Clinical application of removable partial dentures using thermoplastic resin—Part I: Definition and indication of non-metal clasp dentures

Effect of various surface treatment methods on shear bond strength between acrylic denture teeth and thermoplastic nylon denture base

PURPOSE

To evaluate the effect of mechanical, chemical, and mechanical-chemical surface treatment methods on shear bond strength between acrylic denture teeth and thermoplastic nylon denture base.

MATERIALS AND METHODS

Maxillary central incisor teeth were treated with five different surface treatment methods: mechanical (sandblasting, T-shape diatoric holes), chemical (5% acetic acid solution, bonding agent), and mechanical-chemical (sandblasting + bonding agent) were embedded in thermoplastic nylon denture base (n = 10). A universal testing machine with a crosshead speed of 0.5 mm per minute was used to test the shear bond strength. Data obtained were statistically evaluated using one-way ANOVA and followed with Tukey post hoc test (α = 0.05) RESULTS: T-shaped diatoric holes exhibited significantly higher shear bond strength among the surface treatment groups, followed by sandblasting + bonding agent, sandblasting, bonding agent, and the acetic acid group (p < 0.001) CONCLUSION: T-shaped diatoric holes as a mechanical surface treatment showed higher shear bond strength than other methods.

Oral health-related quality of life of conventional removable partial dentures, unilateral nonmetal clasp dentures, and shortened dental arch with 2- or 3-tooth unilateral distal extension tooth loss in the mandible: A randomized, crossover, clinical trial

STATEMENT OF PROBLEM

Conventional removable partial dentures with metal clasps are still a common option for patients with distal-extension tooth loss. However, unilateral nonmetal clasp dentures fabricated by using a thermoplastic denture base resin are increasingly being used. Furthermore, the shortened dental arch concept remains controversial, in spite of being advocated for many years. Nevertheless, these treatment options remain controversial, particularly in patients with the loss of a few distal teeth unilaterally.

PURPOSE

The purpose of this randomized, crossover, clinical trial was to investigate the oral health-related quality of life of participants who requested a new dental prosthesis (unilateral nonmetal clasp dentures or conventional removable partial dentures) at a private practice.

MATERIAL AND METHODS

A 3-period, randomized, crossover design was used in a within-subject, controlled, clinical trial. Twenty-four participants (mean age 59.0 years [7 men: 62.6 {45-85} years; 17 women: 57.5 {24-75} years]) were enrolled. All experimental procedures were approved by the Ethics Committee of Nagasaki University Hospital (#15022313) and registered in the International Standard Randomized Controlled Trial Number registry (ISRCTN49105064). All participants were fully dentate in the maxilla and had unilateral distal-extension loss of 2 or 3 teeth in the mandible. Participants were allocated to 1 of 6 groups and treated with prescribed options in accordance with their allocated sequences and used a dental prosthesis or nothing for 2-week periods. At the end of each intervention, the participants were asked to answer the Oral Health Impact Profile questionnaire. Differences in Oral Health Impact Profile scores among groups were estimated with a mixed-effects model (α=.05).

RESULTS

Total Oral Health Impact Profile scores were higher for unilateral nonmetal clasp dentures (P=.002) and shortened dental arch (P=.049) than for conventional removable partial dentures, with medium and small effects. The unilateral nonmetal clasp dentures had a similar effect compared with shortened dental arch (P>.05). unilateral nonmetal clasp dentures (P=.011) and shortened dental arch (P=.005) demonstrated medium effects in the oral function dimension compared with conventional removable partial dentures. Unilateral nonmetal clasp dentures exhibited large and medium effects in the orofacial appearance dimension compared with conventional removable partial dentures (P=.001) and shortened dental arch (P=.006). In the orofacial pain dimension, shortened dental arch showed effects similar to those of conventional removable partial dentures and unilateral nonmetal clasp dentures (P>.05), and no significant differences were observed in the psychosocial impact dimension (P>.05), but the unilateral nonmetal clasp denture score was lower than the conventional removable partial denture score, with a small effect. Men had significantly lower total Oral Health Impact Profile scores for shortened dental arch than women (P=.033).

CONCLUSIONS

Unilateral nonmetal clasp dentures and shortened dental arch were better than conventional removable partial dentures for the oral health-related quality of life of individuals with unilateral distal-extension tooth loss in the mandible, and sex had a significant effect on removable prosthetic planning.

The Cytotoxic Effect of Thermoplastic Denture Base Resins: A Systematic Review

Partial or complete dentures are constructed from thermoplastic resins that are thermally processed and molded. This review examines the presently available evidence for the cytotoxicity of thermoplasticized denture base resins on human gingival epithelial cells, adipose cells, and fibroblasts; human amnion fibroblasts; and mouse fibroblasts. Electronic searches were performed on PubMed, Scopus, Web of Science, and Google Scholar databases to identify relevant articles to be included in the review until September 2022. Clinical, in vivo, and in vitro studies in English language were searched for. The quality of the studies was assessed using the Toxicological data Reliability Assessment tool (ToxRTool) developed by the European Commission's Joint Research Centre. GRADE assessment was used to evaluate the certainty of evidence. Seven in vitro studies were included in the review. The overall risk of bias was determined to be high, with the majority of studies assessed found to be reliable with restrictions or not reliable. Only two studies were considered reliable without restrictions based on ToxRTool assessment. The effect of thermoplastic denture base resins on viability and cell adherence of human gingival or amnion fibroblasts and mouse fibroblasts (L929s) is not significant. Conditioned media from unpolished specimens of resins were significantly more toxic to cultured cells than those from polished specimens. This may be of concern in cases of poor post-processing of dentures. Based on the limited evidence available, there is low-certainty evidence that thermoplastic denture base resins appear to be biocompatible and show insignificant cytotoxicity. Further well-designed trials adhering to standard reporting guidelines and using objective measures are necessary before outlining universal guidelines for best practice. Long-term in vivo and clinical assessment is necessary to corroborate laboratory findings with clinical outcomes. Denture base resins are in constant contact with oral tissues, and cytotoxic components released by the resins may irritate or inflame the tissues or provoke an allergic response.

Comparison of the impact of two types of removable partial dentures on the periodontal health of the remaining teeth: A prospective clinical study

OBJECTIVE

To evaluate and compare the impact of two removable partial dentures (acrylic removable partial denture [ARPD] and metallic removable partial denture [MRPD]) on periodontal tissues of the remaining teeth in the first 12 months of denture use.

MATERIALS AND METHODS

This prospective clinical study included 40 patients, of which 20 received ARPDs, 20 received MRPDs, nine in the maxilla, and 11 in the mandible each. The patients were 45-65 years old; 24 were females, and 16 were males. Patients' demographic details, clinical indicators of periodontal complications, and biochemical measurement of Hs-C-reactive protein (CRP) and alkaline phosphatase (ALP) were considered. One-way analysis of covariance and Friedman were used to measure the differences in clinical periodontal parameters between the two types of dentures.

RESULTS

The significant findings were: Plaque index (PLAQ) scores for abutment teeth were higher in MRPD wearers (mean = 12.15) than ARPD wearers (mean = 10.45), whereas ARPD users had significantly higher mean bleeding on probing (BOP) values (mean = 1.5) than MRPD users (mean = 0.00); mobility of abutment teeth showed no significant differences; timeline comparisons showed a significant increase in the percentage of nonabutment teeth mobility in ARPD users (p = .028) compared with MRPD users over the same follow-up period (p = .102).

CONCLUSIONS

For a short-term period of 1 year, periodontal and mobility parameters have no significant impact on the abutment and nonabutment teeth of ARPD and MRPD users. Moreover, biochemical markers (CRP and ALP) for periodontal inflammation exhibited no significant difference in both types of dentures.

