Dr Purnendu Bhushan 1st yr MDS Dept.

of Prosthodontics SCB Dental College

 Denture base: the

part of a denture that rests on the foundation tissues and to which teeth are attached

HISTORY
The first dental prosthesis was believed

to have been constructed in Egypt about 2500 BC. Skilfully designed dentures were made as early as 700 BC. During medieval times, dentures were seldom considered as a treatment option. They were hand carved and tied in place with silk threads and had to be removed before eating.

 WOOD: For years, dentures were

designed from wood because it was readily available, relatively inexpensive and could be carved to desired shape. However, it warped and cracked in moisture, lacked aesthetics and got degraded in the oral environment

 BONE: Dentures made from bone became very popular due to its availability, reasonable cost and carvability. It is reported that Fauchard fabricated dentures by measuring individual arches with a compass and cutting bone to fit the arches. It had better dimensional stability than wood, however, esthetic and hygienic concerns remained.

 IVORY: Ivory denture bases and prosthetic

teeth were fashioned by carving this material to desired shape. These were relatively stable in the oral environment, offered esthetic and hygienic advantages compared to Wood or bone. However, ivory was not readily available and was expensive.

 PORCELAIN:
Alexis Duchateau (1774) was the first to fabricate porcelain dentures.

In 1788 AD, a French dentist, Nicholas Dubois de Chemant, made a baked-porcelain complete denture in a single block. The advantages were that it could be shaped easily, ensured intimate contact with the underlying tissues, was stable, had minimal water sorption, smooth surfaces after glazing, less porosity, low solubility and could be tinted but its drawbacks were brittleness and difficulty in grinding and polishing. Loomis (1854), Charles H Land (1890) and Alexander Gutowski (1962) experimented with different types of porcelain dentures.

 GOLD: In 1794 AD, John

Greenwood began to swage gold bases for dentures. He also made dentures of George Washington. Usually 18 to 20 carat gold was alloyed with silver and teeth were riveted to it.

VULCANITE (1855) Rubber with 32 % Sulphur & Metallic oxides. Advantages It is non-toxic, non-irritant, has excellent Mechanical properties material is sufficient hard to polish. Limitation Absorbs saliva becomes unhygiene, leads to bacterial growth & unpleasant odour Poor esthetics Dimensional changes Contraction of 2-4% by volume during addition of sulphur to the rubber

. TORTOISE SHELL: CF Harrington (1850) introduced the first thermoplastic denture material, the tortoise shell base. GUTTA PERCHA: Edwin Truman (1851) used Gutta percha as a denture base but it was unstable. CHEOPLASTIC: Alfred A Blandy (1856) made dentures from a low fusing alloy of silver, bismuth and antimony but it was never accepted. ALUMINIUM: Dr. Bean (1867) invented the casting machine and did the first casting of a denture base in aluminium.

CELLULOID: J. Smith Hyatt (1869) introduced celluloid that was later used as a denture base material because of its translucency and pink colour. However, this material did not gain much popularity because of distortion and discolouration. BAKELITE: Dr. Leo Bakeland (1909) introduced this phenol formaldehyde resin which was easily available but lacked colour quality.

 STAINLESS STEEL and

BASE METAL ALLOYS: Ni-Cr and Co-Cr were obtained by E. Haynes (1907) but they gained popularity after 1937 because of their low density, low material cost, higher resistance to tarnish and corrosion and high modulus of elasticity. Allergy to Nickel and difficulty in adjustment posed a practical problem

VINYL RESIN: Mixtures of polymerized

vinyl chloride and vinyl acetate were under experimentation during 1930 due to their pleasing colour but had difficult processing methods

 POLYMETHYL METHACRYLATE: Rohm and Hass (1936) introduced PMMA in sheet form and Nemours (1937) in powder form.

Dr. Walter Wright (1937) introduced Polymethyl methacrylate as a denture base material which became the major polymer to be used in the next ten years.

