymerization heat treatment.

Bond strength of acrylic teeth to denture base resin after various surface conditioning methods before and after thermocycling

This study aimed to evaluate the durability of adhesion between acrylic teeth and denture base acrylic resin. The base surfaces of 24 acrylic teeth were flatted and submitted to 4 surface treatment methods: SM1 (control): No SM; SM2: application of a methyl methacrylate-based bonding agent (Vitacol); SM3: air abrasion with 30-μm silicone oxide plus silane; SM4: SM3 plus SM2. A heat-polymerized acrylic resin was applied to the teeth. Thereafter, bar specimens were produced for the microtensile test at dry and thermocyled conditions (60 days water storage followed by 12,000 cycles). The results showed that bond strength was significantly affected by the SM (P < .0001) (SM4 = SM2 > SM3 > SM1) and storage regimens (P < .0001) (dry > thermocycled). The methyl methacrylate-based adhesive showed the highest bond strength.

The effect of water immersion on the shear bond strength between chairside reline and denture base acrylic resins: Basic science research

Purpose: The effect of water immersion on the shear bond strength (SBS) between 1 heat-polymerizing acrylic resin (Lucitone 550-L) and 4 autopolymerizing reline resins (Kooliner-K, New Truliner-N, Tokuso Rebase Fast-T, Ufi Gel Hard-U) was investigated. Specimens relined with resin L were also evaluated. Materials and Methods: One hundred sixty cylinders (20 × 20 mm) of L denture base resin were processed, and the reline resins were packed on the prepared bonding surfaces using a split-mold (3.5 × 5.0 mm). Shear tests (0.5 mm/min) were performed on the specimens (n = 8) after polymerization (control), and after immersion in water at 37°C for 7, 90, and 180 days. All fractured surfaces were examined by scanning electron microscopy (SEM) to calculate the percentage of cohesive fracture (PCF). Shear data were analyzed with 2-way ANOVA and Tukey's test; Kruskall-Wallis test was used to analyze PCF data (α = 0.05). Results: After 90 days water immersion, an increase in the mean SBS was observed for U (11.13 to 16.53 MPa; p < 0.001) and T (9.08 to 13.24 MPa, p = 0.035), whereas resin L showed a decrease (21.74 MPa to 14.96 MPa; p < 0.001). The SBS of resins K (8.44 MPa) and N (7.98 MPa) remained unaffected. The mean PCF was lower than 32.6% for K, N, and T, and higher than 65.6% for U and L. Conclusions: Long-term water immersion did not adversely affect the bond of materials K, N, T, and U and decreased the values of resin L. Materials L and U failed cohesively, and K, N, and T failed adhesively. © 2007 by The American College of Prosthodontists.

Factors affecting the strength of denture repairs: Topics of interest

Fracture of dentures is a common clinical finding in daily prosthodontic practice, resulting in great inconvenience to both patient and dentist. A satisfactory repair should be cost-effective, simple to perform, and quick; it should also match the original color and not cause distortion to the existing denture. Different repair materials, surface designs, and mechanical and chemical surface treatments have been recommended in order to obtain stronger repairs. This article reviews some of the available literature with regard to the most important factors that may influence the strength of denture repairs. © 2007 by The American College of Prosthodontists.

Influence of length and diameter of implants associated with distal extension removable partial dentures

PURPOSE

Effect of a post-polymerization treatments on the flexural strength and vickers hardness of reline and acrylic denture base resins

This study evaluated the effect of water-bath and microwave post-polymerization treatments on the flexural strength and Vickers hardness of four autopolymerizing reline resins (Duraliner II-D, Kooliner-K, Tokuso Rebase Fast-TR and Ufi Gel Hard C-UGH) and one heat-polymerized acrylic resin (Lucitone 550-L), processed using two polymerization cycles (short cycle - 90 minutes at 73°C and 100°C for 30 minutes; and long cycle - 9 hours at 71°C). For each material, thirty specimens (64 x 10 x 3.3 mm) were made and divided into 3 groups (n=10). Specimens were tested after: processing (control group); water-bath at 55°C for 10 minutes (reline materials) or 60 minutes (L); and microwave irradiation. Flexural strength tests were performed at a crosshead speed of 5 mm/min using a three-point bending device with a span of 50 mm. The flexural strengths values were calculated in MPa. One fragment of each specimen was submitted to Vickers hardness test. Data were analyzed by 2-way ANOVA followed by Tukey's HSD test (α=0.05). L microwaved specimens (short cycle) exhibited significantly higher flexural strength means than its respective control group (p<0.05). Water-bath promoted a significant increase (p<0.05) in flexural strength of K and L (long cycle). The hardness of the tested materials was not influenced by the post-polymerization treatments. Post-polymerization treatments could be used to improve the flexural strength of some materials tested.

Electromyographic evaluation of masseter and anterior temporalis muscles in resting position and during maximum tooth clenching of edentulous patients before and after new complete dentures.

The aim of this study was to assess the electrical activity of the masseter and anterior temporal muscles in patients with severe bone resorption, with complete dentures worn for over ten years, and five months after having new dentures put in place. The RDC questionnaire was applied to twelve asymptomatic patients, before and five months after new dentures were put in place. The electrical activity recordings were made in the mandibular position at rest, and during maximum tooth clenching. The electrical activity of the masseter and anterior temporal muscles in the position at rest presented no statistically significant difference after five months of wearing the new complete dentures. Electrical activity during tooth clenching exhibited a statistically significant reduction only in the right temporal muscle. A period longer than five months of wearing the new complete dentures is required for adaptation and the acquisition of functional capacity.