Effect of retention hole designs in artificial teeth on failure resistance of the connection with thermoplastic resin

This study aimed to evaluate the effect of retention hole designs in artificial teeth on failure resistance of the connection with a thermoplastic denture base resin. Artificial teeth with the following retention hole designs were attached to polyester and polyamide resins: no hole, vertical hole, horizontal hole, and vertical and horizontal holes. An artificial tooth with no hole attached to polymethyl methacrylate was prepared as the control. The load was applied until connection failure occurred between the artificial tooth and resin, and failure resistance was detected. Although the control showed the highest resistance, the artificial tooth with vertical and horizontal holes showed higher resistance than those with other retention hole designs in both thermoplastic resins. Providing vertical and horizontal retention holes in artificial teeth may be effective in improving failure resistance of the connection with thermoplastic resins.

Strength of Polyether Ether Ketone Composite as a Major Connector Material for Removable Partial Dentures

PEEK composite was tested mechanically as a maxillary removable partial denture (RPD) framework material instead of cast cobalt chromium alloy. Methods: Partial edentulous upper jaw cast was scanned using structured-light 3D scanner, palatal strap (PS) designs for RPD were designed by a designing dental laboratory software. CAD/CAM machine fabricated PSs patterns using their designs’ STL software files. PSs were made from poly-ether-ether ketone (PEEK) reinforced by ceramic fillers using thermal injection press technique and Co-Cr alloy using centrifugal casting, each material group was subdivided into two subgroups according to storage conditions (stored and non-stored subgroups), storage took place in deionized water for about 180 days at 37.5 ± 2 o C. All specimens were subjected to fracture resistance test using universal testing machine then maximum compression load (MCL) result values were subjected to statistical analysis. PEEK composite specimens were scanned by field emission microscope (FEM) and energy dispersive spectroscopy. Storage water of PEEK composite was analyzed using atomic absorption spectroscopy (AAS). Results: In either stored or non-stored subgroups of PEEK composite straps they showed significant lower mean MCL values than corresponding alloy subgroups (p=0.0001). FEM scanning showed fillers agglomerations in non-stored PEEK composite and their nearly absence from stored PEEK composite specimens. AAS detected Al element in PEEK composite storage water. Conclusion: Mechanically thermally injected ceramic reinforced PEEK composite could not replace cast Co-Cr alloy as PSs material for maxillary RPD. Biocompatibility concerns raised in this study due to suspected Al leaching and ceramic fillers dissolution from PEEK composite matrix.

Possibility of Using Flexible Dentures over Iliac Bone Graft in Adolescent Patients with Ameloblastoma: A 9-Month Follow-Up Clinical Report

INTRODUCTION

The use of bone grafts is a common procedure after excision and reconstruction of the mandible, although it is rare in children and adolescents due to incomplete growth, which means a long transition period until reaching an appropriate age for implants or more predictable outcomes. Case Report. This article describes a 9-month follow-up of the use of a flexible denture above a bone graft taken from the anterior iliac crest for adolescent patients with resected mandible due to ameloblastoma. Taking into account prosthetic considerations, radiography, and clinical observation, no complications were seen with the graft.

CONCLUSION

It is safe to use a flexible denture as a prosthetic over an iliac bone graft block during the healing period.

3D Printing of Polyamide to Fabricate a Non-Metal Clasp Removable Partial Denture via Fused Filament Fabrication: A Case Report

The fabrication of a non-metal clasp removable partial denture (RPD) using polymethylmethacrylate in a fully digital workflow has been reported. According to some studies, the polyamide material may be alternatively used for this purpose. The authors are unaware of any reports concerning the additive manufacturing of polyamide. The current proof-of-concept dental technique describes the pathway to construct the non-metal clasp RPD using intraoral scanning and fused filament fabrication (FFF) printing of gingiva-colored polyamide. The present RPD showed acceptable fit and sufficient retention and was considered a valid temporary treatment option.

Flexural and fatigue properties of polyester disk material for milled resin clasps

To evaluate the flexural and fatigue properties of a polyester disk material used in milled resin clasps of removable partial dentures, experimental polyester disk (mPE), injection-molded polyester (iPE), and polymethyl methacrylate disk (mPMMA) were examined by three-point bending tests and cyclic fatigue tests at 0.75 or 1.50 mm deflection. The mPE exhibited significantly higher flexural strength than the iPE (p<0.05). Meanwhile, the mPMMA displayed higher flexural modulus and strength than the polyesters. The mPE exhibited a significantly lower residual strain than the iPE at the cyclic 0.75 mm deflection (p<0.05); however, microcracks were observed in the mPE at the 1.50 mm deflection. The mPMMA showed a high residual strain at the 0.75 mm deflection and fractured within 1,000 cycles at the 1.5 mm deflection. The higher flexural strength and lower residual strain of the mPE compared with the iPE suggest the advantages of milled resin clasps within a limited deflection.

Stress distribution and patient satisfaction in flexible and cast metal removable partial dentures: Finite element analysis and randomized pilot study

Purpose

To compare stress distribution in polyacetyl based flexible RPD (FRPD) with cast metal RPD (CRPD) by using three-dimensional finite element analysis (FEA) and patient satisfaction by using OHIP-14 questionnaire in participants with Kennedy's class I partially edentulous mandibular arch rehabilitated with CRPD and FRPD.

Material and methods

For FEA, 3D models of Kennedy's class I partially edentulous mandibular arch, CRPD in chrome-cobolt alloy, and polyacetyl based FRPD were geometrically modelled and subjected to a vertical load of 100 ​N bilaterally. The in vivo comparison of satisfaction was assessed by enrolling 22 participants with Kennedy's class I partially edentulous mandibular arch. After randomization, 11 participants were rehabilitated by CRPD (group C), and 11 participants by polyacetyl based FRPD (group F). OHIP-14 questionnaire in Hindi language was filled at 1 week and 1 year after denture insertion.

Results

Von Mises stress distribution in CRPD was maximum in mesial rest seat of the primary abutment (100 ​MPa) and minimum for edentulous ridge (7 ​MPa on bone and 6 ​MPa on mucosa). Von Mises stress distribution for polyaccetyl based FRPD was maximum in ridge (25 ​MPa) and minimum in periodontal ligament of the second premolar (3 ​MPa). Patient satisfaction in group F was significantly more than in group C at end of 1 year (P ​= ​.0158).

Conclusion

FRPD is useful in periodontally compromised abutment teeth and CRPD in resorbed ridge conditions. Patient satisfaction is more with polyacetyl based flexible RPD when compared with cast metal RPD at the end of 1 year.

Short-term effect of thermoplastic resin removable partial dentures on periodontal health: a randomized cross-over trial

PURPOSE

This study aimed to compare the short-term effects of thermoplastic resin removable partial dentures (TR-RPDs), referred to as non-metal clasp dentures, with those of metal-clasp-retained RPDs (MC-RPDs) on the periodontal health of abutment teeth.

METHODS

A randomized cross-over trial was conducted in 28 partially dentate patients. Participants were randomized into two groups and received MC-RPDs followed by TR-RPDs, or vice versa, for 3 months. Periodontal clinical parameters, such as the plaque index, gingival index, probing pocket depth, tooth mobility, and microbiological status of the abutment teeth, were evaluated at the delivery and 3 months after using each RPD.

RESULTS

Of the 28 patients enrolled, 24 (mean age, 67.3 years) completed the trial, and 55 abutment teeth were evaluated. The periodontal condition of the abutment teeth did not deteriorate after 3 months of using both types of RPDs. There was no statistically significant difference in the plaque index, gingival index, probing pocket depth, tooth mobility, and the red complex bacteria between TR- and MC-RPDs (p >0.05). The Periotest value for TR-RPDs was significantly lower than that for MC-RPDs (p <0.05). However, this difference was not clinically significant.