Classification of denture base material

METALLIC NON-METALLIC

Cobalt Chromium Gold Alloys Aluminium Stainless Steel Titanium

Acrylic Resin Vinyl Resin

TRY IN

DEFINATIVE Heat-cure Acrylic resin

Self-cure Acrylic resin Shellac Base Plate Hard Base Plate Wax

(1937)

METALLIC

classification
Synthetic Resins are often called as PLASTICS A substance that although dimensionally stable in

normal use was plastic at some stage of manufacture

Thermoplastic they soften again when reheated

(above GTT)
Thermosetting they are resistant to change after

further application of heat

 Thermoplastic Resin Are fusible, soluble in

Thermosetting Resin
These become permanently

organic solvents Better flexural & impact properties Most plastics in Dentistry belong to this group PMMA, Polyvinyl, Polystyrene

hard when heated above critical temp. & they do not soften again on heating Usually cross-linked in state These are insoluble, infusible Crosslinked PMMA, Silicones. Superior abrasion resistance Superior Dimensional Stability

Ideal properties of a denture base material

Mechanical
Adequate flexural& fatigue Strength

Physical
Same thermal expansion coefficient as denture tooth material

Biocompatible
Non-toxic

Aesthetic
Pigmentable

Other
Radioopaque

High modulus of elasticity

High proportional limit High impact strength

Conduct heat
Low density (light Weight) Melting point higher than ingested food/drinks Dimensionally stable (during processing and function)

Non-irritant
In-soluble in oral fluids Non-absorbent

Translucent
Highly polishable

Easy to manufacture
Low cost

Abrasion resistant

Inert

Capable of maintaining high polish

ALTERNATIVE USES
Artificial teeth Tooth restorations Orthodontic space Maxillofacial prosthesis,

maintainance Crown & Bridge facings, provisional crown & bridges

Athletic Mouth Protector Inlay patterns

Dies, Impression trays Endodontic filling

materials

Denture Base Resin

Basic Nature Of Polymer

. Polymer Molecule that is made up of may parts Chemical possessing a molecular weight of more than 5000
Monomer Molecule from which polymer is constructed Molecular Wt. of various polymers

(determines its physical properties)

Degree of Polymerization --- total no. of monomers in polymers . Strength increases with increase in Deg. Of Poly.

Polymerization series of chain reaction by which a macromolecule or polymer is formed from a single molecule
Condensation
Slow method Repeated Elimination of

Addition
In Dental procedures No change in chemical

small molecules By- products NH3, H2O, halogen acids

Functional groups are

repeated (Amide, Urethane, Ester or Sulfide) Here by-product formation is not necessary.

composition & no byproducts Giant molecules (unlimited size) Simple, but not easy to control

CHEMICAL STAGES OF POLYMERIZATION

INDUCTION (INITIATION)
PROPOGATION TERMINATION

CHAIN TRANSFER

 INDUCTION (INITIATION)
Is the time during which the molecules of the initiator

becomes energized or activated & start to transfer the energy to the monomer.
Impurity --- increases length of this period

Increase temp. --- shorter is length of Induction period

Initiation energy is 16000 to 29000 cal/mol.

 3 INDUCTION SYSTEMS
HEAT ACTIVATION free radicals are liberated by

heating Benzoyl peroxide CHEMICAL ACTIVATION atleast 2 reactants --chem. Reaction--- liberate free radicals Benzoyl peroxide + Aromatic Amine(dimetyl-ptoluidine) LIGHT ACTIVATION photons of light energy activate the initiator free radicals . Under visible light Camphoroquinone & an amine --- free radical

 (C6H5COO)2

2 C6H5-

A free radical is a compound with an unpaired electron, usually a fragment of a larger

molecule which has been split by heating.

This unpaired electron makes the radical very reactive.

Propagation

The chain reaction continues with the evolution of heat (about 25 C) until the monomer into has been

changed

polymethyl

methacrylate.

