Complete denture wearing and fractures among edentulous patients treated in university clinics

Objective: The prevalence of wearing and fracture of complete dentures was evaluated among edentulous patients treated in two dental schools in Brazil. Background: Acceptance and wearing of complete dentures are related to adaptive behaviour of edentulous patients. However, one reason that could interfere with the wearing dentures is their potential to fracture, which is still a common complication in denture rehabilitation practice. Material and methods: Two hundred and twenty-four edentulous patients rehabilitated with complete dentures from 2000 to 2005 in Araçatuba and Araraquara Dental School, University of State of São Paulo, were assessed in 2006 and 2007 to answer a questionnaire about wearing and fracture of their dentures. Statistical analysis were performed using Epi Info software and chi-squared test to compare maxillary and mandibular data (α = 0.05). Results: Almost 26% of the patients did not wear their dentures, and among the remainder, the majority wore the maxillary denture. About 30% of the dentures were fractured, with higher prevalence in the maxillary arch (p = 0.003). Conclusions: Discontinuation of wearing dentures was quite high, especially considering the treatment which was carried out in university clinics. Prevalence of fractures was also high, greater for the maxillary denture, and was one of the main reasons for non-wearing of complete dentures. © 2011 The Gerodontology Society and John Wiley & Sons A/S.

Flexural strength of acrylic resin repairs processed by different methods: water bath, microwave energy and chemical polymerization

Denture fractures are common in daily practice, causing inconvenience to the patient and to the dentists. Denture repairs should have adequate strength, dimensional stability and color match, and should be easily and quickly performed as well as relatively inexpensive. Objective: The aim of this study was to evaluate the flexural strength of acrylic resin repairs processed by different methods: warm water-bath, microwave energy, and chemical polymerization. Material and methods: Sixty rectangular specimens (31x10x2.5 mm) were made with warm water-bath acrylic resin (Lucitone 550) and grouped (15 specimens per group) according to the resin type used to make repair procedure: 1) specimens of warm water-bath resin (Lucitone 550) without repair (control group); 2) specimens of warm water-bath resin repaired with warm water-bath; 3) specimens of warm water-bath resin repaired with microwave resin (Acron MC); 4) specimens of warm water-bath resin repaired with autopolymerized acrylic resin (Simplex). Flexural strength was measured with the three-point bending in a universal testing machine (MTS 810 Material Test System) with load cell of 100 kgf under constant speed of 5 mm/min. Data were analyzed statistically by Kruskal-Wallis test (p<0.05). Results: The control group showed the best result (156.04 +/- 1.82 MPa). Significant differences were found among repaired specimens and the results were decreasing as follows: group 3 (43.02 +/- 2.25 MPa), group 2 (36.21 +/- 1.20 MPa) and group 4 (6.74 +/- 0.85 MPa). Conclusion: All repaired specimens demonstrated lower flexural strength than the control group. Repairs with autopolymerized acrylic resin showed the lowest flexural strength.

Effect of long-term water immersion on the fracture toughness of denture base and reline resins

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

T-Bar clasp-retained removable partial denture as an alternative to implant-based prosthetic treatment

This article reports the case of a 55-year-old female patient who presented with unsatisfactory temporary crowns in the right mandibular premolars and molars, and a premolar-to-molar fixed partial denture in the left side. The clinical and radiographic examinations revealed a fracture of the left first premolar that was a retainer of the fixed partial denture and required extraction. Initially, the acrylic resin crowns were replaced by new ones, and a provisional RPD was made using acrylic resin and orthodontic wire clasps to resolve the problem arising from the loss of the fixed partial denture. Considering the patient's high esthetic demands, the treatment options for the definitive prosthetic treatment were discussed with her and rehabilitation with implant-supported dentures was proposed because the clinical conditions of the residual alveolar ridge were suitable for implant installation, and the patient's general health was excellent. However, the patient did not agree because she knew of a failed case of implant-retained denture in a diabetic individual and was concerned. The patient was fully informed that implant installation was the best indication for her case, but the arguments were not sufficient to change her decision. The treatment possibilities were presented and the patient opted for a clasp-retained removable partial denture (RPD) associated with the placement of crowns in the pillar teeth. The temporary RPD was replaced by the definitive RPD constructed subsequently. Although RPD was not the first choice, satisfactory esthetic and functional outcomes were achieved, overcaming the patient's expectations. This case report illustrates that the dentist must be prepared to deal with situations where, for reasons that cannot be managed, the patient does not accept the treatment considered as the most indicated for his/her case. Alternatives must be proposed and the functional and esthetic requirements must be fulfilled in the best possible manner.