CONCLUSIONS

These results suggest that the influence of TR-RPDs on the periodontal health of abutment teeth was limited within 3 months of use.　Trial registration number: The study protocol was registered at UMIN-CTR (UMIN000007310).

Modern partial dentures - part 2: a review of novel metal-free materials and innovations in polymers

New materials are continuously being developed and advanced for the provision of partial dentures. However, the rate at which they are developing makes it hard for the clinician to discern which would be worth adopting into their practice.This paper looks at some of those materials, including the earlier alternatives to conventional acrylic resins, polyamides and acetal resin, followed by a review of the newer novel polymers that are currently in use, including aryl-ketone-polymers and the polymer group polyaryletherketones.The newer polymers have many similarities, in both properties and aesthetics, such as increased elasticity that allows the dentures to engage deeper undercuts, while maintaining high strength. A significant benefit of the novel polymers is in their ability to fit into a digital workflow. Computer-aided design and manufacture confer a high degree of consistency, efficiency and accuracy in the prosthesis. The ability to use precise digital tools to create frameworks and clasps of accurate parameters limits the introduction of technical error that has the potential to be introduced in the construction of a conventional cobalt-chrome framework.The novel high-performance polymers show great promise. Research is needed on these materials investigating the effects on oral health, longevity and survival of the appliances, as well as studies looking at patient satisfaction and the impact on quality of life.

Survey of Current Predoctoral Removable Partial Denture Curriculum in the United States

The purpose of this survey was to determine removable partial denture (RPD) framework design concepts, new materials, and digital technology that are currently being taught in the predoctoral RPD curriculums in the U.S. dental schools. A questionnaire including RPD framework design concepts, materials, and digital technology was created on Qualtrics. The link to the questionnaire was distributed by email in May 2018 to U.S. dental schools. Thirty-nine of the sixty-six schools responded, yielding a response rate of 59%. Most schools are utilizing textbooks by McCracken and/or Stewart as their primary reference (90%). Only a few schools teach incisal rest (24%) and intra-coronal retainers (8%) in the clinic. The majority of schools teach three or less clasp assembly variations for distal extension RPD scenarios and utilize altered cast impression techniques only for selective patient scenarios. Half of schools currently utilize digital technology in their RPD curriculum. Although twenty-five schools (69%) indicated that implant-assisted RPD (IARPD) is being taught in the curriculum, only nineteen of them teach IARPDs in the clinic. Half of schools are utilizing non-metal clasp denture (NMCD) in their curriculum; most of these school provide this treatment as immediate/interim partials or long-term interim partials. Many U.S. dental schools are simplifying RPD design concepts and principles that are being taught. More schools are introducing new concepts and materials such as IARPD and NMCDs while incorporating digital technology in their predoctoral RPD curriculum.

Impact of rehabilitation with removable complete or partial dentures on masticatory efficiency and quality of life: A cross-sectional mapping study

STATEMENT OF PROBLEM

Tooth loss directly affects mastication, cognitive function, and oral health-related quality of life (OHRQoL). Complete dentures (CDs) and removable partial dentures (RPDs) represent a common oral rehabilitation approach. However, studies addressing the impact of removable dentures on replacing missing teeth are lacking.

PURPOSE

The purpose of this clinical study was to evaluate whether the OHRQoL, the jaw function limitation (JFL), and the masticatory efficiency of CD and RPD wearers are similar to those of patients with natural teeth and to evaluate whether wearing removable dentures can predict an effect on the OHRQoL, JFL, and masticatory efficiency of their wearers.

MATERIAL AND METHODS

The Oral Health Impact Profile (OHIP-14) questionnaire and the JFL scale were used to measure OHRQoL and JFL. Masticatory efficiency was analyzed by using a subjective color-mixing index for the chewing gum bolus and shape index and an objective colorimetric analysis by using a software program ViewGum. Data were analyzed with Kruskal-Wallis and post hoc Dunn tests, followed by multiple linear regression (α=.05).

RESULTS

The results from OHIP-14 evidenced that both denture groups presented a low impact on OHRQoL. JFL was higher for all denture wearers. For the subjective color-mixing analysis, the control and RPD groups presented better masticatory efficiency than CD wearers. Colorimetric analysis evidenced better masticatory efficiency for the control group, who differed from the CD and RPD groups. Wearing RPDs was a predictor of impaired JFL and OHRQoL, and the use of CDs was a predictor of impaired JFL and masticatory efficiency.

CONCLUSIONS

Despite being rehabilitated, CD and RPD wearers still had impaired OHRQoL, JFL, and masticatory efficiency. Also, the use of these prostheses can predict a negative effect on these 3 variables.

Bond strength of artificial teeth to thermoplastic denture base resin for injection molding

This research was conducted to investigate the bond strength between artificial teeth and a thermoplastic denture base resin for injection molding with different surface preparations for use in flexible resin removable partial dentures. Composite resin denture teeth and acrylic denture resin teeth were bonded to three types of thermoplastic denture base resins for injection molding (polyamide, polyester, and polycarbonate) and a conventional heat-polymerized polymethyl methacrylate (PMMA) resin (control). The ridge lap surfaces of the artificial teeth were classified into four groups based on the type of ridge lap surface treatment applied (n=10): no treatment, ethyl acetate, small T-shaped tunnel, and large T-shaped tunnel. The specimens were tested for bond strength. The results showed that the ethyl acetate treatment was ineffective for enhancing the bond strength (p>0.05) between the artificial teeth and thermoplastic denture base resin for injection molding, whereas the T-shaped tunnel was quite effective in this regard (p<0.05).

The Relationship of Modulus of Elasticity and Micro-Hardness of Denture Bases to Pressure Transmission under the Thermoplastic Nylon Denture Base

Introduction: The purpose of this study was to evaluate the relationship of modulus of elasticity and micro-hardness of denture bases to pressure transmission under the thermoplastic nylon denture base.Material and Methods: Mandibular first molar acrylic denture teeth (Bioeco) embedded on 15x15x3 mm3 thermoplastic nylon (TCS and BioTone) and poly methyl methacrylate denture bases were evaluated (n=9). A 100N force applied on the specimen using universal testing machine and the pressure transmitted under the specimen observed using pressure transducer. The modulus of the elasticity (n=16) measured on 64x10x3,3 mm3 specimens and micro-hardness (n=16) measured on 10x10x3 mm3 specimens. Data were statistically analyzed using One-way Anova followed by Tukey HSD post hoc test. Pearson correlation test used to evaluate the relationship of modulus of elasticity and micro-hardness on denture bases to pressure transmission (α ≥ 0,05).Results: The results showed that poly methyl methacrylate has the highest pressure transmission compared to others. There was a significant relationship between modulus of elasticity and micro-hardness to pressure transmission under the denture base.Discussion: This study can help dentists to determine the design of dentures, especially in the selection of denture base materials.

Teaching the Design and Fabrication of RPD Frameworks With a Digital Workflow: A Preclinical Dental Exercise

Introduction

The conventional method for teaching removable partial denture (RPD) design using a pencil drawing on a solid cast has always been the basis for teaching RPD design in most dental schools at both the undergraduate and graduate levels. This does not apply to RPD fabrication technology, as more laboratories have recently adopted more efficient and versatile digital techniques to design and fabricate RPD frameworks.

Methods

At the University of Iowa College of Dentistry, we created a pilot workshop to assess the efficiency of a new approach to teaching RPD design utilizing this new digital RPD technology as a teaching tool for graduate prosthodontics residents. Three first-year prosthodontics residents were enrolled in the workshop, which involved learning the new digital workflow of designing RPD.

Results

This new teaching approach very successfully achieved its educational goals. The residents reported that the digital RPD teaching approach enriched their knowledge and deepened their understanding of RPD design.

