Raleigh A. Holt. DMD' Christian C. Zylinski, ODS" Manville G.

Duncanson, r, ODS, PhD'"

Force Versus Time Profiles of Selected Heat-Processed Denture Liners

University o Oklahoma College of Dentistry PO Box 26901 Oklahoma City, Oklahoma 73190

The potential correlation of the force versus time behavior of four resilient lining materials and their acceptance hy patients was investigated. Two modified acrylic resins and two silicone denture lining materials were tested. The response of the soft lining materials to a programmed indentation test was used to define a parameter for each denture liner product. A parameter defined as the "Rebound Index," using force-time data obtained from the indentation measurements, was significantly different for the modified acrylic resins compared to the silicone materials. Improved patient acceptance was correlated with higher values of this index. Intj Prosthodont ]99I;4:164-168.

S resilient materials used as denture base liners.''' These requirements have included dimensional
stability in processing and oral use, permanent resilience, minimal absorption of oral fluids, and adequate bond strength to the denture base. The liner materials should also be hygienic, odorless, tasteless, nonirritating, and nontoxic. One of the first materials used for a denture liner with acrylic resin dentures was plasticized poly(vinyl]chloride.' Many varieties of plasticized acrylic resins and silicones have also been used as denture liners. Investigators have studied the mechanical and physical properties of these materials.'"^ There have been numerous clinical evaluations of soft-lined prostheses reported in the literature.^"''' Others have reviewed the physical properties, use, and manipulation of resilient liners for dentures.'^"'*' Past research has illustrated that it is difficult to use a single physical property for the determination of the clinical success of a denture liner.' However, many clinicians have assumed that the time-dependent shape-recovery behavior of heat-cured resilient liners is related to the liner's

everal authors have suggested requirements for

'Associate Protessor of Removable Prosthodoritics. "Clinical Instructor. '"Proiessor and Chan of Denial Materials.

potential for ridge adaptability and clinical success.'"'*"'^ Shape changes in denture liners are accompanied by an instantaneous component (resiliency) and a time-dependent component (recovery).^ Wilson and Tomlin' used indentation and shape-recovery tests to evaluate the resiliency of soft liner materials. They theorized that a denture liner material must have the ability to return to its original shape as completely as possible after it has been compressed. Their evaluation of several acrylic resin and silicone denture liner materials under simulated oral conditions showed that appreciable recovery occurred for all materials. They concluded that the materials most suitable for clinical use were soft and completely recovered their shape after compression. No material tested possessed both of these characteristics. Eick et al^ evaluated resilient materials for recovery and any appreciable flow following the application of compression forces for varying periods of time. Several resilient materials were compressed for 24 hours, and their recovery was measured at 1-minute and 1-hour intervals. Most acrylic resin materials showed incomplete recovery even after 1 hour. The silicones showed the greatest total recovery within 1 minute. Even though many tests have been performed to characterize the behavior of resilient materials used for denture liners, no parameter to accept or reject denture liner materials has been established. This paper reports research conducted

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 Vs Time Profiles ol Heat-Cured Denlure Line

using selected denture liners to determine a parameter for characterization of these materials. A programmed indentation test was used on the denture liner material, in situ, and a specific parameter was obtained for comparison of the various liners tested.

Table 1 Heat-Processed Denture Liners Study Group

Product Name Protech Type Acrylic resin Manufacturer Protecfi, Inc Centerreach, NY Coe Laboratories, Inc Chicago, IL