CH3 H C C H

CH3 C

H C H

CH3 C

H C H

CH3 C

C6H5

C H

COOCH3 COOCH3

COOCH3

COOCH3

Linear chain of polymethyl methacrylate

Termination

The chain reaction can be terminated

either by direct coupling or by the exchange of hydrogen atom from one growing chain to another.

 CHAIN TRANSFER The active free radical of a growing chain is transferred to another molecule (eg monomer or inactivated polymer chain) and a new free radical for further growth is created, termination occurs in the latter.

Inhibition Of Polymerization
Occurs when there is Complete exhaustion of monomer Or Formation of High Molecular Weight polymer
Inhibited by : IMPURITIES (react with Activated Initiator / Nucleus) Hydroquinone (0.006%) is in Monomer for storage OXYGEN retards polymerization Influence the length of Initiation

Copolymerization
Is required to improve physical properties
Two or more chemically different monomers, each with

desirable property polymerize to form COPOLYMER eg. Butyl methacrylate & methyl methacrylate
TYPES

Random
Block Graft

Application Of Copolymerization
BUTYL METHACRYLATEACRYLATE+ PMMA =

FLEXIBILITY BLOCK & GRAFT Polymers = Improves IMPACT STRENGTH (good adhesive properties + surface characteristics)

CROSS-LINKING (chemical bond between linear

polymers) Applications Improves strength, reduces solubility & water sorption Highly Cross-linked Material provides - increased resistances ------ to solvents, crazing & surface stresses

Plasticizers
These are often added to resin to reduce their

softening or fusion temperature Reduces brittleness But it also reduces Strength & Hardness
EXTERNAL penetrates macromolecules &

neutralizes secondary bond. It Evaporates / Leaches out eg. Dibutyl pthalate

INTERNAL - Copolymer

Acrylic Resin
Are Derivatives of Ethylene & contain a vinyl group in

their structural formula

Acrylic resins used in dentistry are esters of 1 Acrylic acid 2 Methacrylic acid Available as Methyl methacrylate [liquid] &

Poly (Methyl methacrylate) [powder]

Poly(Methyl Methacrylate)Resins
Widely used --- easy to process It is Thermoplastic resin
Liquid [monomer] Methyl Methacrylate is mixed with

Powder [polymer ] Monomer plasticizes the polymer to dough-like consistency which can be easily moulded Types ---- based on method used for its activation Heat activated resins Chemically activated resins Light activated resins

Heat-Activated Denture Base Resin

AVAILABLE AS Powder+ Liquid & Gels Sheets &cakes

COMPOSITION Liquid Methyl Methacrylate Gylcol dimethylacrylate [1-2%] ---- cross-linking agent Hydroquinone ---- inhibitor

Stored in tightly sealed Amber coloured bottle to prevent

evaporation , premature poymerization [by light or U.V radiation]

Composition

Powder Poly (Methyl Methacrylate) Other copolymers (5%) Benzoyl Peroxide ---- Initiator

Zinc / Titanium oxides --- Opacifiers Dibutyl pthalate --- plasticizer Dyed organic filler Inorganic particles like glass fibers / beads

Technical Consideration

COMPRESSION MOULDING TECHNIQUE Prep of wax pattern [waxed dentures] Prep of Split mould [Investing & Dewaxing] Application of Separating Media Mixing of powder & liquid Packing Curing Cooling Deflasking Finishing & polishing

 Prosthetic teeth are selected & arranged esthetic &

functional requirements
Impression making, cast generation, record bases Articulator mounting, teeth arrangement, wax

contouring

Waxed dentures are sealed to master casts removed from articulator

 Preparation of the mold Application of separating

medium Failure to place an separating medium 1. Water from mold surface may difuse in to denture resin, it may affect the polymerization rate as well as optical and physical properties 2. Free monomer may soak into mold surface portions of investing medium may become fused to the denture base

 Tin foil Paint on separating media like cellulose, lacquers, solution containing alginate compounds, soaps, starches were introduced.. Most popular -- water soluble alginate solution Produce thin, relatively insoluble calcium alginate films..