Discussion

The technique garnered significant interest from the students and seemed to also increase their understanding of the steps involved in RPD fabrication as well as the different components of the RPD.

Improving Esthetics of Removable Partial Dentures Using Palatal Retentive Arms

A well-designed removable partial denture can replace the loss of hard and soft tissues, restore masticatory function and maintain arch integrity. It is relatively simple, non-invasive and economical compared to other treatment options. Removable partial denture is therefore a common option among various treatment replacing missing teeth. A removable partial denture replacing anterior missing teeth can improve esthetics and hence the patient’s quality of life. However, metal components of a removable partial denture may be visible and affects patient satisfaction. Esthetics of a removable partial denture can often be improved with some modifications to traditional designs. This article reported the use of a cobalt-chromium-based removable partial denture to replace a missing maxillary lateral incisor and molars. Palatal retentive arms were employed as the retentive components on the premolars to avoid the metal component being seen when speaking and smiling. The indications and design of the removable partial dentures with palatal retentive arms are also discussed.

Cost-effectiveness analysis of prosthetic treatment with thermoplastic resin removable partial dentures

PURPOSE

The aim of this study was to compare the cost-effectiveness of thermoplastic resin removable partial dentures (TR-RPDs) with metal clasp-retained removable partial dentures (MC-RPDs), from the patients' perspective.

METHODS

Patient-reported outcome measures (Oral health-related quality of life [OHRQoL], patient satisfaction, oral appearance) were assessed among 24 partially dentate subjects who completed a randomized crossover trial comparing TR-RPDs and MC-RPDs. The prosthetic treatment fee for patients was used as the direct cost. The cost of achieving a clinically minimum important difference (MID) in Oral Health Impact Profile (OHIP) summary score, and the incremental cost-effectiveness ratio (ICE R) for each outcome measure were determined.

RESULTS

OHRQoL, patient satisfaction, and oral appearance was rated higher with TR-RPDs compared to MC-RPDs. The median cost of achieving a MID in OHRQoL with TR-RPDs ($698) was 6.5 times higher than that with MC-RPDs ($107). The ICER was $67 for the OHIP summary score, $195 for the satisfaction score, and $1,169 for the oral appearance rating.

CONCLUSIONS

Although TR-RPDs provide better OHRQoL, patient satisfaction, and oral appearance than MC-RPDs, the cost-effectiveness of TR-RPDs was inferior to MC-RPDs from the patients' perspective.

Nonmetal clasp dentures: What is the evidence about their use?

The aim was to discuss the indications, contraindications, advantages, and disadvantages of Nonmetal clasp dentures (NMCDs), as well as the most relevant properties of its constituent materials. A search was conducted using the keywords: “nonmetal clasp dentures,” “thermoplastic resin,” “flexible resin removable partial denture,” “polyamide,” and “nylon” in databases PubMed/Medline, Lilacs, SciELO, and textbooks between 1955 and 2020. Theses and texts without reliable sources of publication were excluded. Once the analysis instruments were determined, the data were analyzed and discussed. NMCDs present high flexibility, easy adaptation to the abutments, color compatibility and biocompatibility with the oral mucosa, and absence of visible metal clasps. However, they need laboratory relining, grinding, and polishing, do not have criteria for its planning, become rougher and stained over time, and are able to traumatize supporting tissues. The association with metal components seems to be an alternative to increase the success of NMCDs by combining esthetics and biomechanical principles of conventional removable partial dentures. The lack of long-term clinical studies makes the professionals to rely solely on previous experiences or on the manufacturers' recommendations. It suggested that NMCDs must be indicated with caution when not used temporarily.

Attitude of dental professionals toward cast partial denture: A questionnaire survey in India

Aims:

The use of cast partial dentures (CPDs) has been decreased and its importance has been declined in the teaching curriculum. The purpose of this survey was to evaluate the attitudes of dental professionals toward conditions using CPDs in private practice in India.

Settings and Design:

Descriptive survey

Materials and Methods:

This survey consists of eight close-ended questions concerning the use of CPD by dental professionals practicing in India. The URLs of the questionnaire were shared via E-mail to dentists practicing throughout India, to obtain a response of 384 which is a predetermined sample size.

Statistical Analysis Used:

Statistical analysis was done using counts and percentages and the results were further analyzed statistically by the Chi-square test.

Results:

Nearly 42.79% of general dental practitioners (GDPs), 47.26% of prosthodontists, and 9.95% of other specialist dentists responded to the questionnaire. GDPs mostly preferred removable partial dentures (RPDs) (71.87%) and fixed partial dentures (57.22%), whereas prosthodontists preferred mostly implant (60.91%). GDPs mostly preferred flexible dentures (62.42%), whereas prosthodontists preferred CPDs 62.84%. Almost 52.50% of the GDPs mostly raised a cost issue and 63.11% of the prosthodontists had difficulty in adjustment with CPDs. Nearly 63.46% of the dentists told that implant-supported restorations are better options compared to CPDs; still, majority of the dentists (53.23%) were in favor that more importance for teaching CPDs in graduation curriculum should be given.

Conclusions:

This survey shows that in India a significant proportion of GDPs (71.87%) preferred RPDs, mostly flexible dentures (62.42%) due to their low cost compared to CPDs. Prosthodontists mostly preferred implants (60.91%) because they are more confident and better trained in these. It is recommended that more importance be given in teaching implants along with CPDs in graduation curriculum so that practitioners can better educate their patients about implants and their advantages over flexible dentures and their utilization in cases where patients are not willing for CPDs.

Finite-element analysis and optimization of the mechanical properties of polyetheretherketone (PEEK) clasps for removable partial dentures

PURPOSE

Polyetheretherketone (PEEK), a high-strength, aesthetic, and non-allergic thermoplastic polymer, recently became a candidate for replacing metallic components in dental prosthesis. However, as PEEK is flexible, the need for retention presents a key challenge in terms of its clinical application. In this study, clasps prepared using PEEK were optimized and evaluated to provide the mechanical properties required by dentures.

METHODS

Seventy-two three-dimensional rod-shape models, based on four thickness/width ratios, three base widths, and six taper ratios were created. These models were analyzed using finite-element methods to determine which modified clasp arm shape provided the most appropriate mechanical properties. Three shape-optimized PEEK specimens and one standard-shape Co-Cr alloy specimen were then fabricated. Constant-displacement fatigue testing was performed to calculate load values and deformations after ten years of clinical use.

RESULTS

Shape optimization indicated a maximum stress concentration that was consistently located at the base of the specimen, a correlation between mean load values and thickness that was greater than that with the width, and a correlation between taper ratio and mean load values. Fatigue testing showed that although PEEK exhibited significantly lower average load values than the Co-Cr alloy, these were sufficient for clinical use. All specimens exhibited significant deformation during the first period of cycling; however, there was no significant difference in the deformation between the two materials after fatigue testing.

CONCLUSIONS

PEEK exerts fewer stresses on abutments compared to standard-alloy clasps, provides adequate retention, and satisfy aesthetic demands, indicating that PEEK presents a promising alternative to conventional metal clasps.

Patient satisfaction and preference with thermoplastic resin removable partial dentures: a randomised cross-over trial

PURPOSE

This randomised cross-over trial aimed to comparatively investigate patient preference and satisfaction with thermoplastic resin removable partial dentures (TR-RPDs) and conventional metal clasp-retained removable partial dentures (MC-RPDs).

METHODS

Twenty-eight partially dentate subjects were enrolled and randomised to receive MC-RPDs followed by TR-RPDs or vice versa (n=14, each group). The subjects were asked to score overall satisfaction and denture-related parameters 3 months after delivery of each denture. Additionally, they were asked to choose their preferred denture type at the end of the trial.

