Stress distribution prevents ischaemia and bone resorption in residual ridge

The influence of oral cavity physiological parameters: temperature, pH, and swelling on the performance of denture adhesives - in vitro study

BACKGROUND

The various physical and chemical conditions within the oral cavity are hypothesized to have a significant influence on the behavior of denture adhesives and therefore the overall comfort of denture wearers. As such, this study aims to understand the influence of oral cavity physiological parameters such as temperature (17 to 52 °C), pH (2, 7, 10), and denture adhesive swelling due to saliva (20-120%) on the behavior of denture adhesives. This study further aims to emphasize the need for a collective approach to modelling the in-situ behavior of denture adhesives.

METHODS

Rheological measurements were carried out using the Super Polygrip Ultra fresh brand denture adhesive cream to evaluate its storage modulus (G´) and loss modulus (G´´) values at a range of physiologically relevant temperatures, pH values, and degrees of swelling, to represent and characterize the wide variety of conditions that occur within the oral cavity.

RESULTS

Rheological data was recorded with respect to variation of temperature, pH, and swelling. Overall, it can be seen that the physiological conditions of the oral cavity have an influence on the rheological properties of the denture adhesive cream. Specifically, our data indicates that the adhesive's mechanical properties are weakly influenced by pH, but do change with respect to the temperature in the oral cavity and the swelling rate of the adhesive.

CONCLUSIONS

Our results suggest that the collective inter-play of the parameters pH, temperature and swelling ratio have an influence on the behavior of the denture adhesive. The results clearly highlight the need for developing a multi-parameter viscoelastic material model to understand the collective influence of physiological parameters on the performance of denture adhesives. Multi-parameter models can also potentially be utilized in numerically simulating denture adhesives using finite element simulations.

Effect of dental implant therapy on the preservation of orofacial tissues: A systematic review and meta-analysis

OBJECTIVE

Fundamentally, this review addresses the following question: In partially or fully edentulous patients, do implant-supported dental prostheses preserve orofacial tissues when compared to conventional prostheses or no therapy?

MATERIALS AND METHODS

This study was conducted according to the 2020 PRISMA guidelines for systematic reviews. Electronic searches were conducted at PubMed and Embase databases followed by manual search. Clinical studies comparing the effect of implant-supported prostheses with conventional rehabilitation or no treatment on alveolar bone resorption, remaining teeth, and jaw muscle thickness were considered for inclusion. A qualitative synthesis was conducted with all included studies, and data from selected studies were pooled quantitatively to perform a meta-analysis.

RESULTS

A total of 14 studies were selected for analysis. Six studies reported on the effect of implant therapy on alveolar bone resorption (n = 453), six on the remaining teeth (n = 1014), while four studies evaluated masseter muscle thickness (n = 158). The results of the meta-analyses assessing alveolar bone resorption in the posterior mandible and in the anterior area of the maxilla, both fixed and random effects models, yielded no benefit of rehabilitation with implant-supported prostheses when compared to conventional prostheses. For masseter bone thickness, however, a significant benefit for implant-supported prosthesis was observed.

CONCLUSIONS

This systematic review and meta-analysis were unable to unequivocally answer the focus question. There are some indicators of the benefit of implant-supported prostheses over conventional prostheses or no therapy in preserving orofacial tissues, particularly for masseter muscle thickness. However, the evidence is still insufficient to confirm such perception.

Enhanced healing process of tooth sockets using strontium-doped TiO2

Prevention of residual ridge resorption is important for tooth socket healing in clinical treatment. As a well known biomaterial, titanium dioxide (TiO₂) has been reported to show desirable bone regeneration capability. On the other hand, strontium plays a role in maintaining normal function in organisms and balancing bone remodeling. Hence, we synthesized strontium-doped titanium dioxide mesoporous nanospheres functionalized with amino-group using diphenyl diisocyanate. After incorporation with segmented polyurethane, the obtained injectable SPU/Sr-TiO₂/MDI nanocomposite adhesive showed satisfactory antibacterial activity and cell nontoxicity. This nanocomposite was used for tooth socket healing, and greatly promoted the formation of new bone tissue in the tooth extraction socket.

