Flexural strengths of denture base resin repaired with autopolymerizing resin and reinforcements after thermocycle stressing

Evaluation of flexural strength, impact strength, and surface microhardness of self-cured acrylic resin reinforced with silver-doped carbon nanotubes

BACKGROUND

Poly-methyl methacrylate (PMMA) is a type of polymer mostly used to make denture bases. Self-cured acrylic resin (PMMA) can be used to repair a fractured acrylic denture base; however, even after repair, this area remains vulnerable. Carbon nanotubes (CNTs) could be used as a filler for polymer reinforcement. Furthermore, silver nanoparticles are efficient agents for the prevention of dental biofilm and improving their mechanical properties. The doping of CNTs with silver nanoparticles may lead to a synergistic interaction that is predicted to enhance the mechanical characteristics of the fillers.

OBJECTIVES

The aim of the study was to assess the influnce of manual incorporation of 0.5% weight percent (%wt.) of silver doped carbon nanotubes (Ag-doped CNTs) into commercial self-cured PMMA on its flexural strength, impact strength, and surface microhardness.

METHODS

In this investigation, a total of 60 specimens comprised of acrylic resin were employed. They are divided into two main groups: (a) the control group, which was made by using liquid monomer and commercial self-cured PMMA powder; and (b) the modified group, prepared by hand mixing the purchased silver-doped CNTs powder (0.5% wt.) to self-cured PMMA powder (99.5%wt.), and then the blended powder was incorporated into the liquid monomer. Flexural strength, flexural modulus, impact strength, and surface microhardness were evaluated. Independent sample t-tests were used to statistically analyze the data and compare the mean values of flexural strength, flexural modulus, impact strength, and surface microhardness (p-value ≤ 0.05).

RESULTS

The flexural strength of the modified groups with Ag-doped CNTs (132.4 MPa) was significantly greater than that of the unmodified (control) groups (63.2 MPa). Moreover, the flexural modulus of the modified groups with Ag-doped CNTs (3.067 GPa) was significantly greater than that of the control groups (1.47 GPa). Furthermore, the impact strength of the modified groups with Ag-doped CNTs (11.2 kJ/mm2) was significantly greater than that of the control groups (2.3 kJ/mm2). Furthermore, the microhardness of the modified groups with Ag-doped CNTs (29.7 VHN) was significantly greater than that of the control groups (16.4 VHN), (p-value = 0.0001).

CONCLUSION

The incorporation of 0.5% wt. silver doped CNTs fillers to the self-cured acrylic resin enhanced its flexural strength, flexural modulus, impact strength, and surface microhardness.

Comparison of 4‐ or 6‐implant supported immediate full‐arch fixed prostheses: A retrospective cohort study of 217 patients followed up for 3–13 years

PURPOSE

Choosing four or six implants to support immediate full-arch fixed prostheses (FAFPs) is still controversial worldwide. This study aims to analyze and compare the long-term results of All-on-4 and All-on-6.

MATERIALS AND METHODS

This retrospective cohort study enrolled 217 patients rehabilitated with 1222 implants supporting 271 FAFPs, including 202 prostheses supported by 4 implants (All-on-4 group) and 69 prostheses supported by 6 implants (All-on-6 group), and followed up for 3-13 years. Implant survival, prosthesis survival, complications, and implant marginal bone loss (MBL) were evaluated and compared between two groups. Patient characteristics including age, gender, jaw, opposite dentition condition, smoking habit, bruxism, bone quantity and quality, cantilever length (CL), prosthesis material, and oral hygiene were analyzed to assess their influence on the clinical results of the two groups. Six surgeons and three prosthodontists who performed FAFPs more than 5 years were invited for questionnaires, to assess patient- and clinician-related influences on implant number.