RESULTS

Of the 28 subjects, 24 (86%; mean age, 67.3 years) completed the trial. The overall satisfaction scores and ratings for oral appearance with TR-RPDs were significantly higher than those with MC-RPDs (P<0.05). Moreover, 75% (18/24) and 83% (20/24) of the subjects reported greater overall satisfaction and better oral appearance with TR-RPDs than with MC-RPDs (P<0.001, both). Scores for mucosal pain and food impaction were significantly better with TR-RPDs than with MC-RPDs (P<0.05). Relative to MC-RPDs, TR-RPDs provided slightly better oral comfort and speech, although the differences were not statistically significant (P>0.05). Scores for chewing ability, denture stability, and ease of denture cleaning were almost identical for both types of dentures.

CONCLUSIONS

These results suggest that TR-RPDs hold an advantage over MC-RPDs in terms of oral appearance and can offer greater satisfaction than MC-RPDs in partially dentate arches with at least an occluding pair in the posterior region.

CLINICAL TRIAL REGISTRATION

UMIN Clinical Trials Registry (UMIN000007310).

Fatigue resistance of yttria-stabilized tetragonal zirconia polycrystal clasps for removable partial dentures

With the rapid development of computer-aided design/computer-aided manufacturing (CAD/CAM) systems, the application of zirconia in removable partial dentures is expected to expand. Clasps composed of zirconia should improve esthetics without inducing the risk of metal allergy. The aim of this study was to examine the fatigue resistance of yttria-stabilized tetragonal zirconia polycrystal (Y-TZP) clasps for removable partial dentures. Yttria-stabilized tetragonal zirconia polycrystal and cobalt-chromium (Co-Cr) alloy were prepared using CAD/CAM systems. Specimens were either of the semicircular type or of the flat type, with cross-sectional areas of taper ratios of 0.50, 0.75, and 1.00. All specimens were tested using the cantilever test and the constant displacement fatigue test, and data were analyzed using ANOVA. During the cantilever test, the maximum displacement prior to fracture was greater than the required undercut, and the semicircular-type specimen exhibited a higher fracture load than the flat type. None of the specimens displayed permanent deformation and showed almost the same degree of deformation after fatigue testing. A lower taper ratio was associated with lower average load values and greater displacement. Within the limitations of this study, it was possible to conclude that Y-TZP provides the required undercut and adequate retentive force for removable partial denture clasps. Additionally, Y-TZP and Co-Cr alloy had almost the same degree of deformation even after the simulated lifespan of removable partial dentures.

Influence of block-out on retentive force of thermoplastic resin clasps: an in vitro experimental and finite element analysis

PURPOSE

The purpose of this study was to determine the effect of block-out preparation, used to eliminate the undercut area, on the retentive force and stress distribution of resin clasps.

METHODS

A total of 72 polyester and polyamide resin clasps were fabricated on a premolar abutment crown following six block-out preparations. A combination of two types of vertical block-outs and three types of horizontal block-outs (on the missing side) was used on the abutment tooth. Each clasp was subjected to an in vitro removal test using a universal testing machine. The retentive force and traces of the clasp on the abutment tooth were recorded and analyzed with one-way analysis of variance and post hoc comparisons (α=0.05). Non-linear finite element analysis was performed to assess the stress distributions of the resin clasps.

RESULTS

Resin clasps with a vertical block-out of 0.75mm undercut showed significantly higher retentive force than those with the 0.5mm undercut. Resin clasps with horizontal block-out showed significantly lower retentive force than those without horizontal block-out. There was no significant difference between the two thermoplastic resins. The maximum first principal stress of the resin clasp was concentrated under the shoulder of the clasp and strongly influenced by the width of horizontal block-out in the finite element analysis.

CONCLUSIONS

This in vitro experiment suggested that a horizontal block-out is necessary even for a 0.5-mm undercut. The design of the resin clasp should be considered from two aspects: retentive force and deformation risk.

Use of a Polyetheretherketone Clasp Retainer for Removable Partial Denture: A Case Report

Clasp retainers made of metal alloys may be esthetically unappealing or cause allergic reactions. To investigate alternative materials, we used the nonfiller polyetheretherketone (PEEK) to fabricate the clasp retainer of a removable partial denture for the mandibular bilateral distal free-end abutment of an 84-year-old female. Two years later, few color and texture changes of PEEK were found macroscopically. The rest part and the clasp arm fitted well without any deformation. There were no particular occlusal or periodontal problems. Subjective satisfaction was expressed by both the practitioner and the patient.

Effects of polishing on surface roughness and hardness of glass-fiber-reinforced polypropylene

Removable partial dentures (RPDs) with resin-clasp retentive parts, which are known as non-metal-clasp dentures (NMCDs), have been used as alternatives for conventional RPDs with metal clasp, in case of aesthetic prosthodontic treatments. In this study, a profilometer and dynamic micro-indentation tests were used to investigate the effects of polishing on the surface properties such as surface roughness (Ra), dynamic hardness, and elastic modulus of high-rigidity glass-fiber-reinforced thermoplastics (GFRTPs) composed of E-glass fibers and polypropylene for NMCDs. The Ra values of the GFRTPs after polishing were significantly lower than those before polishing. The values were close to the Ra threshold level of 0.2, which corresponds to an acceptable surface smoothness for denture base materials. Polishing did not significantly change the dynamic hardnesses and elastic moduli of the GFRTPs. The fiber loading did not greatly affect the micromechanical properties of the GFRTPs because the glass-fiber reinforcement is embedded in the polypropylene matrix.

Effects of relining materials on the flexural strength of relined thermoplastic denture base resins

PURPOSE

The aim of this study was to evaluate the effects of relining materials on the flexural strength of relined thermoplastic denture base resins (TDBRs).

MATERIALS AND METHODS

For shear bond strength testing, 120 specimens were fabricated using four TDBRs (EstheShot-Bright, Acrytone, Valplast, Weldenz) that were bonded with three autopolymerizing denture relining resins (ADRRs: Vertex Self-Curing, Tokuyama Rebase, Ufi Gel Hard) with a bond area of 6.0 mm in diameter and were assigned to each group (n=10). For flexural strength testing, 120 specimens measuring 64.0×10.0×3.3 mm (ISO-1567:1999) were fabricated using four TDBRs and three ADRRs and were assigned to each group (n=10). The thickness of the specimens measured 2.0 mm of TDBR and 1.3 mm of ADRR. Forty specimens using four TDBRs and 30 specimens using ADRRs served as the control. All specimens were tested on a universal testing machine. For statistical analysis, Analysis of variance (ANOVA) with Tukey's test as post hoc and Spearman's correlation coefficient analysis (P=.05) were performed.

RESULTS

Acry-Tone showed the highest shear bond strength, while Weldenz demonstrated the lowest bond strength between TDBR and ADRRs compared to other groups. EstheShot-Bright exhibited the highest flexural strength, while Weldenz showed the lowest flexural strength. Relined EstheShot-Bright demonstrated the highest flexural strength and relined Weldenz exhibited the lowest flexural strength (P<.05). Flexural strength of TDBRs (P=.001) and shear bond strength (P=.013) exhibited a positive correlation with the flexural strength of relined TDBRs.

CONCLUSION

The flexural strength of relined TDBRs was affected by the flexural strength of the original denture base resins and bond strength between denture base resins and relining materials.

Evaluation of the flexural mechanical properties of various thermoplastic denture base polymers

This study evaluated the flexural mechanical properties of various thermoplastic denture base polymers (six polyamides, four acrylic resins, polyester, polypropylene, and polycarbonate) by three different testing conditions; specimens were tested in water bath at 37°C (Wet/Water, by ISO 20795-1), or in ambient air (Wet/Air) after being immersed in distilled water for 50 h, or after desiccation for 7 days (Dry/Air). The mean ultimate flexural strength (UFS) and flexural modulus (FM) for most products ranged from 27 to 61 MPa and from 611 to 1,783 MPa respectively, which failed to meet the minimum requirements of the international standard, except for polycarbonate (89 and 2,245 MPa). The mean UFS and FM values were ranked Dry/Air>Wet/Air>Wet/Water (p<0.05). In conclusion, the flexural mechanical properties of denture base polymers varied with the products and were significantly affected by the testing medium (air or water) and specimen conditions (wet or dry).