Materials and Methods

Table 1 lists the denture liners used in this study. They were evaluated, in situ, on complete mandibular dentures worn by patients requiring this method of treatment. Each patient's mandibular denture base area was divided at the midiine. The two silicones and the two acrylic resin soft lining materials were paired, since they have similar chemical classifications and laboratory processing procedures. It also allowed for intrapatient evaluation of two different products. Patients who could not satisfactorily wear a hard acrylic resin denture base were obtained from the University of Oklahoma College of Dentistry Student Clinics. These patients were alternately assigned to the "acrylic resin group" or the "silicone group." These patients were wearing dentures that had been fabricated in the student clinics within a 6-month interval prior to this investigation. The criteria for the patients' dissatisfaction were 11) the inability to wear their mandibular dentures for a period of 6 hours without "soreness," requiring a dental visit for adjustment, and (2) inability to chew a soft-solid diet consisting of soups, cooked vegetables, and ground meat. A previously described functional impression technique with Lynal (LD Caulk Co, Milford, Delaware) was used to make a final impression for the reline of the mandibular dentures, and a "waxshim" technique was used to place the resilient materials for processing onto the dentures.'" The

Coe Super-Soft Acrylic resin Prolastic fwiolloplast B

Silicone Young Dental Products ivlaryland Heights. MO Silicone Regeneri S Co Germany

"wax-shim" technique was used to ensure a proper thickness of the soft lining materials in each denture base. A brief review of the procedure follows. After wax elimination procedures and recovery of tbe denture from the flask, tinfoil substitute is applied to the master cast. The cast is allowed to cool, and a wax shim is placed on the master cast in the areas where the denture lining material is desired. Sheets of record base are placed approximately 2 mm thick, and a periodontal probe is used to measure this thickness. The denture base thickness is reduced to allow space for additional acrylic resin. This procedure permits filling of the denture base area with hard acrylic resin, except in the area of the wax shim. The new acrylic resin is bench processed for 4 to 6 hours. The flask is then opened and the wax shim removed. The denture lining material is placed in the space left by removal of the wax shim, and the flask is closed under recommended pressure and heat processed. Five patients received soft liners of the modified acrylic resin types (A and B) on each half of their dentures, and four patients received soft liners of silicone types (C and D) on each half of their dentures (Fig 1). Identical home care instruction sheets were given to all patients and reviewed with them.

Fig 1 Five patients received soft liners of the modified acrylic resin types (A and B} on eacfi half of tfieir dentures, and four patients recerved soft liners of tfie silicone types (C and D| on each half of tfieir dentures.

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Force Vs Time Proliies of Hoat-Curcd Denture Une

A mechanical testing instrument (Model 1135, Instron Corp, Canton, Massachusetts) was used to perform the indentation tests on the soft-lined dentures. An orientation plate was machined for placement on the platen of a 2,000-g load cell. The plate was constructed to fit a modified surveyor so that a plaster index could be fabricated for each denture. Each plaster index was designed to locate an area

of denture liner on the buccal flange of ihe denture with a 2,0-mm thickness. An indentor ,0 mm in diameter was used to indent this arej on each denture base at the time intervals of the tests (Fig 2], Fach denture was tested before clinical placement and then retested at 7, 32, and 92 days following placement. The indentation tests were conducted on the dentures after temperature equilibration at

Fig 2 <Le) Ah ihflentor 3,0 mm in diameter was used to indent this area on each denture base at the time intervals of the tests. Fig 3 (Above) Dentures were placed on their individual indices on the orientation plate.

Fig 4 Graph produced by the X-Y recorder during a typical test cycle of a soft lining material, F^j. = maximum kgforce measured after ioading; F, = minimum kg-force measured after relaxation phase of testing; F = preload 90-g; t^ = time zero: t, = loading time; t, = relaxation phase; ti = unloading time.

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 Vi Time Profiles of Heat-Cureri Demure Lir

Table 2

Mean Values and Standard Deuiations tor Parameters Studied

Maximum force F. (kg) 0.47 0.42 0.91 0.98 0.12 0.12 0.18 0.20 Minimum force F_ (kg) 0.37 0.36 0.84 0.89 -^ -^ -^ 0.09 0.10 0.17 0.18 Time
F

Rebound index
11

Product
A B C D F,^ F. I t

t, (sec) 115+29 138+30 136 -1- 23 U l 18 56.82 + 14 64.29 * 9 89.63 15

maximum recorded iorce load) afer loading @ 0 02 in/mm. = recorded Iorce after (iie relaxation interval. = loading time interval = 120 seconds. = unloading time interval.

