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Liquid-supported dentures. Part II: Clinical study, a preliminary report
SECTIONEDITORS I__! *.
Liquid-supported dentures. preliminary report Gert Care1 ACTA
Boere,
D.D.S.,*
L. Davidson, University
Hans
de
Koomen,
Part Ph.D.,**
II: Clinical
study,
a
and
Ph.D.*** of Amsterdam
and Free
TTniversity.
Amsterdam,
The
Netherlands
A clinical study was made of 11 selected patients wearing liquid-supported dentures. The experiences and opinions of the patients were assembled and the results are discussed. The most important conclusions of this study are that it is possible to make a liquid-supported denture that in general fits and feels comfortable, has proper retention, a slightly diminished masticatory function, and that can provide a solution to some problematic prosthodontic situations. (J PROSTHET DENT 1989;62:434-6.)
D
urmg the past few decades the application of soft lining materials has proved to be a useful aid in preserving or regaining the health of denture-supporting tissues.‘y2 However, shortcomings of these materials have been reported for as long as they have been in use.3 A new alternative is the liquid-supported denture described in Part I of this study.4 This study investigated the clinical performance of a liquid-supported denture. Functional properties, such as retention, stability, and tissue response in the supporting tissues were studied.5 In addition, the patients’ appreciation of comfort and functioning of the liquid-support,ed denture and its durability were examined.
MATERIAL
AND
METHODS
A group of 11 volunteers with a variety of prosthodontic situations was selected. They were experienced denture wearers in the age range of 35 to 72 years. The group included (1) six patients with complete dentures, (2) two patients with a complete maxillary denture and a complete natural mandibular dentition, (3) two patients with a complete maxillary denture and a tooth-supported partial mandibular denture, and (4) one patient with a complete mandibular denture and a partial maxillary denture. In this group of 11 patients, three had problems with their dentures, one suffered from chronic pain caused by loading forces on the mandibular ridge (support problem),
*Research Associate, Department of Dental Materials Science and general practitioner. **Professor and Chairman, Department of Prosthetic Dentistry. ***Professor and Chairman, Department of Dental Materials Science.
10/l/17026 434
one experienced chronic pain at the incisive foramen in a resorbed alveolar process, and one patient did not wear a mandibular denture because of adaptation difficulties. The other eight patients had no specific prosthodontic problems and could function well with their dentures. The degree of resorption and firmness of the residual alveolar ridge differed among the patients. To test the applicability, 15 liquid-supported dentures were made in the following categories. A. Maxillary and mandibular liquid-supported dentures were made for four patients (one was the patient with chronic mandibular pain). B. Maxillary liquid-supported dentures opposing the natural dentition or tooth-supported removable partial dentures were made for four patients. In the patient with the painful palate, a liquid-supported denture was made opposing an existing conventional mandibular denture. C. For two patients, only a mandibular liquid-supported denture was made; one patient had the mandibular denture made opposing a gingivally supported partial denture and the other patient (with the adaptation difficulty), opposing a complete denture. To , /obtain answers to questions regarding retention, stability, supporting area, and appreciation, a questionnaire solicited the opinions and experiences of these patients. Some questions were designed to compare the conventional denture with the liquid-supported denture. The patients were seen regularly for oral inspection of the supporting areas. At the same time, the dentures were checked for leakage, and the condition of the foil and fluid was inspected.
RESULTS The results of the questionnaires are summarized in Table I. From the inquiry and our own observations, the following statements can be made. 1. The retention of the liquid-supported denture did not APRIL1990
VOLUME63
NUMBER4
LIQUID-SUPPORTED
Table
DENTURES.