Glass fiber-reinforced thermoplastics for use in metal-free removable partial dentures: combined effects of fiber loading and pigmentation on color differences and flexural properties

PURPOSE

The purpose of this study was to investigate the combined effects of fiber loading and pigmentation on the color differences and flexural properties of glass fiber-reinforced thermoplastics (GFRTPs), for use in non-metal clasp dentures (NMCDs).

METHODS

The GFRTPs consisted mainly of E-glass fibers, a polypropylene matrix, and a coloring pigment: the GFRTPs with various fiber loadings (0, 10, and 20mass%) and pigmentations (0, 1, 2, and 4mass%) were fabricated by using an injection molding. The color differences of GFRTPs were measured based on the Commission Internationale de l'Eclairage (CIE) Lab color system, by comparing with a commercially available NMCD. The flexural properties of GFRTPs were evaluated by using a three-point bending test, according to International Standards Organization (ISO) specification number 20795-1.

RESULTS

The visible colors of GFRTPs with pigment contents of 2mass% were acceptable for gingival color, and the glass fibers harmonized well with the resins. The ΔE* values of the GFRTPs with pigment contents of 2mass% obtained by using the CIE Lab system were lowest at all fiber loadings. For GFRTPs with fiber contents of 10 and 20mass% at 2mass% pigment content, these GFRTPs surpassed the ISO 20795-1 specification regarding flexural strength (> 60MPa) and modulus (> 1.5GPa).

CONCLUSIONS

A combination of the results of color difference evaluation and mechanical examination indicates that the GFRTPs with fiber contents of 10 or 20mass%, and with pigment contents of 2mass% have acceptable esthetic appearance and sufficient rigidity for NMCDs.

Color stability of glass-fiber-reinforced polypropylene for non-metal clasp dentures

PURPOSE

The purpose of this study was to investigate the color stability of a glass-fiber-reinforced thermoplastic (GFRTP), for use in non-metal clasp dentures (NMCDs).

METHODS

GFRTPs composed of E-glass fibers and polypropylene with 2 mass% of pigments were fabricated using injection molding. According to our previous study on the optimum fiber content for GFRTPs, we prepared GFRTPs with fiber contents of 0, 10, and 20 mass% (GF0, GF10, and GF20). Commercially available NMCD and PMMA materials were used as controls. The color changes of GFRTPs at 24h, and at 1, 2, and 4 weeks of coffee immersion at 37°C were measured by colorimetry, using the Commission Internationale de l'Eclairage (CIE) Lab system. The color stabilities of the GFRTPs were evaluated in two units: the color difference (ΔE^∗) and National Bureau of Standards (NBS) units.

RESULTS

After immersion, none of the GFRTPs showed visible color change. From the colorimetry measurement using the CIE Lab system, the ΔE^∗ values of the GFRTPs were 0.65-2.45. The NBS values of the GFRTPs were 0.60-2.25, all lower than the threshold level of 3.0, demonstrating clinically acceptable color changes. On the other hand, an available polyamide-based NMCD material exhibited "appreciable" color change, as measured in NBS units.

CONCLUSIONS

The results indicate that the GFRTPs showed clinically acceptable color stability and might be satisfactory for clinical use. Therefore, GFRTPs are expected to become attractive materials for esthetic dentures.

Fabrication of a nonmetal clasp denture supported by an intraoral scanner and CAD-CAM

This clinical report describes the management of a patient who had a metal allergy and had difficulty sitting in a dental chair for an extended period. The presented treatment used an intraoral scanner and computer-aided design and computer-aided manufacturing (CAD-CAM) to fabricate a nonmetal clasp denture. The described procedure may reduce patient discomfort and chair-time.

Investigation of the cytotoxicity of thermoplastic denture base resins

PURPOSE

The purpose of this study was to investigate the in vitro cytotoxicity of thermoplastic denture base resins and to identify the possible adverse effects of these resins on oral keratinocytes in response to hot water/food intake.

MATERIALS AND METHODS

Six dental thermoplastic resin materials were evaluated: three polyamide materials (Smile tone, ST; Valplast, VP; and Luciton FRS, LF), two acrylic materials (Acrytone, AT; and Acryshot, AS), and one polypropylene resin material (Unigum, UG). One heat-polymerized acrylic resin (Vertex RS, RS) was chosen for comparison. After obtaining extracts from specimens of the denture resin materials (Φ=10 mm and d=2 mm) under different extraction conditions (37℃ for 24 hours, 70℃ for 24 hours, and 121℃ for 1 hour), the extracts (50%) or serial dilutions (25%, 12.5%, and 6.25%) in distilled water were co-cultured for 24 hours with immortalized human oral keratinocytes (IHOKs) or mouse fibroblasts (L929s) for the cytotoxicity assay described in ISO 10993.

RESULTS

Greater than 70% viability was detected under all test conditions. Significantly lower IHOK and L929 viability was detected in the 50% extract from the VP (70℃) and AT (121℃) samples (P<.05), but only L929 showed reduced viability in the 50% and 25% extract from LF (37℃) (P<.05).

CONCLUSION

Extracts obtained from six materials under different extraction conditions (37℃, 70℃, and 121℃) did not exhibit severe cytotoxicity (less than 70% viability), although their potential risk to oral mucosa at high temperatures should not be ignored.

Double-Layer Surface Modification of Polyamide Denture Base Material by Functionalized Sol-Gel Based Silica for Adhesion Improvement

PURPOSE

Limited surface treatments have been proposed to improve the bond strength between autopolymerizing resin and polyamide denture base materials. Still, the bond strength of autopolymerizing resins to nylon polymer is not strong enough to repair the fractured denture effectively. This study aimed to introduce a novel method to improve the adhesion of autopolymerizing resin to polyamide polymer by a double layer deposition of sol-gel silica and N-2-(aminoethyl)-3-aminopropyltrimethoxysilane (AE-APTMS).

MATERIALS AND METHODS

The silica sol was synthesized by acid-catalyzed hydrolysis of tetraethylorthosilicate (TEOS) as silica precursors. Polyamide specimens were dipped in TEOS-derived sol (TS group, n = 28), and exposed to ultraviolet (UV) light under O₂ flow for 30 minutes. UV-treated specimens were immersed in AE-APTMS solution and left for 24 hours at room temperature. The other specimens were either immersed in AE-APTMS solution (AP group, n = 28) or left untreated (NT group, n = 28). Surface characterization was investigated by fourier transform infrared spectroscopy (FTIR) and atomic force microscopy (AFM). Two autopolymerizing resins (subgroups G and T, n = 14) were bonded to the specimens, thermocycled, and then tested for shear bond strength with a universal testing machine. Data were analyzed with one-way ANOVA followed by Tukey's HSD (α = 0.05).

RESULTS

FTIR spectra of treated surfaces confirmed the chemical modification and appearance of functional groups on the polymer. One-way ANOVA revealed significant differences in shear bond strength among the study groups. Tukey's HSD showed that TS_T and TS_G groups had significantly higher shear bond strength than control groups (p = 0.001 and p < 0.001, respectively). Moreover, bond strength values of AP_T were statistically significant compared to controls (p = 0.017).

CONCLUSION

Amino functionalized TEOS-derived silica coating is a simple and cost-effective method for improving the bond strength between the autopolymerizing resin and polyamide denture base.