37C for 5 minutes. The dentures were placed on their individual indices on tbe orientation plate (Fig 3). For test uniformity, tbe area selected for indentation was preloaded to 90 g to ensure comparable initial indentor contact. With an Instron crossbead speed of 0.02 in/min, the selected area of the softlined denture was continually loaded for a period of 2 minutes. Tbe indentor was beld at this position for another minute, and an observation of the forcerelaxation phenomenon of the liner materials was recorded. After this relaxation interval, the unloading, at 0.02 in/min, was performed until the force recording was 0, Recording of the force versus time data was accomplished with an X-Y recorder (Model 7005B, Hewlett Packard, Mountain View, California), set at a chart speed of 10 seconds per inch (0.1 in/sec). An example of a typical graph recording during a test cycle is shown in Fig 4.

measured and used in the statistical analysis are listed and defined in Table 2. Means and standard deviations were obtained for the calculated Rebound Indices to compare the products. A one-way analysis of variance indicated that a statistically significant difference existed among the four means (F = 21.49, df = 3, P > \^ = .0001). A specific comparison test was then performed to rank the products and determine significant differences with respect to the Rebound Index. The significance level for this analysis was P < .05. A plot of the value of the Rebound Index as a function of time is shown in Fig 5. Considerable variation in the value of the Rebound index can be seen at the different time intervals. At one observation interval, namely 7 days, the value is greater than 100%. F,7F,^ is still less than 1, but the ratio of t|/t^i is greater than 1.0 because of the greater

Results
100%

The Rebound Index (Rl) is defined by the following equation: RI = - ^ X X 100% >

/\
/ - ^
. , - - - -

c
75% ,

_^
-

This equation stems from an examination of the means of the experimental data. Observation of the data for F^,, F , t^^i, and t, support the fact that for their means, F, < F and t, < t,. Since this is true, the ratio of F^i/F^ is also less than 1 for F^,. not equal to 0. F^, > 0 and F ^ > 0; therefore, the ratio of F^,/F^ is between 0 and 1, since F^,n < F^^. Also, t| > 0 and t, > 0; therefore, the ratio of t^i/ti 5 also between 0 and 1, since t| < t,. The product of the two rational numbers (F,n/F^J(t^i/ t|) will therefore be less than 1 and greater than 0. This product times 100% is defined as the Rebound Index and is asserted, and supported by the data, to distinguish among the compositional types of the soft liners investigated in this study. The variables

A
50% .

25%

. . -

1 1
7

1
32

1
92

Time Wear (days)

Fig 5 Plot of the value of the Rebound Index as a tunction of time. A. Protech; B, Coe Super Soft; C, Prolastic; D, Molloplast B.

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Force Vs Time Proliies of Heat-Cured Dentun

time required for loading in relation to the time required tor unloading. Isolated occurrences of this nature are assumed to be related lo the intrinsic viscoelastic properties of the material, which are yet to be investigated. However, Ihe preponderance of the data points toward the Rebound Index lying within the interval 0 to 1. No regular specimen dimensions exist that could allow the use of viscoelastic equations for the computation of time-dependent properties. The Rebound Index calculation makes some assumptions that could be called into question. If the load and unload curves are considered triangles, the load curve would represent the work done in compressing the reline material and the unload curve the energy released after the relaxation time. The energy relationships, or work done, would be: Work done in compressing = 1/2F^J (tj. However, since the load curve is not a triangle, the equation must be modified to: 1/2 (F^^,] (R,), where R, must be less than 1.0 and is a correction factor, the ratio of the actual area beneath the load curve to the triangular area. Similarly, the unload curve expression is: energy released in decompressing = 1/2 (F^J (tJ (R^), where R; is a similar correction factor for the unload curve. Taking the ratio of work done in compression to energy released after 1 minute relaxation results in the equation for the Rebound Index only if R, = R;. However, the correction factors are probably not calculable under the conditions of this indentation test. Summary and Conclusions The Rebound Index separates the denture liners into two distinct groups, which elicited different clinical responses. The same criteria under which patients were selected for this study were used to observe the clinical experiences of the patients wearing the various denture lining materials. Patients who used products A and B continued to experience soreness that required adjustments after 6 hours of use. These patients reported very little improvement in their ability to chew a soft-solid diet. Patients with products C and D reported no soreness requiring adjustments of the liner material during the 92 days of this study. On the other hand, all of these patients had improved ability to chew a soft-solid diet. The denture liners used in this group of patients had higher Rebound Indices than those of products A and B. After 92 days, all patients were given a choice of denture lining materials for placement in their mandibular dentures. All patients in group A-B requested another denture lining