Investigation of dental elastomers as oral mucosa simulant materials

Objective

To measure mechanical properties of dental soft liners in tensional stress to identify their suitability as human oral mucosa simulant materials.

Methods

Eleven different dental elastomers were subjected to tensile testing to obtain their tensile strength and elastic moduli (n = 15/group) according to the ISO‐527 method. Fractured surfaces of one specimen per sample group were examined under the light microscope and scanning electron microscope (SEM). Energy‐dispersive X‐ray spectroscopy (EDS) was performed for the elemental analysis or chemical characterization of each sample group. The obtained data were quantitatively and qualitatively analysed. They were also statistically analysed using SPSS version 25.

Results

The tensile strength of dental elastomers ranged from 0.43 MPa (±0.09) to 7.41 MPa (±1.11) and had statistically significant differences between tested groups (p = 0.001). Vertex soft heat‐cure soft liner, GC impression silicones and Silagum soft liners were found to have tensile strengths close to that of the oral mucosa reported by previous studies. SEM analysis revealed that the elastomers with higher filler contents showed rough fractured surface with plucking of particles after tensile fracture.

Conclusion

This is the first study assessing the suitability of dental elastomers as human oral mucosa simulant materials which can be used for in vitro, mathematical modeling and finite element analysis (FEA) to study masticatory force distribution in oral mucosa. Out of 11 studied, six (Vertex Soft, GC heavy and Light body, Molloplast B, Algin X Ultra and Exaclear) dental elastomers showed similar mechanical properties to the Theil embalmed gingival tissues. Vertex Soft, GC Light body, and Molloplast B may be used for the majority of oral mucosal model when considering tensile strength as the primary factor for mechanical stimulation.

Effects of occlusal forces on the peri-implant-bone interface stability

The occlusal forces and their influence on the initiation of peri-implant bone loss or their relationship with peri-implantitis have created discussion during the past 30 years given the discrepancies observed in clinical, animal, and finite element analysis studies. Beyond these contradictions, in the case of an osseointegrated implant, the occlusal forces can influence the implant-bone interface and the cells responsible for the bone remodeling in different ways that may result in the maintenance or loss of the osseointegration. This comprehensive review focuses on the information available about the forces transmitted through the implant-crown system to the implant-bone interface and the mechano-transduction phenomena responsible for the bone cells' behavior and their interactions. Knowledge of the basic molecular biology of the peri-implant bone would help clinicians to understand the complex phenomenon of occlusal forces and their effects on the implant-bone interface, and would allow better control of the negative effects of mechanical stresses, leading to therapy with fewer risks and complications.

Blood Flow Alterations in the Anterior Maxillary Mucosa as Induced by Implant-Retained Overdenture

PURPOSE

Blood flow disturbance from functional pressure may lead to ischemia and accumulation of metabolites leading to residual ridge resorption (RRR) underneath complete dentures. The purposes of this study were to determine the effect of mandibular complete denture (CD) and implant-retained overdenture (IRO) on blood flow disturbance in the opposing denture bearing-mucosa of maxillary CD and to compare the blood flow disturbance to RRR of the anterior maxilla.

MATERIALS AND METHODS

The test group included 9 participants rehabilitated by maxillary CD opposing mandibular IRO, while the control group consisted of 4 participants with CDs. Blood flow was measured by laser Doppler flowmetry (LDF) after denture removal for 0, 30, 60, and 90 minutes. RRR was quantified as reduction in bone volume a year post-treatment. The measurement of blood flow was then compared to the quantification of RRR.

RESULTS

The mean blood flow measure for the IRO group was significantly lower than CD after immediate denture removal and 30 minutes later. After 60 minutes, the mean difference was not significant between groups, and at 90 minutes, the mean blood flow of both groups equalized to reach a steady state of 377 BPU. The mandibular IRO had reduced the initial blood flow measure in the opposing anterior maxilla mucosa to almost a quarter (103 BPU) of the steady state value (377 BPU) compared to the CD, which reduced it to only about one half (183 BPU), suggesting greater blood flow disturbance in the IRO group. This result is in tandem with the greater reduction of bone volume observed in the IRO group, which was 7.3 ± 1.3% after a year, almost three times higher than CD group at 2.6 ± 1.7%.