CLINICAL IMPLICATIONS

Amino-functionalized silica coating could represent a more applicable and convenient option for improving the repair strength of autopolymerizing resin to polyamide polymer.

Effect of fiber content on flexural properties of glass fiber-reinforced polyamide-6 prepared by injection molding

The use of non-metal clasp denture (NMCD) materials may seriously affect the remaining tissues because of the low rigidity of NMCD materials such as polyamides. The purpose of this study was to develop a high-rigidity glass fiber-reinforced thermoplastic (GFRTP) composed of E-glass fiber and polyamide-6 for NMCDs using an injection molding. The reinforcing effects of fiber on the flexural properties of GFRTPs were investigated using glass fiber content ranging from 0 to 50 mass%. Three-point bending tests indicated that the flexural strength and elastic modulus of a GFRTP with a fiber content of 50 mass% were 5.4 and 4.7 times higher than those of unreinforced polyamide-6, respectively. The result showed that the physical characteristics of GFRTPs were greatly improved by increasing the fiber content, and the beneficial effects of fiber reinforcement were evident. The findings suggest that the injection-molded GFRTPs are adaptable to NMCDs because of their excellent mechanical properties.

Water sorption and solubility of polyamide denture base materials

Purpose: Some patients experience adverse reactions to poly(methyl methacrylate)-based (PMMA) dentures. Polyamide (PA) as an alternative to PMMA has, however, not been well documented with regard to water sorption and water solubility. The aim of this in vitro study was to measure water sorption and water solubility of two PA materials compared with PMMA, and to evaluate the major components released from the PA materials and the effect on hardness of the materials. Methods: Ten discs (40.0 mm diameter, 2.0 mm thick) of each material (PA: Valplast and Breflex; PMMA: SR Ivocap HIP) were prepared according to manufacturers' recommendations. The specimens were tested for water sorption and water solubility, according to a modification of ISO 20795-1:2008. Released substances were analysed by gas chromatography/mass spectrometry (GC/MS). Results: There were statistically significant differences among the materials regarding water sorption, water solubility and time to water saturation. Breflex had the highest water sorption (30.4 μg/mm³), followed by PMMA-material (25.8 μg/mm³) and Valplast (13.6 μg/mm³). Both PA materials had statistically significant lower water solubility than the PMMA. Both PA had a net increase in weight. Analysis by GC/MS identified release of the compound 12-aminododecanolactam from the material Valplast. No release was found from the Breflex material. Conclusions: The PA denture materials show differences in water sorption and solubility, but within the limits of the standard requirements. The PA showed a net increase in weight after long-term water sorption. The clinical implications of the findings are not elucidated.

Pressure transmission area and maximum pressure transmission of different thermoplastic resin denture base materials under impact load

PURPOSES

The purposes of the present study were to examine the pressure transmission area and maximum pressure transmission of thermoplastic resin denture base materials under an impact load, and to evaluate the modulus of elasticity and nanohardness of thermoplastic resin denture base.

METHODS

Three injection-molded thermoplastic resin denture base materials [polycarbonate (Basis PC), ethylene propylene (Duraflex), and polyamide (Valplast)] and one conventional heat-polymerized acrylic resin (PMMA, SR Triplex Hot) denture base, all with a mandibular first molar acrylic resin denture tooth set in were evaluated (n=6). Pressure transmission area and maximum pressure transmission of the specimens under an impact load were observed by using pressure-sensitive sheets. The modulus of elasticity and nanohardness of each denture base (n=10) were measured on 15×15×15×3mm³ specimen by using an ultramicroindentation system. The pressure transmission area, modulus of elasticity, and nanohardness data were statistically analyzed with 1-way ANOVA, followed by Tamhane or Tukey HSD post hoc test (α=.05). The maximum pressure transmission data were statistically analyzed with Kruskal-Wallis H test, followed by Mann-Whitney U test (α=.05).

RESULTS

Polymethyl methacrylate showed significantly larger pressure transmission area and higher maximum pressure transmission than the other groups (P<.001). Significant differences were found in modulus of elasticity and nanohardness among the four types of denture bases (P<.001).

CONCLUSIONS

Pressure transmission area and maximum pressure transmission varied among the thermoplastic resin denture base materials. Differences in the modulus of elasticity and nanohardness of each type of denture base were demonstrated.

Oral health-related quality of life in patients with non-metal clasp dentures: a randomised cross-over trial

We investigated the efficacy of non-metal clasp dentures (NMCDs) with regard to the oral health-related quality of life (OHRQoL) and compare the findings with those for conventional metal clasp-retained dentures (MCDs). This single-centre, randomised controlled, two-phase, open label, cross-over trial included 28 partially dentate individuals. The patients were randomised to receive MCDs followed by NMCDs, or the opposite sequence (n = 14 in each group); each denture was worn for 3 months. OHRQoL was evaluated using the Oral Health Impact Profile-Japanese version (OHIP-J) at entry (T-entry; before treatment with the first denture) and at 3 months after treatment with each denture (T3). An examiner evaluated denture stability, oral appearance and surface roughness before denture delivery (T0) and at T3 and denture hygiene at T3. A total of 24 patients completed the trial. There were no complications related to the dentures, abutment teeth or denture-bearing mucosa during the follow-up periods for both dentures. The mean OHIP summary score was lower for NMCDs than for MCDs, and the difference (9 points) was greater than the minimal important difference (6 points), indicating the difference was clinically relevant. The effect size was medium (0·70). Statistical analyses with linear mixed models found a significant effect of the denture type on the OHIP summary score and scores for the Oro-facial appearance, Oro-facial pain and Psychological impact domains (NMCD < MCD; P < 0·05). The results of our study suggest that NMCDs allow for better OHRQoL compared with MCDs.

Effect of surface treatment methods on the shear bond strength of auto-polymerized resin to thermoplastic denture base polymer

PURPOSE

Polyamide polymers do not provide sufficient bond strength to auto-polymerized resins for repairing fractured denture or replacing dislodged denture teeth. Limited treatment methods have been developed to improve the bond strength between auto-polymerized reline resins and polyamide denture base materials. The objective of the present study was to evaluate the effect of surface modification by acetic acid on surface characteristics and bond strength of reline resin to polyamide denture base.

MATERIALS AND METHODS

84 polyamide specimens were divided into three surface treatment groups (n=28): control (N), silica-coated (S), and acid-treated (A). Two different auto-polymerized reline resins GC and Triplex resins were bonded to the samples (subgroups T and G, respectively, n=14). The specimens were subjected to shear bond strength test after they were stored in distilled water for 1 week and thermo-cycled for 5000 cycles. Data were analyzed with independent t-test, two-way analysis of variance (ANOVA), and Tukey's post hoc multiple comparison test (α=.05).

RESULTS

The bond strength values of A and S were significantly higher than those of N (P<.001 for both). However, statistically significant difference was not observed between group A and group S. According to the independent Student's t-test, the shear bond strength values of AT were significantly higher than those of AG (P<.001).

CONCLUSION

The surface treatment of polyamide denture base materials with acetic acid may be an efficient and cost-effective method for increasing the shear bond strength to auto-polymerized reline resin.

Flexible Removable Partial Denture Prosthesis: A Survey of Dentists' Attitudes and Knowledge in Greece and Croatia

PURPOSE

The aim of this study was to investigate through a questionnaire the knowledge, attitudes and possible differences in the use of flexible RPDPs among dentists in Greece and Croatia.

MATERIAL AND METHODS

A questionnaire of 16 questions was originally created in English, translated into Greek and Croatian language following a two way translation and tested for apprehension, precision, clarity and homogeneity by a number of native English speaking Greek and Croatian dentists. Following the necessary corrections, the questionnaires replicated in two online surveys and their addresses with an informed consent were sent by emails to nearly 4000 dentists in each country to participate. Collected data were analyzed by chi-square tests at a= .05 level of significance.