Mixing Of Powder & Liquid

Accepted ratio 3:1 by volume or 2:1 by weight If more Monomer [lower polymer/monomer ratio]

Greater poly. Shrinkage Additional time is reqd. to reach the packing

consistency Tendency for porosity

If less Monomer [lower polymer/monomer ratio]

Less wetting Granular acrylic Dough will be difficult to manage not fuse into

continous unit of plastic

Polymer-Monomer Interaction
When mixed in proper proportions, the resultant mass

passes through five distinct stages 1.Sandy 2. stringy 3. Dough like 4. rubbery 5. Stiff
1.Sandy

During sandy stage, little or no interaction occurs on a

molecular level. Polymer beads remain unaltered.

2. Stringy stage Later, mixture enters stringy stage. Monomer attacks the surfaces of individual polymer beads. Stage charcterized by stringiness, 3. dough like stage The mass enters a dough like stage. On molecular level increased number of polymer chains are formed. Clinically the mass becomes as a pliable dough. It is no longer tacky ( sticky)

This stage is ideal for compression molding.

4.Rubbery or elastic stage Following dough like stage, the mixture enters rubbery or elastic stage. Monomer is dissipated by evaporation and by further penetration into remaining polymer beads. In clinical use the mass rebounds when compressed or stretched 5. Stiff Stage Upon standing for an extended period, the mixture becomes stiff. This may be due to the evaporation of free monomer. From clinical point, the mixture appears very dry and resistant to mechanical deformation

Dough forming time

Time reqd for the resin mixture to reach a dough-like stage
ADA specification no. 12 in less than 40 mins Clinically most resins reach a doughlike consistency in less than 10 mins

Depends on
Controlled by manufacturer

1 Deg. Of polyn. higher the polyn, lower the Dough-forming Time 2 Particle size Smaller the particle size, shorter the Dough-forming

Time

Controlled by operator

3 Polymer:Monomer ratio : If this is high (less monomer), there is

shorter dough forming time 4 Temperature Higher the temp., shorter dough forming time 5 Plasticizer reduces the dough forming time

Working Time
May be defined as the time that a denture base

material remains in dough like stage At least 5 mins Affected by temp., extended via refigeration (moisture can degrade properties) Can be avoided by storing in air tight container

 PACKING Placement and adaptation of

denture base material within the mold cavity is termed packing Overpacking- leads to excessive thickness and malpositioing pf prosthetic teeth Underpacking- leads to noticeable denture base porosity Trial packing is done to ensure proper packing of resin mass in the mold. After the final closure of the flasks, they should remain at room temperature for 30- 60 min. it is called bench curing

 Bench curing It permits equalization

of pressure throughout the mold Allows more time for uniform dispersion of monomer throughout the mass of dough If resin teeth are used, it provides a longer exposure of resin teeth to the monomer producing a better bond of the teeth with the base material

 POLYMERIZATION PROCEDURE/ CURING When heated above 60 c, molecules of benzoyl peroxide decompose to yield free radicals. Each free radicals, rapidly reacts with an available monomer molecule to initiate polymerization Heat is required to cause decomposition of benzoyl peroxide. Therefore heat is termed as activator. Decomposition of benzyol peroxide molecule yields free radicals that are responsible for initiation of chain growth. Hence it is termed as initiator

 Temperature rise The polymerization of denture base resin is exothermic and the amount of the heat evolved may affect the properties of the processed denture bases. temperature of resin should not allowed to exceed the boiling point of the monomer (100.8oC) which produces significant effects on the physical characteristics of the processed resin.