RESULT

In general, All-on-4 group indicated no significant difference with All-on-6 group in the implant survival (implant-level: hazard ratio [HR] = 1.0 [95% confidence interval (CI): 0.8-1.2], P = 0.96; prosthesis-level: HR = 0.8 [95% CI: 0.3-1.8], P = 0.54), prosthesis survival (odds ratio [OR] = 0.8 [95% CI: 0.3-2.8], P = 0.56), biological complications (OR = 0.9 [95% CI: 0.5-1.8], P = 0.78), technical complications of provisional prosthesis (OR = 1.3 [95% CI: 0.7-2.3], P = 0.42), technical complications of definitive prosthesis (OR = 1.1 [95% CI: 0.6-2.2], P = 0.33) and the 1st, 5th, and 10th year MBL (P = 0.65, P = 0.28, P = 0.14). However, for specific covariates, including elderly patients, opposing natural/fixed dentition, smoking, bruxism, long CL, low bone density, and all acrylic provisional prostheses, All-on-6 was more predictable in some clinical measurements than All-on-4. The implant prosthodontists and the medium-experienced clinicians showed significant preference for All-on-6 (P < 0.05).

CONCLUSION

Based on this study, the long-term clinical results showed no significant difference between All-on-4 and All-on-6 groups in general. However, for some specific characteristics, All-on-6 seemed to be more predictable in some clinical measurements than All-on-4. For the clinicians' decision-making, medium-experienced clinicians and the implant prosthodontists showed significant preference for All-on-6.

Influence of Incorporating 5% Weight Titanium Oxide Nanoparticles on Flexural Strength, Micro-Hardness, Surface Roughness and Water Sorption of Dental Self-Cured Acrylic Resin

Background: Polymethyl methacrylate (PMMA) is used in fabricating acrylic denture bases. Repairing a fractured acrylic denture base can be done by self-cured PMMA, yet this is still a weak point after repair. The aim of this study was to evaluate the effect of incorporating 5% weight titanium oxide nanoparticles (TiO₂) to self-cured PMMA on flexural strength, surface micro-hardness, roughness, and water sorption. Methods: A total of 160 acrylic–resin specimens were used in this study. They were divided in two main groups; (a) control group, prepared by mixing self-cured PMMA powder to its liquid monomer, (b) treated group, prepared by blending 5% weight TiO₂ nanoparticles to self-cured PMMA powder then this blend was mixed with the liquid monomer. Flexure strength, surface micro-hardness, roughness, and water sorption were evaluated. Data were analyzed using independent sample t-tests (p ≤ 0.05). Results: There was a significant increase in the flexural strength of PMMA of the treated group after the addition of TiO₂ (137.6 MPa) compared with the control (75.4 MPa) (p ≤ 0.001). No significant difference between the two groups in terms of micro-hardness (p = 0.385) and surface roughness (p = 0.269). Water sorption showed a significant reduction in the treated group (p ≤ 0.001). Conclusions: Addition of 5% weight TiO₂ nanoparticles to the self-cured acrylic resin improved its flexural strength and reduced its water-sorption without impairing the surface micro-hardness and roughness.

Effects of repeated use of tungsten carbide burs on the surface roughness and contact angles of a CAD-CAM PMMA denture base resin

STATEMENT OF PROBLEM

The surface roughness (Ra) and wettability of complete denture base materials must meet certain clinical requirements. Although computer-aided design and computer-aided manufacturing (CAD-CAM) systems have recently become popular for the fabrication of complete dentures, the effects of the repeated usage of milling burs on the surface properties of CAD-CAM denture base acrylic resins have not yet been fully investigated.

PURPOSE

The purpose of this in vitro study was to evaluate the effects of new and used burs on the Ra and contact angles (wettability) of a CAD-CAM polymethylmethacrylate (PMMA) denture base material.

MATERIAL AND METHODS

A total of 40 Ø2×10-mm disks were fabricated from 1 brand of CAD-CAM PMMA resin (Polident). Half of the specimens (group N) were milled with a new tungsten carbide bur set, while the other half (group U) was milled with a used tungsten carbide bur set. Moreover, half of the specimens (groups NT and UT) were subjected to thermocycling before Ra and contact angle testing. Ra was tested by using a profilometer, and the surfaces were also examined by scanning electron microscopy (SEM). The contact angle was measured by using the sessile drop method. Data were analyzed with the Kruskal-Wallis and Dunn Pairwise Comparison tests (α=.05).