PART
II
I. Opinions and experiences of patients concerning liquid-supported Patient No. category
and
Maxillary
Ret
Sta
SUP
t
0 -
0
+
0
0
0
+
0
0
+
Mas
Sw
Rep
0 -
0
1
+
0
1
++
+
0
Corn
denture
1 (A) 2 (A) 3 (A) 4 (A) 5 (B) 6 (B) 7 (B)
+
+ + +
Mandibular 1 (A)
+
0
0
0
+
0
0
+
0
0
0 0
2
0
(A) (A) (C) (0
0 0
0
0
0
0
+ ++ +
cause specific difficulties. Seven of the 11 patients noticed improved retention. 2. All of the patients noticed the mobility of the denture. In general, patients with a partial natural dentition in the mandible found this phenomenon somewhat annoying. 3. In two patients, the condition of the supporting tissues seemed to improve. They found their pain problems solved. The other patients showed no noticeable differences in the condition of the oral tissues. Pressure spots were neither indicated by the patients nor observed. 4. Nearly all patients appreciated the smooth feeling of the liquid-supported denture base. The patient with the adaptation problem was able to wear this denture 6 hours per day. 5. Most patients had some problems with mastication with the liquid-supported denture, except the patients with the pain problems. The patients with maxillary and mandibular dentures (not necessarily both liquid-supported dentures) had fewer problems than the patients with a denture opposing the partial natural dentition. 6. Few patients had problems with speech. The negative remarks made by two patients were probably because of the difference in arrangement of the anterior teeth compared with the arrangement in the former denture. 7. In seven dentures a leakage developed; in six dentures the joint between foil and denture coat separated because of failure of attachment of the foil. In one denture the foil ruptured, and the cause was unknown. In the dentures where the joint was damaged, the patients noticed only a difference in softness of the denture base.
DISCUSSION The evaluation by the patients was used to determine some of the properties and possibilities of the liquid-supOF
PROSTHETIC
DENTISTRY
0
1
0
1
0 0
+
Ret, retention; sta, stability; sup, supporting area; corn, comfort without any loading forces; mas, mastication; distinction compared with the former conventional denture; 0, no difference; -, negative distinction compared
JOURNAL
1
--
0
denture
2 (Al
THE
0
++
8 (B) 9 (B)
3 4 10 11
dentures
0 spe, speech; rep, number with former conventional
of repairs; denture.
+, positive
ported denture. The conclusion of several studie& 7 was that the relation between satisfaction of patients with their dentures and the quality of the dentures is often ambiguous and as such has questionable worth, even more so because the former denture, with which the liquid-supported denture was compared, had been accepted. However, the retention was comparable to a conventional denture. The stability of the liquid-supported denture, despite its degree of freedom, was acceptable to patients with resorbed ridges or flabby ridges, probably because the conventional denture also showed mobility in functioning. The comfort of the liquid-supported denture was one of the main advantages and was appreciated as such. The pain problems that had been solved returned when a leakage occurred. In some patients, mastication caused problems. When the bolus of food was at one side, the denture tended to be dislodged. This problem was more pronounced in the maxillary denture than in the mandibular denture. The problems decreased gradually or disappeared as the patient grew accustomed to the movement. The patients with firm ridges and the patients with a liquid-supported denture opposite the partial natural dentition needed a longer time to adapt. To improve the stability, the influence of other liquids and the outline of the liquid space, especially in the maxillary denture, are being studied. The liquid-supported denture is more voluminous and more ponderous than a conventional denture, but this factor did not influence speech or comfort. Of the seven dentures with leakage, six showed partial rupture at the joint, indicating that the quality of the joint must be improved. Several adhesives have been tried and one or two are promising. 435
BOERE, mKOOMEN,ANDDAVIDSON
When the joint between the foil and denture coat was damaged, the patients noticed only a difference in softness of the base material. They neither tasted nor noticed the silicone fluid. Some contamination and discoloration of the foil was observed. Scanning electron microscopic inspection showed no corrosion.
CONCLUSIONS
6. The life span of the liquid-supported denture depends on the atts~hment of the foil. There were six leakages at the joint ar - Jne rupture of the foil. The techniques and materials are still subject to improvements. 7. The liquid-supported denture is comfortable for the patient and can improve some prosthodontic problems. We
After a period of 1 year in which patients have worn or are still wearing one or two liquid-supported dentures some conclusions can be drawn. 1. It is possible to make a denture with a liquid as a supporting medium. 2. The retention of this denture is comparable to the retention of a conventional denture. 3. The stability of the denture is different compared with a conventional denture because of the fluid system. Patients with a maxillary liquid-supported denture and a natural rn~dib~~ dentition found this floating freedom unpleasant. Patients with resorbed or flabby ridges did not mind. 4. The foil base does not cause observable irritation of the supporting tissues. Problems of patients with chronic pain were solved. 5. Time is needed to become used to the changes in mastication. Patients with firm alveolar ridges or (partial) natural dentition wearing a liquid-supported denture experienced a diminished masticatory function.
Bound
volumes
available
thank Professor G. E. Flogel for
his advice
in
this study.
