Manipulation

4.

Processing: porosity, processing strains.

common mistakes can be happened while you are making a denture. The most common one is porosities, and the problem in these is that they are unstable and they cause weakness of the denture. And there are many types of porosities and each one has a specific reason.

1. 2.

Porosity: caused by, Polymerization shrinkage (contraction porosity) Volatilization of monomer (gaseous porosity), which is caused by
the evaporation of the monomer, which happens when boil the water much higher than 100, because the evaporation temp. of the monomer is 100.3 . And usually this happened in the thick portion of the denture, which is the palatal portion. Since these areas are thick, the temp. raised quickly and cause evaporation. So, during processing, temp. should be raised slowly.

3.

4.

Granular porosity, due to loss of monomer while resin mix is left to stand until dough stage is reached. Also if the resin mix is dry and its because of 2 reasons: 1- adding too much powder
when its mixing with the monomer, so the mix will be dry. 2- the mix it correct but when we dont cover it after we finish mixing, therell be evaporation and itll be dry also.
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Continue,
1.

Contraction porosity: occurs due to monomer contraction (shrinkage) by 20% during processing. Processing involves a raise in temperature to initiate polymerization at first as its put in a boiling water and then temperature raised due to the exothermic reaction During this, resin flows (under pressure) into spaces created by curing contraction and itll be less that what we want. SO, excess resin is important to maintain this pressure.
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Continue,

Once resin becomes rigid, thermal contraction may occur (change from curing temperature to room temperature). Curing temperature for cold cure resin is lower than heat cure resin. Insufficient amounts of resin packed in the flask may lead to voids or porosity. Also resin should be packed in the DOUGH stage. Prior to that the resin would flow too rapidly and pressure is lost

Porosity
2.
1.

Gaseous porosity:
Caused by a rise in the resin temperature during curing above 100C (> boiling temperature of resin) Gaseous monomer forms and causes gaseous porosity This is avoided by allowing a slow and controlled rise in temperature

2.

3.

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Processing strains:
Internal strains occur during processing of resin, and
thats because the pressure and raising of the temp. that you cause while working.

These stresses and strains shouldnt be allowed to relax completely, because If

its

allowed, warpage, distortion and crazing (tiny surface defects) occur.

Some are relieved as the material flows but thermal contraction strains may remain. This can be minimized by:

Slowly cooling flask (cooling and warming) Using acrylic rather than porcelain teeth to ensure compatible shrinking . Porcelain and acrylic resin has different
coefficient of contraction and expansion. Now, this difference can cause stress inside the material if we use porcelain teeth. But if we use the acrylic one, the coefficient will be similar; so, therell be no stress created inside the material.
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Properties of resin

Biocompatibility:

High, however, allergy may occur due to leachable components mainly the monomer and benzoic acid. Allergy is mainly associated with cold cure resin due to high residual monomer As a replacement, denture bases maybe constructed from polycarbonate

Properties continue,

Dimensional stability and accuracy:

What is the difference between retention and stability? It is important for the denture to be retained intraorally. Why?

They are dimensionally stable if the patient takes care of them (putting them in a humid environment) and if our processing was correct according to the temp. and pressure. Otherwise, theyll loose water and the shape might change.

Accurate fit to ensure good adhesion (large surface area) and cohesion (accurate fit) To ensure good peripheral seal (all of these things we take them
next year)
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Properties continue,

Mechanical properties: one of the properties of the resin material is low impact state,
which mean, if the patient accidentally drops the denture, itll easily break.

Creep is a problem, which is changes in shape and its susceptible to distortion. Its minimized by cross-linking agents Tensile strength 50 MPa Dentures are prone to fracture Elastic modulus Low Commonly, midline of upper Flexural 2200-2500 denture modulus MPa Mainly caused by:

Trauma, leading to cracks then failure. So, if there are defects, pores, bubbles
or tiny fractures inside the denture, the denture will be weaker.

Poor quality processing: lack of bonding between resin and teeth Crazes

Mechanical properties continue,

Solution to patients who commonly fracture dentures:

High impact resistant resin (contain rubber toughening agent), decrease crack, but the problem is that it may lower flexural modulus and lead to fatigue due to excessive flexure. And finally it might be broken.
Incorporation of fibers to produce fiber reinforced resin:

Carbon fibers: difficult to handle, poor esthetics Aramid fibers: lack of bonding with rein Ultra high molecular weight polyethylene fibers, UHMPE: low density, neutral color, biocompatible, bonds to resin but processing is time consuming Glass fibers: most promising, incorporated as short fibers or loose form.