CONCLUSION

IRO may cause significantly higher blood flow disturbance than CD and may have contributed to greater RRR in the anterior maxilla.

Biomechanical aspects of reinforced implant overdentures: A systematic review

PURPOSE

The purpose of this systematic review was to investigate the effect of reinforcement on the mechanical behaviour of implant overdenture (IOD) bases and its cumulative biological effect on the underlying supporting structures (implants and the residual ridge).

MATERIAL AND METHODS

The required documents were collected electronically from PubMed and Web of Science databases targeting papers published in English that focused on denture base reinforcement for IOD prostheses in order to recognize the principal outcomes of reinforcement on the mechanical and biological properties of overdentures. Such biological outcomes as: strains on implants, peri-implant bone loss, residual ridge resorption, and strain on the residual alveolar ridge.

RESULTS

A total of 269 citations were identified. After excluding any repeated articles between databases and the application of exclusion and inclusion criteria, only 13 publications fulfilled the inclusion criteria. Three publications investigated the mechanical properties of fibre and/or metal-reinforced implant overdentures while another 3 articles investigated the effect of metal reinforcement on stress distribution and strains transmitted to the underlying implants. In addition, 3 in vitro studies investigated the effect of metal reinforcement on overdenture base strain and stresses. Stress distribution to the residual ridge and strain characteristics of the underlying tissues were investigated by 2 in vitro studies. Five clinical studies performed to assist the clinical and prosthetic maintenance of metal-reinforced IOD were included. Data concerning denture base fracture, relining, peri-implant bone loss, probing depth, and implant survival rates during the functional period were extracted and considered in order to evaluate the mechanical properties of the denture base, residual ridge resorption and implant preservation rates, respectively.

CONCLUSION

The use of a denture base reinforcement can reduce the fracture incidence in IOD bases by enhancing their flexural properties and reducing the overdenture base deformation. Strains on the underlying supporting structures of overdenture prostheses including dental implants and the residual ridge can be decreased and evenly distributed using a metal reinforcement.

Changes in hardness of addition-polymerizing silicone-resilient denture liners after storage in artificial saliva

STATEMENT OF PROBLEM

The hardness of silicone resilient denture liners was reported to be more stable than that of acrylic resin resilient denture liners. However, the changes in hardness of these materials in artificial saliva are unclear.

PURPOSE

The purpose of this in vitro study was to evaluate changes in the hardness of addition-polymerizing silicone-resilient denture liners for long-term use after storage in artificial saliva.

MATERIAL AND METHODS

Four addition-polymerizing silicone resilient denture liners were tested: GC Reline Soft, Elite Soft Relining, Megabase, and Mucopren Soft. All were long-term relining materials of the soft type. Fifteen disk-shaped specimens were prepared for each of the tested materials (40 mm in base diameter, 8 mm in thickness). Their initial hardness was assessed with a Shore A durometer, after which they were stored in artificial saliva at a temperature of 37°C. Hardness was examined after 7, 30, and 90 days. Statistical analysis was performed using parametric ANOVA for dependent and independent variables and Tukey honest significant difference (HSD) post hoc tests (α=.05).

RESULTS

All resilient denture liners increased in hardness during the experiment. The change was least for Elite Soft Relining, and GC Reline Soft was the hardest material. Initially, Megabase and Mucopren Soft were significantly softer than the other 2 materials, but their hardness increased rapidly after the first 7 days of specimen conditioning, achieving values close to Elite Soft Relining.

CONCLUSIONS

Within the limitations of the study, room temperature vulcanizing addition-polymerizing polyvinyl siloxanes of the soft type have different initial hardness, and this changes with storage time in artificial saliva at the temperature of the oral cavity.