REFERENCES 1. Boucher CO, Hickey JC, Zarb GA. Prosthodontic treatment for edentulous patients. 7th ed. St Louis: CV Moaby Co, 19’75;3. 2. Gonzales JB. Use of tissue conditioners and reailient liners. Dent Clin North Am 197~2~249-59. 3. Ping Chaing BK. Polymers in the service of prosthetic dentistry. 3 Dent 1984$2:203-14. 4. Davidson CL, Boere G. Liquid-supported dentures. Part I: theoretical and technical considerations. J PROSTHZT DENT 1989;63:303-6. 5. Heartwell CM, Rahn AO. Syllabus of complete dentures. 4th ed. Philadelphia: Lea & Febiger, 1986507-44. 6. Waas MAJ van. Ben k~stgebit, een kwestie van doorbijten (artificial teeth, a question of ‘grinning and bearing”) [Thesis]. Utrecht: State University of Utrecht, 1985. 7. Kalk W. Dentures, happy ventures. Netherlands Dent J 1980;87(Suppl 18):45-54. Reprint
requests
to:
DR. CAREL L. DAVUXON SCHOOL OF DENTISTRY, Undo OF A~~~~
ACTA
LcuwFawRG 1 1066 EA AMSTERDAM THE NETHERLAWS
to subscribers
Bound volumes of the JOURNAL OF PROSTHBTIC DENTISTRY are available to subscribers (only) for the 1989 issues from the publisher at a cost of $44.00 ($56.00 international) for Vol. 61 (Janu~y-June) and Vol. 62 (Joy-December~. Shipping charges are included. Each bound volume contains a subject and author index, and all advertising is removed. Copies are shipped within 30 days after publication of the last issue in the volume. The binding is durable buckram with the journal name, volume number, and year stamped in gold on the spine. Volumes 59 and 60 are also available. Payment must accompany all orders. Contact The C. V. Mosby Co., Circulation Department, 11830 Westline Industrial Drive, St. Louis, MO 63146-3318, USA; phone (860) 325-4177, ext. 7351. Subscriptions must be in force to qualify. Bound volumes are not available in place of a regular JOURNAL subscription.
436
APRIL
1990
VOLUME68
NUMBER4
Liquid-supported dentures. preliminary report Gert Care1 ACTA
Boere,
D.D.S.,*
L. Davidson, University
Hans
de
Koomen,
Part Ph.D.,**
II: Clinical
study,
a
and
Ph.D.*** of Amsterdam
and Free
TTniversity.
Amsterdam,
The
Netherlands
A clinical study was made of 11 selected patients wearing liquid-supported dentures. The experiences and opinions of the patients were assembled and the results are discussed. The most important conclusions of this study are that it is possible to make a liquid-supported denture that in general fits and feels comfortable, has proper retention, a slightly diminished masticatory function, and that can provide a solution to some problematic prosthodontic situations. (J PROSTHET DENT 1989;62:434-6.)
D
urmg the past few decades the application of soft lining materials has proved to be a useful aid in preserving or regaining the health of denture-supporting tissues.‘y2 However, shortcomings of these materials have been reported for as long as they have been in use.3 A new alternative is the liquid-supported denture described in Part I of this study.4 This study investigated the clinical performance of a liquid-supported denture. Functional properties, such as retention, stability, and tissue response in the supporting tissues were studied.5 In addition, the patients’ appreciation of comfort and functioning of the liquid-support,ed denture and its durability were examined.
MATERIAL
AND
METHODS
A group of 11 volunteers with a variety of prosthodontic situations was selected. They were experienced denture wearers in the age range of 35 to 72 years. The group included (1) six patients with complete dentures, (2) two patients with a complete maxillary denture and a complete natural mandibular dentition, (3) two patients with a complete maxillary denture and a tooth-supported partial mandibular denture, and (4) one patient with a complete mandibular denture and a partial maxillary denture. In this group of 11 patients, three had problems with their dentures, one suffered from chronic pain caused by loading forces on the mandibular ridge (support problem),
*Research Associate, Department of Dental Materials Science and general practitioner. **Professor and Chairman, Department of Prosthetic Dentistry. ***Professor and Chairman, Department of Dental Materials Science.
