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Clinical evaluation of a radiopaque denture base resin
Clinical evaluation of a radiopaque denture base resin D. H. Tsao, D.D.S.,* H. J. Guilford, D. H. Bell, Jr., D.D.S.** Medical College of Virginia,
D.D.S.,* A. Kazanoglu, D.M.D., M.S.,* and
School of Dentistry, Richmond, Va.
lhe need f or radiopaque denture base material has been well documented.‘-’ Heavy metal salts and glass fillers have been incorporated into denture base acrylic resin to achieve opacity on radiographs.‘-’ The varying degrees of radiopacity achieved and reported have depended on the composition and quantity of these additives.“” According to the status report given by the American Dental Association, Council on Dental Materials, radiopaque denture base materials combining adequate physical and esthetic properties with processing characteristics similar to those of the wellaccepted radiolucent acrylic resin plastics are not commercially available.3 The purpose of this article is to report a clinical trial use of a radiopaque denture base resin and to evaluate its long-term effect on oral tissues and the stability of its physical properties.
MATERIAL
AND METHODS
In a period of approximately 3 years (1973 to 1975), 102 patients at the Medical College of Virginia (MCV) Dental School Clinic were treated with complete or removable partial dentures processed with a radiopaque denture base resin (Radio-Opaque, L. D. Caulk Co., Milford, Del.). Patients were randomly selected and were not aware of the ongoing study. They did not receive information other than routine home care instruction. No technical modification was necessary in fabrication of these dentures. The radiopaque denture base material was processed in the same manner as conventional heat-cured denture base resin (165” F for 9 hours).” After the dentures were remounted on the articulator with new interocclusal records and the occlusion was corrected, the dentures were polished and delivered to the patients. Twenty-four-hour and l-week recalls
were carried out as a part of the routine postinsertion care. Five-year recalls were started at the end of 1980. Because of the high mobility of the patient population, only 22 patients were able to come back for the follow-up appointment. During the follow-up visit a thorough oral examination was made by two prosthodontists. Patients were encouraged to comment on the experience with their denture(s). Responses to specific questions relating to such factors as peculiar tastes; methods of cleaning the dentures; and history of fractures, repairs, and relines were recorded. Dentures were also examined for stains, discoloration, fractures, repairs, and surface characteristics. Each prosthesis was photographed to record the color of the denture base and the degree of staining. Close-up 2-inch X 2-inch Kodak Ektachrome color slides were also made. Two radiographs 2M inches X 3 inches of the denture outside the patient’s mouth were also made with a control chip lying beside the denture to serve as a contrast for later evaluation. The control chip was a rectangular flat piece processed with the radiopaque resin having the following four graded thicknesses: 1.4 mm, 2.5 mm, 4 mm, and 5.3 mm. The radiographic technique was standardized to 70 kV(p), 15 mA, and 0.35 second with a target-film distance of 12 inches. The denture was placed directly on the film. In order to provide a reliable basis for comparison, 17 dentures from 10 patients were photographed to serve as a control group. These patients were also randomly selected with the requirement that their denture(s) had to have been made at the MCV Dental School Clinic during the 1973 to 1975 period with other denture base resins. No denture history was taken and no clinical oral examination made.
RESULTS *Assistant Professor,Department of Removable Prosthodontics. **Professor and Chairman, Department of Removable Prosthodontits.
Twenty-two patients responded to the 5-year recall appointments, and 38 removable radiopaque dentures
APRIL
1904
VOLUME
51
NUMBER
4
RADIOPAQUE
DENTURE
BASE RESIN
Table I. Classification
of the dentures Studied group
Control group
22 38
10 17
17 10 2 9
8 2 1 6
Total No. of patients Total No. of hentures Type of denture MaxillaTy complete denture Mandibular complete denture Maxillary partial denture Mandibular partial denture
Table II. Comparison of the denture bases
of surface characteristics
5%of dentures judged positive Studied group
Control scrouu
7.00 13.15 23.68 44.73
23.53 23.53 17.64 52.94
Rough surface Discoloration Texture change Stain, calculus
were subsequently evaluated. A tabulation of these dentures is shown in Table I. The patients’ experiences with the radiopaque dentures were generally positive. Eighteen patients said that they were comfortable and satisfied with their radiopaque dentures. Of the four patients who complained of difficulties, one did not wear his radiopaque dentures at all and had another set of dentures made outside the school clinic 3 months later. No patient noticed any peculiar taste while wearing a radiopaque denture. Three patients complained that their radiopaque dentures were hard to clean. Five patients had radiopaque dentures that had fractured and been repaired once, while another patient reported having had the same experience twice. Two patients had one artificial tooth missing from their radiopaque dentures; one patient had two teeth missing. Three patients had their maxillary dentures relined. One patient cleaned her dentures with Clorox. No patient complained of acute pain of denture origin. Oral examination revealed that most patients demonstrated pink, firm denture basal seats. Three patients had localized red irritations over their denturebearing mucosa. Two patients demonstrated severe generalized mechanical trauma with epulis fissurata over their ridges. No tumorlike lesion, chronic ulcerlike lesion, or allergic reaction of oral tissue was noticed in any of the patients. Radiographically, all the studied dentures showed minimum radiopacity roughly equivalent to that of the thinnest part of the control chip (Fig. 1). Apparently
THE JOURNAL
OF PROSTHETIC
DENTISTRY
Fig. 1. Radiographs of radiopaque dentures after 5 years of service alongside control chip. A, Maxillary denture. B, Mandibular denture. the thickness of the denture base had a major effect on radiopacity. The thicker the denture base, the more radiopaque. The physical appearance of the radiopaque denture bases was very much like that of bases processed with conventional heat-cured radiolucent resins. From the records on the color slides, efforts were made to detect any appreciable difference between the dentures of the studied group and those of the control group. Table II is a summary of these comparisons, which revealed little meaningful interpretation. The stains on the radiopaque dentures were basically extrinsic in nature and could readily be polished off with a wet rag wheel and pumice powder.