Effect of mucostatic and selective pressure impression techniques on residual ridge resorption in individuals with different bone mineral densities: A prospective clinical pilot study

STATEMENT OF PROBLEM

Although different impression techniques have been advocated for complete denture prosthodontics, objective studies that predict their effect on alveolar bone resorption are lacking.

PURPOSE

The purpose of this prospective clinical pilot study was to objectively evaluate the effect of complete dentures fabricated by different impression techniques on mandibular residual ridge resorption in individuals with different bone mineral density.

MATERIAL AND METHODS

Ninety-six participants with edentulism, selected according to inclusion criteria, underwent bone mineral density assessment and were divided into normal, osteopenic, and osteoporotic groups. Half of the participants in each group were provided with dentures fabricated by selective pressure impression technique (subgroup SIT), and the other half were provided with dentures fabricated by mucostatic impression technique (subgroup MIT). Computed tomographic scans of the mandible were made at denture delivery and 1 year after prosthesis use to assess alveolar bone height and width difference at marked locations at and after denture delivery. The data obtained were analyzed with the Student t test (α=.05).

RESULTS

Significantly less reduction in mandibular ridge height and width was found in the MIT versus the SIT subgroups in both osteopenic and osteoporotic participants (P<.05). No significant subgroup difference was found for normal bone mineral density group, although resorption increased in height and width for the SIT subgroup.

CONCLUSIONS

Mandibular residual ridge resorption was reduced for dentures fabricated using the mucostatic impression technique compared with the selective pressure impression technique in individuals with diminished bone density.

Association between occlusal force distribution in implant overdenture prostheses and residual ridge resorption

This study aimed to investigate residual ridge resorption (RRR) of anterior and posterior maxillary and mandibular edentulous ridges, in patients treated with mandibular implant overdentures (IOD) and compare with conventional complete denture (CD) wearers, and to determine at each location, the association of RRR with the occlusal forces distribution and other patients' variables. The anterior and posterior RRR of IOD (six males, 17 females) and CD (12 males, 11 females) groups were determined using baseline and follow-up dental panaromic radiographs (DPT) (mean intervals 4 ± 1·8 years). The bone ratios were calculated using proportional area: anatomic to fixed reference areas and mean difference of ratios between the intervals determined RRR. The ridge locations included anterior and posterior maxillary and posterior mandibular arches. The T-Scan III digital occlusal system was used to record anterior and posterior percentage occlusal force (%OF) distributions. There were significant differences in anterior and posterior %OF between treatment groups. Two-way anova showed RRR was significant for arch locations (P = 0·005), treatment group (IOD versus CD) (P = 0·001), however, no significant interaction (P = 0·799). Multivariate regression analyses showed significant association between RRR and %OF at anterior maxilla (P = 0·000) and posterior mandible (P = 0·023) and for treatment groups at posterior maxilla (P = 0·033) and mandibular areas (P = 0·021). Resorption was observed in IOD compared to CD groups, with 8·5% chance of less resorption in former and 7·8% in the latter location. Depending on arch location, ridge resorption at various locations was associated with occlusal force distribution and/or treatment groups (implant prostheses or conventional complete dentures).

Biomechanics of oral mucosa

The prevalence of prosthodontic treatment has been well recognized, and the need is continuously increasing with the ageing population. While the oral mucosa plays a critical role in the treatment outcome, the associated biomechanics is not yet fully understood. Using the literature available, this paper provides a critical review on four aspects of mucosal biomechanics, including static, dynamic, volumetric and interactive responses, which are interpreted by its elasticity, viscosity/permeability, apparent Poisson's ratio and friction coefficient, respectively. Both empirical studies and numerical models are analysed and compared to gain anatomical and physiological insights. Furthermore, the clinical applications of such biomechanical knowledge on the mucosa are explored to address some critical concerns, including stimuli for tissue remodelling (interstitial hydrostatic pressure), pressure–pain thresholds, tissue displaceability and residual bone resorption. Through this review, the state of the art in mucosal biomechanics and their clinical implications are discussed for future research interests, including clinical applications, computational modelling, design optimization and prosthetic fabrication.