10/l/17026 434
one experienced chronic pain at the incisive foramen in a resorbed alveolar process, and one patient did not wear a mandibular denture because of adaptation difficulties. The other eight patients had no specific prosthodontic problems and could function well with their dentures. The degree of resorption and firmness of the residual alveolar ridge differed among the patients. To test the applicability, 15 liquid-supported dentures were made in the following categories. A. Maxillary and mandibular liquid-supported dentures were made for four patients (one was the patient with chronic mandibular pain). B. Maxillary liquid-supported dentures opposing the natural dentition or tooth-supported removable partial dentures were made for four patients. In the patient with the painful palate, a liquid-supported denture was made opposing an existing conventional mandibular denture. C. For two patients, only a mandibular liquid-supported denture was made; one patient had the mandibular denture made opposing a gingivally supported partial denture and the other patient (with the adaptation difficulty), opposing a complete denture. To , /obtain answers to questions regarding retention, stability, supporting area, and appreciation, a questionnaire solicited the opinions and experiences of these patients. Some questions were designed to compare the conventional denture with the liquid-supported denture. The patients were seen regularly for oral inspection of the supporting areas. At the same time, the dentures were checked for leakage, and the condition of the foil and fluid was inspected.
RESULTS The results of the questionnaires are summarized in Table I. From the inquiry and our own observations, the following statements can be made. 1. The retention of the liquid-supported denture did not APRIL1990
VOLUME63
NUMBER4
LIQUID-SUPPORTED
Table
DENTURES.
PART
II
I. Opinions and experiences of patients concerning liquid-supported Patient No. category
and
Maxillary
Ret
Sta
SUP
t
0 -
0
+
0
0
0
+
0
0
+
Mas
Sw
Rep
0 -
0
1
+
0
1
++
+
0
Corn
denture
1 (A) 2 (A) 3 (A) 4 (A) 5 (B) 6 (B) 7 (B)
+
+ + +
Mandibular 1 (A)
+
0
0
0
+
0
0
+
0
0
0 0
2
0
(A) (A) (C) (0
0 0
0
0
0
0
+ ++ +
cause specific difficulties. Seven of the 11 patients noticed improved retention. 2. All of the patients noticed the mobility of the denture. In general, patients with a partial natural dentition in the mandible found this phenomenon somewhat annoying. 3. In two patients, the condition of the supporting tissues seemed to improve. They found their pain problems solved. The other patients showed no noticeable differences in the condition of the oral tissues. Pressure spots were neither indicated by the patients nor observed. 4. Nearly all patients appreciated the smooth feeling of the liquid-supported denture base. The patient with the adaptation problem was able to wear this denture 6 hours per day. 5. Most patients had some problems with mastication with the liquid-supported denture, except the patients with the pain problems. The patients with maxillary and mandibular dentures (not necessarily both liquid-supported dentures) had fewer problems than the patients with a denture opposing the partial natural dentition. 6. Few patients had problems with speech. The negative remarks made by two patients were probably because of the difference in arrangement of the anterior teeth compared with the arrangement in the former denture. 7. In seven dentures a leakage developed; in six dentures the joint between foil and denture coat separated because of failure of attachment of the foil. In one denture the foil ruptured, and the cause was unknown. In the dentures where the joint was damaged, the patients noticed only a difference in softness of the denture base.
DISCUSSION The evaluation by the patients was used to determine some of the properties and possibilities of the liquid-supOF
PROSTHETIC
DENTISTRY
0
1
0
1
0 0
+
Ret, retention; sta, stability; sup, supporting area; corn, comfort without any loading forces; mas, mastication; distinction compared with the former conventional denture; 0, no difference; -, negative distinction compared
JOURNAL
1
--
0
denture
2 (Al
THE
0
++
8 (B) 9 (B)
3 4 10 11
dentures
0 spe, speech; rep, number with former conventional
of repairs; denture.