Curing cycle
. Processing denture base resin in Constant temp water bath at 74*C (165*F) for 8 hrs or longer, with no terminal boiling 2. Processing the resin at 74*C for approx. 2 hrs & then increasing the temp. of water bath to 100*C & processing for 1 hour more
Other Methods of supplying heat for activation Steam, Dry air Oven, Dry heat (electrical), Infrared heating, Induction/Dielectric heating, Microwave radiation [Specially formulated resin & Non-metallic Flask: Speedy process]

Polymerization by Microwave
Microwave energy may also be used to polymerise poly methyl

methacrylate resins. For this technique, a non-metallic investment flask must be used along with resin specifically formulated for microwave processing. The microwave is used to provide thermal energy which allows the polymerisation reaction within the resin denture base to take place. The main advantage of microwave polymerisation techniques is the speed with which the denture base can be produced. Current evidence suggests that denture bases produced by this method have a dimensional accuracy and physical properties similar to those of conventional materials and resins (Keenan et al., 2003; Memon et al., 2004)

Internal Porosity
Resin & Dental stone Poor thermal conductors, heat

of reaction cannot be dissipated, so temp. of resin rises above that of stone & surrounding water Temp. exceeds the boiling pt. of Monomer (100.8*C)
Porosity not seen on surface, as heat is dissipated Centrally, heat generated in thick portions cannot be

dissipated --- boiling of unreacted monomer ---porosity

External Porosity
. Lack of Homogenity Portions containing more

monomer will shrink more than the adjacent areas, results in voids & resin appears white.(proper powder:liquid, homogenous mix pack in dough stage) 2. Lack of adequate pressure Lack of dough during final closure (Flash indicates adequate material)
OTHER PROBLEMS : Crazing[Cracks] & production of

Internal Stresses

Cooling
After Curing Denture flasks should be cooled slowly

to room temp. Rapid Cooling warpage of denture base because of differences in thermal contraction of resin & stone Slow Cooling Minimizes potential difficulties So, Bench-Cooling for 30 mins, then flask should be immersed in cool tap water for 15 mins Cooling overnight is ideal

Deflasking,Finishing & Polishing

Deflasking has to be done with care to avoid flexing

& breaking of Acrylic denture

Finishing Metal Trimmer, Acrylic/Alpine Stone, Dry

& Wet Sand paper

Polishing suspension of finely ground pumice in

water

Injection Molding Technique

Mold space can be filled by

injecting resin under pressure in specially designed flasks Sprue hole / Vent hole are formed in stone mold Soft resin (dough stage) is contained in injector & is forced into mold Resin under pressure until it has hardened Polystyrene resin polymer is first softened under heat & injected while hot, then it solidifies in mold upon cooling No trial closures are required

Injection Molding Technique

Advantages
Dimensional accuracy Low free monomer content

Disadvantages
High capital costs Difficult mold design

Good impact strength

prblems Less craze resistance Less creep resistance Special flask is required

Chemically activated denture base resins Chemical activators are used to induce polymerization. Does not require thermal energy and therefore may be completed at room temperature. Hence often referred to as cold curing, self curing or autopolymerizing resins

Chemical activation is accomplished through the addition of a tertiary amine such as dimethyl- paratoluidine to the liquid. Upon mixing, the tertiary amine causes decomposition of benzoyl peroxide. Consequently, free radicals are produced and polymerization is initiated

 Advantages
Better initial fit

Disadvantages
Lesser degree of

Less thermal contraction

For repairing dentures, as

it avoids warpage due to re-curing

polymerization, so these have slightly inferior physical properties Colour stability is inferior, due to subsequent oxidation of the tertiary amine

Manipulation
. Adapting technique
1. Sprinkle On technique

3. Fluid resin technique

4. Compression moulding technique

5. Injection moulding technique

Fluid Resin Technique

These have high molecular wt powder that are smaller in

size & when they are mixed with monomer, the mix is very fluid They are used with lower powder-liquid ratio 2 : 1 -2.5 : 1
This aids to prevent undue increase in viscosity during

mixing & pouring stages This technique commonly involves use of Agar Hydrocolloid for the mould preparation Fluid mix is poured in the mould quickly & allowed to polymerize under pressure at 0.14 Mpa (20 psi).