Shape Optimization for Additive Manufacturing of Removable Partial Dentures--A New Paradigm for Prosthetic CAD/CAM

With ever-growing aging population and demand for denture treatments, pressure-induced mucosa lesion and residual ridge resorption remain main sources of clinical complications. Conventional denture design and fabrication are challenged for its labor and experience intensity, urgently necessitating an automatic procedure. This study aims to develop a fully automatic procedure enabling shape optimization and additive manufacturing of removable partial dentures (RPD), to maximize the uniformity of contact pressure distribution on the mucosa, thereby reducing associated clinical complications. A 3D heterogeneous finite element (FE) model was constructed from CT scan, and the critical tissue of mucosa was modeled as a hyperelastic material from in vivo clinical data. A contact shape optimization algorithm was developed based on the bi-directional evolutionary structural optimization (BESO) technique. Both initial and optimized dentures were prototyped by 3D printing technology and evaluated with in vitro tests. Through the optimization, the peak contact pressure was reduced by 70%, and the uniformity was improved by 63%. In vitro tests verified the effectiveness of this procedure, and the hydrostatic pressure induced in the mucosa is well below clinical pressure-pain thresholds (PPT), potentially lessening risk of residual ridge resorption. This proposed computational optimization and additive fabrication procedure provides a novel method for fast denture design and adjustment at low cost, with quantitative guidelines and computer aided design and manufacturing (CAD/CAM) for a specific patient. The integration of digitalized modeling, computational optimization, and free-form fabrication enables more efficient clinical adaptation. The customized optimal denture design is expected to minimize pain/discomfort and potentially reduce long-term residual ridge resorption.

Biomechanical factors related to occlusal load transfer in removable complete dentures

Owing to economic conditions, removable dentures remain popular despite the discomfort and reduced chewing efficiency experienced by most denture wearers. However, there is little evidence to confirm that the level of mucosal load exceeds the pressure pain threshold. This discrepancy stimulated us to review the current state of knowledge on the biomechanics of mastication with complete removable dentures. The loading beneath dentures was analyzed in the context of denture foundation characteristics, salivary lubrication, occlusal forces, and the biomechanics of mastication. The analysis revealed that the interpretation of data collected in vivo is hindered due to the simultaneous overlapping effects of many variables. In turn, problems with determining the pressure beneath a denture and analyzing frictional processes constitute principal limitations of in vitro model studies. Predefined conditions of finite element method simulations should include the effects of oblique mastication forces, simultaneous detachment and sliding of the denture on its foundation, and the stabilizing role of balancing contacts. This review establishes that previous investigations may have failed because of their unsubstantiated assumption that, in a well-working balanced occlusion, force is only exerted perpendicular to the occlusal plane, allowing the denture to sit firmly on its foundation. Recent improvements in the simulation of realistic biomechanical denture behavior raise the possibility of assessing the effects of denture design on the pressures and slides beneath the denture.

Long-Term Soft Denture Lining Materials

Long-term soft denture lining (LTSDL) materials are used to alleviate the trauma associated with wearing complete dentures. Despite their established clinical efficacy, the use of LTSDLs has been limited due to the unfavorable effects of the oral environment on some of their mechanical and performance characteristics. The unresolved issue of LTSDL colonization by Candida albicans is particularly problematic. Silicone-based LTSDL (SLTSDL) materials, which are characterized by more stable hardness, sorption and solubility than acrylic-based LTSDLs (ALTSDLs), are currently the most commonly used LTSDLs. However, SLTSDLs are more prone to debonding from the denture base. Moreover, due to their limitations, the available methods for determining bond strength do not fully reflect the actual stability of these materials under clinical conditions. SLTSDL materials exhibit favorable viscoelastic properties compared with ALTSDLs. Furthermore, all of the lining materials exhibit an aging solution-specific tendency toward discoloration, and the available cleansers are not fully effective and can alter the mechanical properties of LTSDLs. Future studies are needed to improve the microbiological resistance of LTSDLs, as well as some of their performance characteristics.