Effect of repeated disinfections by microwave energy on the physical and mechanical properties of denture base acrylic resins

The present study evaluated the effect of repeated simulated microwave disinfection on physical and mechanical properties of Clássico, Onda-Cryl and QC-20 denture base acrylic resins. Aluminum patterns were included in metallic or plastic flasks with dental stone following the traditional packing method. The powder/liquid mixing ratio was established according to the manufacturer's instructions. After water-bath polymerization at 74ºC for 9 h, boiling water for 20 min or microwave energy at 900 W for 10 min, the specimens were deflasked after flask cooling and finished. Each specimen was immersed in 150 mL of distilled water and underwent 5 disinfection cycles in a microwave oven set at 650 W for 3 min. Non-disinfected and disinfected specimens were subjected to the following tets: Knoop hardness test was performed with 25 g load for 10 s, impact strength test was done using the Charpy system with 40 kpcm, and 3-point bending test (flexural strength) was performed at a crosshead speed of 0.5 mm/min until fracture. Data were analyzed statistically by ANOVA and Tukey's test (α= 0.05%). Repeated simulated microwave disinfections decreased the Knoop hardness of Clássico and Onda-Cryl resins and had no effect on the impact strength of QC-20. The flexural strength was similar for all tested resins.

Fatigue resistance of denture teeth

AIMS: There is no standard test to determine the fatigue resistance of denture teeth. With the increasing number of patients with implant-retained dentures the mechanical strength of the denture teeth requires more attention and valid laboratory test set-ups. The purpose of the present study was to determine the fatigue resistance of various denture teeth using a dynamic load testing machine. METHODS: Four denture teeth were used: Bonartic II (Candulor), Physiodens (Vita), SR Phonares II (Ivoclar Vivadent) and Trubyte (Dentsply). For dynamic load testing, first upper molars with a similar shape and cusp inclination were selected. The molar teeth were embedded in cylindrical steel molds with denture base material (ProBase, Ivoclar Vivadent). Dynamic fatigue loading was carried out on the mesio-buccal cusp at a 45° angle using dynamic testing machines and 2,000,000 cycles at 2Hz in water (37°C). Three specimens per group and load were submitted to decreasing load levels (at least 4) until all the three specimens no longer showed any failures. All the specimens were evaluated under a stereo microscope (20× magnification). The number of cycles reached before observing a failure, and its dependence on the load and on the material, has been modeled using a parametric survival regression model with a lognormal distribution. This allowed to estimate the fatigue resistance for a given material as the maximal load for which one would observe less than 1% failure after 2,000,000 cycles. RESULTS: The failure pattern was similar for all denture teeth, showing a large chipping of the loaded mesio-buccal cusp. In our regression model, there were statistically significant differences among the different materials, with SR Phonares II and Bonartic II showing a higher resistance than Physiodens and Trubyte, the fatigue resistance being estimated at around 110N for the former two, and at about 60N for the latter two materials. CONCLUSION: The fatigue resistance may be a useful parameter to assess and to compare the clinical risk of chipping and fracture of denture tooth materials.

Effect of monomer treatment and polymerisation methods on the bond strength of resin teeth to denture base material

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

Effect of different repair techniques on the accuracy of repositioning the fractured denture base

Objective:This study investigated the efficacy of different techniques for the union of fragments of a denture before repair and on the accuracy of the reposition.Materials and methods:For this study, 20 maxillary dentures made with Lucitone 550 heat-cured resin were used. Points were determined with a scanner on the cusp of the teeth, as a measurement of the segments. After digitisation, each model was exported to the AUTOCAD R 14 program and two-dimensional measurements of the distances between the marked points were made. After the initial analysis, the dentures were fractured into two segments using an impact test machine. For the repair, maxillary dentures were divided into two groups; in the first, the repair was carried out using Kerr's sticky wax and in the second group, Super Bonder was used to join the fragments, with subsequent inclusion of DENTSPLY((R)) Repair Material resin. After the repair, the points of the maxillary dentures were measured again. The numerical values obtained were tabulated to compare the measurements before fracture and after the repair. For statistical analysis, analysis of variance was employed, using a single factor and double factor, followed by the Tukey test with a reliability of 95%.Results:The results demonstrated a statistically significant difference between the materials used to join the dentures for repair, where the dentures were joined with sticky wax presented a larger variation in the distances between the points.Conclusion:The variation in distances between the points is influenced by the agent of repair.

Influence of thermal and mechanical stresses on the strength of intact and relined denture bases