RESULTS

The mean contact angle was highest for group U (80 degrees) and lowest for group UT (66 degrees) (P<.05). Ra values were highest for group N (1.3 μm) and lowest for group U (0.93 μm) (P<.05).

CONCLUSIONS

Specimens milled with new tungsten carbide burs had lower mean contact angles and higher Ra values than specimens milled with used burs. The contact angles of CAD-CAM PMMA resin specimens milled with used burs decreased significantly after thermocycling. Regardless of whether or not thermocycling was performed, contact angle values decreased as Ra values increased.

Fibre-reinforced and repaired PMMA denture base resin: Effect of placement on the flexural strength and load-bearing capacity

OBJECTIVES

To measure the effect of placement of glass fibre mesh on the flexural strength and load bearing capacity of repaired polymethylmethacrylate (PMMA) denture base resin.

MATERIALS AND METHODS

A total of 150 heat-polymerised acrylic resin specimens were fabricated with dimensions of 5 × 30 × 50 mm for flexural strength testing. Specimens were divided into 5 groups according to repair width and placement of the fibre mesh. Three groups (n = 90) had a repair width of 20 mm (including the control group), and two groups (n = 60) had a narrower repair width of 16 mm. Fibre mesh was either embedded at the neutral (bottom of the repair area) or tension (top of the repair area) zone of the specimen when subjected to flexural strength testing. Half of the specimens from each group were subjected to artificial ageing by thermocycling (5 °C and 55 °C, 30s dwell time) for 10,000 cycles to stimulate 12 months in vivo. All the specimens were stored in distilled water at 37 °C for 24 h prior to testing. The flexural strength of the specimen was obtained by three-point bend testing, and data were statistically analysed using ANOVA and post-hoc analysis (SPSS; significance level p < 0.05). Probability of failure was calculated using Weibull analysis. Scanning electron microscopy analysis was used to identify the mode of failure.

RESULTS

Specimens repaired with the 20 mm fibre mesh placed in the tension zone showed the highest mean flexural strength (101.33 ± 12.66 MPa) with statistical significance (p = 0.05) to the other groups except for the specimens repaired with the 16 mm fibre mesh placed in the tension zone (p = 0.072). The highest Weibull modulus was found in the thermal cycling group of the specimens with 20 mm repair width repaired with the fibre mesh embedded at the neutral zone (10.01). The lowest Weibull modulus was found in the non-thermal cycling group of the control group (3.15).

CONCLUSION

Placing fibre mesh in the tension zone of a PMMA specimen significantly improved the flexural strength of the repair. Placing the fibre mesh in the neutral zone or the fibre mesh width was short of the lower support rollers resulted in no significant increase in flexural strength compared to the non-reinforced control group. Ageing via thermal cycling resulted in a decrease in flexural strength across all sample groups. This study highlights the importance of recognising the valid repair region and to have the mesh embedded in certain dimensions, otherwise it will have no significant contribution towards the repair and increase of flexural strength of the denture.

Influence of Different Repair Acrylic Resin and Thermocycling on the Flexural Strength of Denture Base Resin

Background and Objectives: Fractured acrylic denture base is a common occurrence in clinical practice. The effective denture repair procedure is cost-effective, time conserving, and results in lesser time without denture for the patient. Along with various reinforcements and surface modifications; different acrylic resins are investigated in improving the flexural strength of the fractured site. The aim of this study was to evaluate the flexural strength of a polymethyl methacrylate (PMMA) denture base repaired with heat-polymerized (HPA), auto-polymerized (APA) and light-polymerized acrylic (LPA) resins after thermocycling. Materials and Methods: Forty rectangular shaped (50 mm × 25 mm × 3 mm) PMMA specimens were fabricated. Group 1 specimens (n = 10) were kept as controls and the remaining 30 samples were sectioned at the center with a repair site dimension of 3 mm. The samples from three groups (n = 10) were repaired with HPA, APA, and LPA resins, respectively. The specimens were thermocycled for 5000 cycles and subjected to a three-point flexural test. The maximum load required to fracture the specimens was recorded, and further analyzed with ANOVA and the Games-Howell Post hoc test at the significance level p = 0.05. Results: The average maximum load and flexural strength of the control group was 173.60 N and 13.02 Mpa and corresponding values for denture repaired with HPA was 87.36 N and 6.55 Mpa. The corresponding values for APA resin and LPA resins were 62.94 N, 57.51 N, and 4.72 Mpa, 4.06 Mpa, respectively. Conclusions: The PMMA specimens repaired with HPA resins resulted in a significantly higher load to fracture compared to APA resin and LPA resin.