Advantages
Improved adaptation to

Disadvantages Shifting of teeth during

underline soft tissue

processing

Decrease probablity to

damage prosthetic teeth & denture bases during deflasking Reduced material cost Simplification of lab procedure for flasking (no trial closure),deflasking & finishing of denture

Air entrapment within

denture base material Poor bonding between the denture base material & acrylic resin teeth Technique sensitive

 Autopolymerizing
Heat is not necessary for

Heat-Cured

polymerisation Porosity is greater. Have lower average molecular weight. Higher residual monomer content. Material is not strong.(coz of their lower molecular weight mols.) Poor color stability. Easy to deflask. Rheological properties: A) Show greater distortion. B) More initial deformation. C) Increased creep & slow recovery

Heat is necessary for polymerisation Porosity is less Higher average molecular weight (5

lakhs-10 lakhs) Lower residual monomer content Material is strong

Good color stability Difficult to deflask

A) Show lesser distortion B) Less initial deformation C) Less creep & quicker recovery

Light activated Denture Base Resin

Composition

Urethane dimethacrylate matrix Acrylic copolymer Microfine silica fillers Photoinitiator system Camphoroquinone amine

Supplied in pre-mixed sheets having clay-like consistency Provided in opaque light packages to avoid premature

polymerization Adapted to cast when in plastic form Polymerized in light chamber with light of 400-500 nm from high intensity quartz halogen bulbs

Properties of Light-activated Resin

1. These are indicated for PMMA sensitive patient as it

does not contain methyl methacrylate monomer 2.They exibit smaller polymerization shrinkage 3. Elastic modulus and flexural strength are lower than conventional resin 4. Inferior bond strength with resin denture teeth but can be improve with use of bonding agent 5.Biocompability is concern with report of hypersensitivity & cytotoxicity in epithelial cells in culture.

Properties of Denture Base Resins

Methyl Methacrylate Monomer: Clear, transparent, volatile, has

sweetish odour. Melting pt: -48*C Boiling pt: 100.8*C Heat of polymerization: 12.9Kcal/mol Volume shrinkage during polymerization: 21%

Poly (Methyl Methacrylate ) Tasteless, odourless, clear transparent, has adequate compressive &

tensile strength, has low hardness-can be easily scratched & abraded Shrinkage ---- thermal shrinkage on cooling & polymerization shrinkage Volume shrinkage is 8% & Linear Shrinkage is 0.69%

 Compressive and tensile strengths: These materials are typically low in strength. However, they have adequate compressive and tensile strength

for complete or partial denture Compressive strength - 75 MP Tensile strength - 52 MP Hardness: Acrylic resins are materials having low hardness. They can be easily scratched and abraded. Heat cured acrylic resin : 18.20 KHN Self cured acrylic resin : 16 18 KHN

Modulus of elasticity: Acrylic resins have sufficient stiffness (modulus of elasticity 2400 MPa) for use in complete and partial dentures. However, when compared with metal denture bases it is low. Self cured acrylic resins have slightly lower values. Dimensional stability: A well processed acrylic resin denture has good dimensional stability. The processing shrinkage is balanced by the expansion due to water sorption. Shrinkage: Acrylic resins shrink during processing due to two reasons: 1. Thermal shrinkage on cooling 2. Polymerization shrinkage

Polymerization shrinkage
Clinically, the polymerization of Denture base Resin

produces volumetric & linear shrinkage. Molecular Events Each molecule of methylmethacrylate an electric field that repels nearby molecule. The distance between molecule significantly greater than C-C bond. During polymerization C-C linkage is formed that produces net decrease in space occupied by the molecules. When methylmethacrylate polymerizes to form polymethylmethacrylate, the density of mass changes from 0.94-1.19g/cm3. This change in density result in volumetric shrinkage of 21%

 But clinically when suggested polymer-monomer ratio

of 3:1 is use than volumetric change is about 6-8% only and linear shrinkage is about 0.69% Thermal shrinkage of resin is primarly responsible for linear shrinkage. It depends on Tg & linear cofficient of thermal expansion. Range of linear shrinkage: 0.12-0.97% for various comercial denture resins