+, positive
ported denture. The conclusion of several studie& 7 was that the relation between satisfaction of patients with their dentures and the quality of the dentures is often ambiguous and as such has questionable worth, even more so because the former denture, with which the liquid-supported denture was compared, had been accepted. However, the retention was comparable to a conventional denture. The stability of the liquid-supported denture, despite its degree of freedom, was acceptable to patients with resorbed ridges or flabby ridges, probably because the conventional denture also showed mobility in functioning. The comfort of the liquid-supported denture was one of the main advantages and was appreciated as such. The pain problems that had been solved returned when a leakage occurred. In some patients, mastication caused problems. When the bolus of food was at one side, the denture tended to be dislodged. This problem was more pronounced in the maxillary denture than in the mandibular denture. The problems decreased gradually or disappeared as the patient grew accustomed to the movement. The patients with firm ridges and the patients with a liquid-supported denture opposite the partial natural dentition needed a longer time to adapt. To improve the stability, the influence of other liquids and the outline of the liquid space, especially in the maxillary denture, are being studied. The liquid-supported denture is more voluminous and more ponderous than a conventional denture, but this factor did not influence speech or comfort. Of the seven dentures with leakage, six showed partial rupture at the joint, indicating that the quality of the joint must be improved. Several adhesives have been tried and one or two are promising. 435
BOERE, mKOOMEN,ANDDAVIDSON
When the joint between the foil and denture coat was damaged, the patients noticed only a difference in softness of the base material. They neither tasted nor noticed the silicone fluid. Some contamination and discoloration of the foil was observed. Scanning electron microscopic inspection showed no corrosion.
CONCLUSIONS
6. The life span of the liquid-supported denture depends on the atts~hment of the foil. There were six leakages at the joint ar - Jne rupture of the foil. The techniques and materials are still subject to improvements. 7. The liquid-supported denture is comfortable for the patient and can improve some prosthodontic problems. We
After a period of 1 year in which patients have worn or are still wearing one or two liquid-supported dentures some conclusions can be drawn. 1. It is possible to make a denture with a liquid as a supporting medium. 2. The retention of this denture is comparable to the retention of a conventional denture. 3. The stability of the denture is different compared with a conventional denture because of the fluid system. Patients with a maxillary liquid-supported denture and a natural rn~dib~~ dentition found this floating freedom unpleasant. Patients with resorbed or flabby ridges did not mind. 4. The foil base does not cause observable irritation of the supporting tissues. Problems of patients with chronic pain were solved. 5. Time is needed to become used to the changes in mastication. Patients with firm alveolar ridges or (partial) natural dentition wearing a liquid-supported denture experienced a diminished masticatory function.
Bound
volumes
available
thank Professor G. E. Flogel for
his advice
in
this study.
REFERENCES 1. Boucher CO, Hickey JC, Zarb GA. Prosthodontic treatment for edentulous patients. 7th ed. St Louis: CV Moaby Co, 19’75;3. 2. Gonzales JB. Use of tissue conditioners and reailient liners. Dent Clin North Am 197~2~249-59. 3. Ping Chaing BK. Polymers in the service of prosthetic dentistry. 3 Dent 1984$2:203-14. 4. Davidson CL, Boere G. Liquid-supported dentures. Part I: theoretical and technical considerations. J PROSTHZT DENT 1989;63:303-6. 5. Heartwell CM, Rahn AO. Syllabus of complete dentures. 4th ed. Philadelphia: Lea & Febiger, 1986507-44. 6. Waas MAJ van. Ben k~stgebit, een kwestie van doorbijten (artificial teeth, a question of ‘grinning and bearing”) [Thesis]. Utrecht: State University of Utrecht, 1985. 7. Kalk W. Dentures, happy ventures. Netherlands Dent J 1980;87(Suppl 18):45-54. Reprint
requests
to:
DR. CAREL L. DAVUXON SCHOOL OF DENTISTRY, Undo OF A~~~~
ACTA
LcuwFawRG 1 1066 EA AMSTERDAM THE NETHERLAWS
to subscribers
Bound volumes of the JOURNAL OF PROSTHBTIC DENTISTRY are available to subscribers (only) for the 1989 issues from the publisher at a cost of $44.00 ($56.00 international) for Vol. 61 (Janu~y-June) and Vol. 62 (Joy-December~. Shipping charges are included. Each bound volume contains a subject and author index, and all advertising is removed. Copies are shipped within 30 days after publication of the last issue in the volume. The binding is durable buckram with the journal name, volume number, and year stamped in gold on the spine. Volumes 59 and 60 are also available. Payment must accompany all orders. Contact The C. V. Mosby Co., Circulation Department, 11830 Westline Industrial Drive, St. Louis, MO 63146-3318, USA; phone (860) 325-4177, ext. 7351. Subscriptions must be in force to qualify. Bound volumes are not available in place of a regular JOURNAL subscription.
436
APRIL
1990
VOLUME68
NUMBER4