A Comparative Evaluation of Effect of Reinforced Autopolymerizing Resin on the Flexural Strength of Repaired Heat-polymerized Denture Base Resin before and after Thermocycling

Aims and Objective:

Denture fractures are a common problem in clinical practice. Despite the use of different reinforcement materials (metal wires, metal plates, and various types of fibers) for denture repairs, recurrent fractures are still common. The purpose of this study was to compare the maximum flexural loads of the heat-polymerized denture base resin when repaired with autopolymerizing resin reinforced with relatively smaller diameter metal wires and glass fibers, before and after thermocycling.

Materials and Methods:

Heat polymerized rectangular specimens were fabricated and repaired with autopolymerized resin and different reinforcement materials. Stainless steel wires, coaxial wires, beta-titanium wires, and glass fibers were used as reinforcement materials. Metal wires were sandblasted before placing in the center of the specimen along with autopolymerizing resin. Control specimens were repaired without any reinforcements. Intact heat- and self-cure specimens were also prepared for comparison. Half of the specimens of each group were subjected to thermocycle stressing (5°C and 55°C, 30 s dwell time) for 2000 cycles. All the specimens, nonthermocycled as well as thermocycled, were then tested for flexural strength by using 3 point flexural test in Lloyd's Universal testing machine at 5 mm/min crosshead speed. The maximum flexural loads (N) for each specimen were recorded. The readings, thus obtained, were subjected to statistical analysis using two-way ANOVA and Tukey's multiple comparison test.

Results:

The metal wire reinforcements increased the flexural strength of repaired specimens, whereas, glass fiber reinforcement produced slightly lower flexural strength when compared to those of control specimens, i.e., repair without any reinforcement. The highest flexural strength was demonstrated by specimens repaired with coaxial wire reinforcements (50.01 and 43.77 N before and after thermocycling, respectively). The increase in flexural strength with the use of stainless steel wire (45.12 and 41.56 N) and beta-titanium wire reinforcements (45.54 and 42.61N) was insignificant.

Conclusions:

Coaxial wire reinforcement produced significantly higher flexural loads than control. Increase in strength with stainless steel wire and beta-titanium wire was insignificant, whereas glass fiber reinforcement reduced the strength.

Reinforcement in removable prosthodontics: a literature review

Removable prosthodontics are often associated with mechanical troubles in daily use, such as fracture or deformation. These troubles render prostheses unusable and reduce wearers' QOL. Various reinforcements are used to prevent such problems, but consensus on reinforcement has not been reached. This review aimed to summarise the effects of reinforcement and to propose favourable reinforcement based on material, design and position in the prostheses. Initially, 139 articles were selected by electronic and manual searches. After exclusion of 99 articles based on the exclusion criteria, 40 articles were finally included in the review. Electronic searches were performed for articles published from 2005 to 2015 in PubMed, EMBASE, MEDLINE and Cochrane Library, and manual searches were performed in 10 journals relevant to the topic of removable prosthodontics. For in vitro studies, certain dental alloys and fibres were mainly used. Their forms were different, including complicated forms in dental alloys and various forms in fibres. The materials were examined for mechanical properties like fracture strength, flexural strength and elastic modulus and compared with one another or without reinforcement. There were a few clinical studies and one longitudinal study. Cast metal reinforcement seemed to be most favourable in terms of fracture toughness and stiffness. The most favourable forms differed depending on the prostheses, but placement around thin and deformable areas was effective. However, randomised or longitudinal clinical reports and comparative clinical studies on the use of reinforcement were still lacking and such studies are necessary in the future.