Water Absorption.
Polymethacrylate absorbs relatively small amount of

water when placed in aqueous environment Water molecules penetrate the polymethacrylate mass and occupy positions between polymer chain. Effects 1.It causes slight expansion of polymerized mass. 2.It act as plasticizers- interfer with entaglement of polymer chains. It exhibit water absorption value of 0.69mg/cm2. It has been estimated that for 1% increase in weight produce by water absorption, acrylic resin expands 0.23% linearly.

 Crazing Crazing is formation of surface cracks on the denture base resin. These cracks may be microscopic or macroscopic in size .In some cased it has a hazy or foggy appearance raphe than cracks
Crazing has a weakening effect on the resin and reduces the esthetic qualities. Cracks formed on crazing are

indicative of the beginning of a fracture. Causes: Crazing is due to 1. Mechanical stresses or 2. Attack by a solvent

Reinforcement of Acrylic Resin Denture Base

Reinforcement of a

denture base is the process of strengthening the denture base to make it more resistant to fatigue and fracture

Heat-polymerizing acrylic resin, since its introduction several decades ago, has been the material of choice for the construction of denture bases for numerous reasons: Excellent appearance. Ease in processing. Repairability. Economical. Stable in oral enviroment

However it is associated with two important clinical disadvantages: 1. low flexure fatigue and impact resistance. 2. Fractures in acrylic dentures result from impact or bending forces.

Impact forces typically are created during an accidental fall into a washbasin or onto the floor. Bending forces are developed mainly during mastication because of poor adaptation of the denture to the underlying mucosa, improper occlusion, morphology of the palate, excessive masticatory forces, or denture deformation during use. Those bending forces in longterm contribute to fatigue of the material.

When to make reinforcement: Patient dentures are fitting well but are still breaking A full denture combined with natural dentition in the opposing jaw Thin dentures where vertical space is limited Patients with strong bites Removable implant-supported dentures

Strengthening the acrylic resin prosthesis can be approached by modifying or reinforcing the resin. Methods of reinforcement: 1. High impact resin: One method is to incorporate a rubber phase(butadine styrene) in the bead polymer which produces high impact resin but unfortunately the high cost of these materials restricts their use. 2. Metal wires and strips: One of the most common reinforcing technique is the use of metal wires embedded in prosthesis. however, the primary problem of this technique is poor adhesion between resin and wires.

3. Cast metal plates and mesh:

Cast metal plates also have been used to replace some parts of the denture. Although metal plates increase the flexural and impact strength, they may be expensive, and prone to corrosion; moreover, metalreinforced dentures may be unesthetic as well

4. Fiber reinforcement:

Another approach is the reinforcement of acrylic resin dentures with fibers. Various types of fibers including carbon, Kevlar, glass, and polyethylene have been tested. Carbon and Kevlar fibers are useful in strengthening PMMA; however, they produce clinical problems such as, difficulty in polishing and poor esthetics. Woven polyethylene fibers normally develop anisotropic properties to the composite. They are more esthetic but the process of etching, preparing and positioning layers of them may not be practical in the dental office

Glass fibers are the most common form of all used fibers; they improve mechanical properties of denture base polymers, have easy manipulation, and they are esthetic. Light cured glass fibers, new technique more esthetic, stronger and easy manipulation.

Limitation of Reinforced Denture Base Resin

1. Tissue irritation can occure from protruding glass

fibers 2.Poor esthetics is associated with dark carbon fibers or straw colored kevlar fibers 3. Require increased production time 4.Difficulties in handling, orientation, placement or bonding of the fibers within the resin 5.Metal insert has been associated with failures due to stress concentration around embeded insert.