material. All patients in group C-D requested either C or D materials. After receiving product C or D, palients in group A-B showed similar clinical improvement as group C-D, Although one parameter does not necessarily make a denture lining material acceptable or unacceptable for clinical use, the Rebound Index did separate these heat-processed soft liners into two distinct groups. The higher Rebound Indices of products C and D did correlate with improved clinical performance, eg, nonsymptomatic wear time and increased chewing ability. Although the sample size of this study was small, there is evidence to merit further investigation of the usefulness of the Rebound Index parameter.

References
1. Wilson HJ, Tomlin HR: Soft lining materials: Some relevant properties and their determination. / Prosthet Dent I969;21:244-25O. 2. Craig RC, Gibbons P: Properties of resilient denture liners. / Am Dent Assot 1961;6:382-39O. 3. Lammie GA, Storer R: Preliminary report on resilient denlure plastics. / Prosthet Dent 195&:SA ft-424. 4. Srorei R: Resilient denture base materials. Fr Dent I962;i13:195-2O3. 5. Eick ID, Craig RG, Reyton FA: Properties of resilient denture liners in simulated mouth conditions. / Prosthet Dent 1962;12:1O43-1O52. 6. Schmidt WF, 5mith DE: A six-year retrospective study of Molloplast B-lined dentures. Part II: Liner serviceability. / Prosthet Dent 1983;50:459-465. 7. Matthews E: Soft resin lining for dentures. Br Dent I ]945;7B:I4O-145, 8. Robinson JE: Clinical experiments and experiences with silicone rubber in dental prostheses. ; Prosthet Dent 1963:13:669-675. 9. Means CR, Rupp NW, Paffenbarger GC: Clinical evaluation of two types of resilient liners on dentures. M m Dent Assoc l971;e2:1376-1380. 10. Wrigbt PS: The success and failure of denture soft-lining materials in clinical use, / Dent 1984;12:319-327. 11. Bascom PW: Resilient denture base materials. ; Prosthet Dent ]9&6;16:646-649. 12. Segall BW, Glassman A: Use of a medical-grade silicone mucosal irritation. / Prosthet Denf 1982:47:85-87, 13. Crum R), Loiselle R|, Rooney GE: Clinical use of a resilient l i n e d m a n d i b u l a r d e n t u r e , / Am Dent Assoc 1971;fi,1:1093-1096. 14. Duncan |D, Clark L: The use of a soft denture liner for chronic residual ridge soreness. ; Am Dent Assoc 1985:111 64-65. 15. Laney WR: Processed resilient denture. Denf Clin North Am 1970;14:531-551. 16. Gonzalez |B, Laney WR: Resilient materials for denture prostheses. / Prosthet Dent 1 966,1 6:438-444. 17. Makila E: Soft linings to relieve soreness beneath dentures. / Ora; Re/ia/V ]976;,:145-I5D. 18. Holt RA, Stratton R), McBride C: Impression technique and laboratory procedures for a processed resilient denture liner. Quint Dent Tethnol 1986,10:9-72.

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