Reinforcing effect of glass fiber-reinforced composite reinforcement on flexural strength at proportional limit of a repaired denture base resin

Objective: This study evaluated the reinforcing effect of glass fiber-reinforced composite (FRC) reinforcement on flexural strength at the proportional limit (FS-PL) of a repaired denture base resin.

Materials and methods: Repaired denture base resins reinforced with metal and with FRC reinforcement, and that without reinforcement were tested. The ultimate flexural strength, the FS-PL and the elastic modulus of repaired denture base resins were tested. The joint efficiency (times) of the repaired denture base resins on the intact denture base resin was evaluated.

Results: The repaired denture base resins reinforced with metal reinforcement and with FRC reinforcement had significantly higher ultimate flexural strength than the repaired denture base resin without reinforcement (p < 0.05) and were not significantly different from each other (p > 0.05). The FS-PL of a repaired denture base resin reinforced with the FRC reinforcement was similar to that with the metal reinforcement (p > 0.05), and these were significantly higher than the FS-PL of a repaired denture base resin without reinforcement (p < 0.05). The elastic modulus of the repaired denture base resin reinforced with the FRC reinforcement was significantly lower than that with metal reinforcement (p < 0.05) and was significantly higher than that without reinforcement (p < 0.05). The joint efficiency of the FRC reinforced specimen was 0.98.

Conclusion: The FRC reinforcement had a reinforcing effect on the FS-PL of a repaired denture base resin.

In vitro comparison of two different materials for the repair of urethan dimethacrylate denture bases

PURPOSE

The purpose of this in vitro study was to investigate the flexural properties of a recently introduced urethane dimethacrylate denture base material (Eclipse) after being repaired with two different materials.

MATERIALS AND METHODS

Two repair groups and a control group consisting of 10 specimens each were generated. The ES group was repaired with auto-polymerizing polymer. The EE group was repaired with the Eclipse. The E group was left intact as a control group. A 3-point bending test device which was set to travel at a crosshead speed of 5 mm/min was used. Specimens were loaded until fracture occurred and the mean displacement, maximum load, flexural modulus and flexural strength values and standard deviations were calculated for each group and the data were statistically analyzed. The results were assessed at a significance level of P<.05.

RESULTS

The mean "displacement", "maximum load before fracture", "flexural strength" and "flexural modulus" rates of Group E were statistically significant higher than those of Groups ES and EE, but no significant difference (P>.05) was found between the mean values of Group ES and EE. There was a statistically significant positive relation (P<.01) between the displacement and maximum load of Group ES (99.5%), Group EE (94.3%) and Group E (84.4%).

CONCLUSION

The more economic and commonly used self-curing acrylic resin can be recommended as an alternative repair material for Eclipse denture bases.

Factors Affecting the Strength of Denture Repairs

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

Effect of thermal cycling on microleakage of a fissure sealant polymerized with different light sources

The purpose of this study was to examine the effect of thermal cycling on microleakage of a fissure sealant after it was bonded with different bonding agents and polymerized with different light curing units. To this end, two bonding agents (Xeno III, iBond), three light curing units (Astralis 3, Elipar free-light, Elipar free-light 2), and a fissure sealant (Fissurit FX) were used. Microleakage was then evaluated using a dye penetration method after thermal cycling. When the fissure sealant was polymerized with Elipar free-light and Elipar free-light 2, microleakage at 10,000 cycles was significantly increased compared with that at 5,000 cycles. In terms of comparison among the curing units, the best microleakage score was observed with Astralis 3 (p<0.05). In terms of comparison between the two bonding agents, no significant differences in microleakage score were observed (p>0.05). Further, it was concluded that in order to evaluate microleakage scores appropriately, it was necessary for specimens to be subjected to thermocycling of 10,000 times or more.