Sometimes, they add sheets of these fibers to make the denture stronger (specially the palatal area). The most common place that they put them is the midline (even upper or lower midlines), because the midline is easier to be broken.
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Physical properties
Thermal conductivity Very low, thats why patients always burn their mouths, disadvantage: Isolates tissue from temperature sensation Coefficient of thermal High, if teeth are from expansion (CTE) porcelain, differential expansion loose teeth Water sorption & solubility Absorb water 1-2% wt. slowly and we can lose it, so we should put it in a humid environment. Insoluble in oral fluids

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Denture lining material

After we make the denture and the patient used it; then after few years, it contacts telling that the denture is loosed or its not with the vertical dimension of the face. So, wrinkles will appear in the face and also the ability of eating will be affected as well. Sometimes, theres nothing wrong with the denture but still the patient is complaining from pain; then he/she just has to get used to it.

Divided into:

Permanent hard reline materials Semi-permanent soft liners Tissue conditioners/temporary liners

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Hard reline materials:

Criteria for using it to reline dentures:

Poor retention and stability Loss of vertical dimension Degradation of the denture base (destroyed for some reasons) For older patients for home getting use to a new denture base would be difficult (they can do relining to make it fit
better)

Lack of denture extension into mucobuccal fold areas (important for facial support)

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Materials used:

its composition is similar to the resin material. Sometimes it uses ethyl instead of methyl. Ethyl is less irritant than methyl. So, they are different than each other; so, if the patient irritate from one of them, we should give him the other one.

Heat cure resin, in the lab. Cold cure resin, chairside. (can be used in the clinic immediately) Disadvantages:

Poor taste Poor color stability Exothermic reaction, it can cause irritation, so, we shouldnt keep it in the
patients mouth all the time; we place it for sometime and then we finish the setting out side.

Lack of control over amount of denture removes & thickness of reline

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Two types of cold cure resin used

Type I Powder 1.PMMA 2.Benzoyl peroxide 3.Pigments MMA. Amine. Di-n-butylphalate

Type II (<irritant, < dimensional stability) 1.PEMA 2.Benzoyl peroxide 3.Pigments Butyl.MA. Amine

Liquid

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Semi-permanent soft liners

When is it used: In cases of discomfort and soreness from an otherwise satisfactory denture. Lasts for 6 months maximum. This discomfort is usually associated with the mandible due to small surface area, possibility of sharp, thin resorbed ridge Soft liner with absorb some of the masticatory forces

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Continue,

Desirable qualities in materials used:

Rubbery Resilient Low elastic modulus

Some materials (polymers) are naturally rubbery. Others can be modified by adding plasticisers Plasticisers: act as lubricants for polymer chains and make it easier for them to slide over one another, so material can deform easily. In other words, it adds some elasticity to the material. And if they leach out
(lost), the material will be brittle.
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Semi-permanent reline materials:

Silicon rubber: polydimethyl siloxane polymer+ filler to achieve correct consistency The material solidifies by cross-linking rather than polymerization since its already a polymer An adhesive is needed to bond silicon to denture because they are from another material (not like the acrylic liners). E.g.:

Alkyl-silane coupling agent Silicon polymer dissolved in solvent

Disadvantages: weak bond, encourage Candida albicans growth (susceptible for fungal infection)
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Semi-permanent liners

Acrylic soft liners: can bind to denture base

1. Leachable plasticizer systems, composition:

Powder: mix of PMMA & PEMA Liquid: MMA with 25-50% plasticizer (dibutylphalate)

Disadvantages and recommendations: plasticizer leaches out so I becomes stiff. Avoid using high temperature and strong bleaches 2. Polymerisable plasticizer systems, advantage: resist dissolution. Hard at room temperature, softens in the mouth

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Relative merits of soft liners

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Tissue conditioners/temporary soft liners

If the patient feel a pain due to excess material or a hot one, we can use this type of liners to relief it. It has to be removed every 2 or 3 days because it has plasticizers.

1.

Usually needed in cases of tissue injury such as inflammation or ulceration. Tissue conditioners: soft material applied to fitting surface of denture to allow better stress distribution
1.

2.

Composition: PEMA+ ethyl alcohol solvent+ plasticizer. Needs to be replaced every few days due to leaching out of solvent and plasticizer

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Disadvantages:

Need for frequent replacement Prone to microorganism colonization Prone to damage by denture cleansers, so patient should be instructed to use plain soap and water

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Acrylic teeth
Construction considerations

Advantages compared to ceramic teeth:

Tough Bond to denture base material Easy to grind during occlusal adjustment Do not wear natural, artificial opposing teeth Easily repolished Soft and easily wear Stain over time

Constructed in layers to simulate natural color Gingival portion is made from minimally cross-linked resin to ensure good bonding with denture base

Disadvantages:

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References

Introduction to dental materials. Chapter 3.2 Dental materials, clinical applications for dental assistants and dental hygienists. Chapter 13

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