Rapid Heat-Polymerized Resin

These are hybrid acrylics that are polymerized in boiling water immediately after being packed into a denture flask. After being placed into the boiling water, the water is

brought back to a full boil for 20 minutes. After the usual bench cooling to room temperature, the denture is deflasked, trimmed, and polished in the usual manner The initiator is formulated to allow for rapid polymerization without the porosity that one might expect.

Relining & Rebasing of Denture Bases

DEFINITIONS(Winkler) Relining is the process of adding some material to the tissue side of a denture to fill the space between the tissue and the denturebase Rebasing is a process of replacing all the base material of a denture. The purpose such a process is to fill the space between the tissue and the denture base without changing the position of the teeth and the relation of the denture.

Indications for Relining or Rebasing

1. 1.Immediate dentures at 3-6 months after their

original constructions. 2.When the residual ridges have resorbed and the adaptation of the denture bases to the ridge is poor. 3. When patient can not afford the cost of new denture. 4. when seris of appointment for new denture may cause physical and mental stress e.g geriatric or chronically ill patients.

Contraindication
Excessive resorption of the alveolar ridge Highly inflamed/ abused soft tissues Poor, unacceptable esthetics TMJ problems Unsatisfactory jaw relation
Horizontal, vertical and orientation relations

Severe osseous undercuts which require surgical correction Severe speech problems

Materials
1.

PMMA
Heat cured acrylic resin Cold cured acrylic resin

2.

Modifications of PMMA
Butyl meth acrylate

3.

Soft liners/ tissue conditioners

Plasticized acrylic resin

Chemically activated. short term denture liners Heat activated. long term denture liners

Vinyl resins Silicone materials

Chemically activated Heat activated

Problems with soft liners

1. Leachig out- plasticized acrylic resin

2.poor adherence 3. It decreares the strength of denture 4. It can not be cleaned effectivly 5. Disagreable taste & odors related to these materials 6. most common fungal growth candida albicans found on these liners

Growth of Biofilms on denture Base

The predominant oral fungus isolated from dentures is

C. albicans(75%).These fungi and other bacterial species collectively form biofilms. Adhesion of such film cause adverse effect like denture induced stomatitis. --- In absence of adequate oral hygiene, water sorption, cracks, surface imperfections and microporosity are some of the contributing factor for biofilm formation.

Control of Biofilm
1.Frequent cleansing and soaking the dentures in c

chemical cleansers. 2. The temporary treatment of resin surface with Nystatin and chlorhexidine 3.Copolymerization with methacrylic acid,creates a surface-modified PMMA(mPMMA) that alters ionic interaction between the resin base and candida hyphae and decreasing adhesion of micoorganism to base 4. Coating the resin surface with self bonding protective polymer eg. Poly(dimethylsiloxane)

Recent Advancement- Flexible Denture Bases

Unilateral or bilateral undercuts are frequently encountered and may complicate successful fabrication of denture prosthesis. Management of these situations conventionally includes alteration of the denture prosthesis bearing area, adaptation of denture base , careful planning of the path of insertion and the use of resilient lining material. An alternative denture prosthesis design in which optimal flange height and thickness can be achieved is by using flexible denture base

 It is nylon based

thermoplastic material that does not sacrifice aesthetics. Soft dentures are an excellent alternative to traditional hard-fitted dentures Some of the commercially available products are Valplast, Duraflex, Flexite, Proflex, Lucitone, Impak where as valplast and lucitone are monomer free.reserves

 Advantages
Translucency of the material picks up underlying tissue tones, making it almost impossible to detect in the mouth. No clasping is visible on tooth surface. The material is exceptionally strong and flexible. Free movement is allowed by the overall flexibility. Complete biocompatibility is achieved because the material is free of monomer and metal, these being the principle causes of allergic reactions in conventional denture materials.

Disadvantages
Flexible dentures generally not

used for long-term restorations and is intended only for provisional or temporary applications. Flexible dentures tend to absorb the water content and will discolor often. Procedure is technique sensitive. Extreme caution is necessary when processing

References
1. Philips Science of Dental Material

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