RESULTS

378 dentists from Greece and 304 from Croatia participated in the study. 137(36.2%) dentists from Greece and 56(18.4%) from Croatia provided flexible RPDPs to their patients. Statistical analysis for all providers indicated no significant difference between genders (P>.05), significant differences between age groups (P<.01), years of practice (P<.05), specialization (P <.001), and instruction on flexible prostheses (P <.001). The analysis between the two countries showed differences for gender and age groups (P<.01) but no differences between experienced, specialized or instructed groups (P >.05).

CONCLUSION

The survey indicated differences between the two countries in the percentages of dentists using, selecting and providing RPDPs for their patients. Practitioners' age, years in practice and instruction were associated with the provision of the prostheses, while comfort, esthetics and cost were the reasons for deciding to use the flexible RPDPs.

CONCLUSION

Although dentists are not educated in their schools about flexible RPDPs, almost a third of them offer this treatment to their patients. Long term success of these devices depends on clinical education, more experience and definitely more research.

Fabrication and physical properties of glass-fiber-reinforced thermoplastics for non-metal-clasp dentures

Recently, non-metal-clasp dentures (NMCDs) made from thermoplastic resins such as polyamide, polyester, polycarbonate, and polypropylene have been used as removable partial dentures (RPDs). However, the use of such RPDs can seriously affect various tissues because of their low rigidity. In this study, we fabricated high-rigidity glass-fiber-reinforced thermoplastics (GFRTPs) for use in RPDs, and examined their physical properties such as apparent density, dynamic hardness, and flexural properties. GFRTPs made from E-glass fibers and polypropylene were fabricated using an injection-molding. The effects of the fiber content on the GFRTP properties were examined using glass-fiber contents of 0, 5, 10, 20, 30, 40, and 50 mass%. Commercially available denture base materials and NMCD materials were used as controls. The experimental densities of GFRTPs with various fiber contents agreed with the theoretical densities. Dynamic micro-indentation tests confirmed that the fiber content does not affect the GFRTP surface properties such as dynamic hardness and elastic modulus, because most of the reinforcing glass fibers are embedded in the polypropylene. The flexural strength increased from 55.8 to 217.6 MPa with increasing glass-fiber content from 0 to 50 mass%. The flexural modulus increased from 1.75 to 7.42 GPa with increasing glass-fiber content from 0 to 50 mass%, that is, the flexural strength and modulus of GFRTP with a fiber content of 50 mass% were 3.9 and 4.2 times, respectively, those of unreinforced polypropylene. These results suggest that fiber reinforcement has beneficial effects, and GFRTPs can be used in NMCDs because their physical properties are better than those of controls. © 2016 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 105B: 2254-2260, 2017.

Bond strength of a chairside autopolymerizing reline resin to injection-molded thermoplastic denture base resins

PURPOSE

This study evaluated the shear bond strength of a chairside autopolymerizing reline resin to injection-molded thermoplastic denture base resins.

METHODS

Four kinds of injection-molded thermoplastic resins (two polyamides, a polyethylene terephthalate copolymer and a polycarbonate) and PMMA, as a control, were tested. The eight types of surface treatment: ((1) no treatment, (2) air abrasion, (3) dichloromethane, (4) ethyl acetate, (5) 4-META/MMA-TBB resin, (6) air abrasion and 4-META/MMA-TBB resin, (7) tribochemical silica coating, and (8) tribochemical silica coating and 4-META/MMA-TBB resin) were applied to each specimen. The chairside autopolymerizing reline resins were bonded to disks of the injection-molded thermoplastic denture base resins. All of the specimens were immersed in water for 4 months and then thermocycled for 10,000 cycles in water between 5 and 55°C. The shear bond strengths were determined.

RESULTS

The shear bond strengths of the two polyamides treated using air abrasion, dichloromethane and ethyl acetate and no treatment were exceedingly low. The greatest bond strength was recorded for the polyethylene terephthalate copolymer specimens treated with tribochemical silica coating and 4-META/MMA-TBB resin (22.5MPa). The bond strengths of the other injection-molded thermoplastic denture base resins increased using 4-META/MMA-TBB resin.

CONCLUSIONS

Tribochemical silica coating and 4-META/MMA-TBB resin were the most effective surface treatments among all denture base resins tested.

Wear resistance of injection-molded thermoplastic denture base resins

Objective This study investigated the wear resistance of injection-molded thermoplastic denture base resins using nanoindentation instrument.

Materials and methods Six injection-molded thermoplastic denture base resins (two polyamides, two polyesters, one polycarbonate, one polymethylmethacrylate [PMMA]) and a PMMA conventional heat-polymerized denture-based polymer control were tested. Elastic modulus, hardness, wear depth, and roughness were calculated using a nanoindentation instrument.

Results Elastic modulus and hardness of the injection-molded thermoplastic denture base resins were significantly lower than those of the PMMA conventional heat-polymerized denture-based polymer. Wear depth of polycarbonate and PMMA conventional heat-polymerized denture-based polymer were significantly higher than that of other injection-molded thermoplastic denture base resins. The roughness of injection-molded thermoplastic denture base resins was significantly more than that of PMMA conventional heat-polymerized denture-based polymer after testing.

Conclusions Wear resistance of injection-molded thermoplastic denture base was low compared to PMMA conventional heat-polymerized denture-based polymers.

Assessment of clasp design and flexural properties of acrylic denture base materials for use in non-metal clasp dentures

PURPOSE

The purpose of this study was to investigate the possibilities of utilizing new acrylic denture base materials in resin clasps using three-point flexural tests and cantilever beam tests.

METHODS

Seven non-metal clasp denture (NMCD) materials and four acrylic denture base materials were used for three-point flexural tests and six NMCD materials and three acrylic denture base materials were used for cantilever beam tests. The flexural strength, elastic modulus, and 0.05% proof stress were measured by three-point flexural tests according to International Organization for Standardization (ISO) 20795-1. And load at 0.5mm deformation, elastic modulus were measured by Cantilever beam tests.

RESULTS

For the three-point flexural tests, only materials that met the conditions for both flexural strength and elastic modulus were the polycarbonate Reigning N (REN) and the acrylics Acron (AC), Pro Impact (PI), Procast DSP (PC) and IvoBase High Impact (HI) which are required in ISO 20795-1, Type 3 denture base materials. And for cantilever beam tests there was no significant difference between PI and either EstheShot (ES), EstheShot Bright (ESB), REN or Acry Tone (ACT) in load at 0.5mm deformation, and no significant difference between PI and either Lucitone FRS (LTF), ES, ESB, REN or ACT in elastic modulus.

CONCLUSIONS

The results thus suggested that some of the acrylic materials used as denture base materials may also be usable for NMCDs, and that the flexural properties of the acrylic material PI resemble those of ES, ESB and ACT, meaning that similar clasp designs may also be feasible.

The Use of a Modified Poly-Ether-Ether-Ketone (PEEK) as an Alternative Framework Material for Removable Dental Prostheses. A Clinical Report

This clinical report presents a modified poly-ether-ether-ketone (PEEK) as an alternative material for the fabrication of distal extension removable dental prosthesis (RDP) frameworks. This material can be used for patients allergic to metals, or who dislike the metallic taste, the weight, and the unpleasant metal display of the denture framework and retentive clasps. This modified PEEK material, known as BioHPP, is a biocompatible, nonallergic, rigid material, with flexibility comparable to bone, high polishing and low absorption properties, low plaque affinity, and good wear resistance. It has been used for years in orthopedics and medical technology. BioHPP frameworks can be constructed either via CAD/CAM manufacturing or via the conventional lost wax technique. The clinical use of a BioHPP RDP framework is presented as an alternative for the treatment of a distal extension case.