Statement of problem. Denture bases may become increasingly weaker as a result of thermal stress and flexural cyclic loading. Information regarding this potential problem and its relationship to the denture base reline is limited.Purpose. This study evaluated the influence of thermal and mechanical stresses on the strength of intact and relined denture bases.Material and methods. Twenty-eight microwave-polymerized (Acron MC) intact denture bases were prepared in the shape of a 3-mm-thick maxillary denture. Additionally, fifty-six 2-mm-thick denture bases were relined with 1 mm of autopolymerizing resin (Tokuyama Rebase Fast II or New Truliner) (n = 28). Intact and relined specimens were divided into 4 groups (n = 7) as follows: without stress (control); a mechanical stress at 0.8 Hz for 10,000 cycles; 5000 thermal cycles between 5 degrees C and 55 degrees C; or a combination thermo-mechanical stress. The specimens were vertically loaded in compression with a rounded rod at 5 mm/min until failure, using a universal testing machine. Data on maximum fracture load (N), deflection at fracture (%), and fracture energy (N-mm) were analyzed by 2-way analysis of variance and Student-Newman-Keuls tests (alpha = .05).Results. The strength of the denture bases relined with New Truliner was not significantly affected by any of the experimental conditions, but comparing the control groups, New Truliner exhibited the lowest maximum fracture load values. The maximum fracture load of intact denture bases (P = .002) and those relined with Tokuyama Rebase Fast II (P = .01) showed a significant decrease after thermal stress. Additionally, cyclic loading significantly decreased the maximum fracture load (P < .001), deflection at fracture (P = .025), and fracture energy (P < .001) of intact denture bases and those relined with Tokuyama Rebase (P values of .002, .039, and .001, respectively).Conclusion. Thermal and mechanical stresses exert deleterious effects on the strength of intact and/or relined denture bases, which vary according to the relining material used.

Effect of microwave disinfection on the bond strength of denture teeth to acrylic resins

During microwave disinfection, the dentures are exposed to water at high temperature and this may affect the bond between the denture teeth and the acrylic resin from which dentures are made. In this study, a shear test was used to evaluate the effect of microwave disinfection (650W/6 min) on the bond strength of two types of denture teeth to three acrylic resins, with different polymerization methods. The specimens were submitted to the shear tests (0.5 mm/min) after: immersion in water (37 degrees C) for 48 h or 8 days (controls); two or seven cycles of microwave disinfection (test groups). Data (MPa) were analyzed using three-way ANOVA and Tukey HSD test (alpha = 0.05). Microwave disinfection did not adversely affect the bond strength of all tested materials with the exception of QC-20 bonded to SR Vivodent PE, for which a significant reduction was recorded after seven cycles of irradiation. (C) 2007 Elsevier Ltd. All rights reserved.

Effect of water storage on the shear strength and fatigue limit of the reline resin bond to denture base resins

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

Effect of disinfection by microwave irradiation on the strength of intact and relined denture bases and the water sorption and solubility of denture base and reline materials

This study evaluated the influence of microwave disinfection on the strength of intact and relined denture bases. Water sorption and solubility were also evaluated. A heat-polymerized acrylic resin (Lucitone 550) was used to construct 4-mm-thick (n = 40) and 2-mm-thick (n = 160) denture bases. Denture bases (2mm) were relined with an autopolymerizing resin (Tokuso Rebase Fast, Ufi Gel Hard, Kooliner, or New Truliner). Specimens were divided into four groups (n = 10): without treatment, one or seven cycles of microwave disinfection (650 W for 6 min), and water storage at 37 degrees C for 7 days. Specimens were vertically loaded (5 mm/min) until failure. Disc-shaped specimens (50 min x 0.5 mm) were fabricated (n = 10) to evaluate water sorption and solubility. Data on maximum fracture load (N), deflection (%), and solubility (%) were analyzed by two-way analysis of variance and Student-Newman-Keuls tests (alpha = 0.05). One cycle of microwave disinfection decreased the deflection at fracture and fracture energy of Tokuso Rebase Fast and New Truliner specimens. The strength of denture bases microwaved daily for 7 days was similar to the strength of those immersed in water for 7 days. Microwave disinfection increased the water sorption of all materials and affected the solubility of the reline materials. (C) 2007 Wiley Periodicals, Inc.

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.

Severe fracture of the maxillary alveolar process associated with extrusive luxation and tooth avulsion: A case report

Aim: The aim of this report is to present a case of severe fracture of the maxillary anterior alveolar process with substantial bone dislodgement associated with extrusive tooth luxation and avulsion. Background: Dentoalveolar trauma is a challenge to dentistry, especially in young patients, for it can lead to early tooth loss which compromises oral function, esthetics, self-esteem, and alter the long-term plan of care for the victim. Case Report: A 12-year-old girl with severe dentoalveolar trauma to the maxillary anterior region presented for emergency care for her injury. Treatment consisted of fracture reduction of the alveolar process, repositioning of the teeth that had suffered extrusive luxation, placement of a semi-rigid splint, and suturing of soft tissue lacerations. The traumatized teeth presented with pulpal necrosis and were treated endodontically. After 24 months of follow up, the fracture of the alveolar process was completely healed and the displaced teeth presented no signs of ankylosis or root resorption. Summary: First-aid care contributed remarkably to this case allowing the re-establishment of esthetics, function, and patient's self-esteem. In spite of trauma extension the treatment outcomes were favorable. Clinical Significance: Cases of dentoalveolar trauma should be evaluated on an individual basis. However, early emergency management and adequate follow-up can prevent further complications and contribute to treatment success.