CONCLUSION Denture bases processed with a radiopaque resin behaved much the same as those processed with conventional radiolucent heat-cured denture base resins. They were firm, tasteless, pink, and reasonably satisfying to the patients. Because 100% of the dentures in this
457
-E&40 ET AL
study still show at least minimum opacity after 5 or more years of in vivo service, it seems appropriate to conclude that the denture base resin used in this study was efkctive in maintaining radiopacity without significant clinical complications.
7.
RRFERENCES
8.
1. Schncide, S. S., and Roistacher, S.: Aspiration of denture base materials. J kKxSTHET DENT 25~493, 1971. 2. Chandler, H. H., Bowen, R. L., and Paffcnbarger, G. C.: The need for radio-opaque denture base materials: A review of the literature. J Biomed Mater Res 5~245, 1971. 3. Braucr, G. M.: The desirability of using radiopaque plastics in dentistry--A status report, The Council on Dental Materials, Instruments, and Equipment. J Am Dent Assoc 102:347, 1981. 4. Chandler, H. H., Bowen, R. L., and Paffcnbargcr, G. C.: Development of a radiopaque denture base material. J Biomcd Mater Rcs 5~253, 1971. 5. Elaay, R. P., Pearson, G. O., and Irish, E. F.: Clinical and
458
6.
9. 10 Il.
hrstologic cv.aluation of commercially prcpamd radiopaw denture matcrial. J PR~STHET DENY !25:251. 1971. Chandler. H H.. Bowen, R. L., and Paffcnbargcr, G. C.: Radiopaquc denture base materials technic denture. J Biomcd Mater Rcs 5:359, 1971. Stafford, G. D., and MacCulloch, W. T.: Radiopaquc denture base materials. Br Dent J 131:22, 1971. Combe, E. (!.: Further studies on radio-opaque dcnturc-base materials. J Dent 1:93, 1972. Primack, J. E.: Radiopaquc denture matertab. J PFXXTHET DENT 28~363, 1972. McCabe. J. F.: A radiopaquc denture material. J Dent 4211, 1976. Guide to Dental .Matcrials and Devices, ed 8. Chicago, 1976-1978. .Amcrican Dental Association, p 153.
Rtymnl reyuest.~ 4.0: DR. DING H. Ts/,o MEDICAL COLLEGEOF VIRGINIA SCHWI. OF DENT.STRY, Box 566 RICHMOND, VA 2.3298
APRIL
1984
VOLUME
51
NUMBKR
4
D.D.S.,* A. Kazanoglu, D.M.D., M.S.,* and
School of Dentistry, Richmond, Va.
lhe need f or radiopaque denture base material has been well documented.‘-’ Heavy metal salts and glass fillers have been incorporated into denture base acrylic resin to achieve opacity on radiographs.‘-’ The varying degrees of radiopacity achieved and reported have depended on the composition and quantity of these additives.“” According to the status report given by the American Dental Association, Council on Dental Materials, radiopaque denture base materials combining adequate physical and esthetic properties with processing characteristics similar to those of the wellaccepted radiolucent acrylic resin plastics are not commercially available.3 The purpose of this article is to report a clinical trial use of a radiopaque denture base resin and to evaluate its long-term effect on oral tissues and the stability of its physical properties.
MATERIAL
AND METHODS
In a period of approximately 3 years (1973 to 1975), 102 patients at the Medical College of Virginia (MCV) Dental School Clinic were treated with complete or removable partial dentures processed with a radiopaque denture base resin (Radio-Opaque, L. D. Caulk Co., Milford, Del.). Patients were randomly selected and were not aware of the ongoing study. They did not receive information other than routine home care instruction. No technical modification was necessary in fabrication of these dentures. The radiopaque denture base material was processed in the same manner as conventional heat-cured denture base resin (165” F for 9 hours).” After the dentures were remounted on the articulator with new interocclusal records and the occlusion was corrected, the dentures were polished and delivered to the patients. Twenty-four-hour and l-week recalls
were carried out as a part of the routine postinsertion care. Five-year recalls were started at the end of 1980. Because of the high mobility of the patient population, only 22 patients were able to come back for the follow-up appointment. During the follow-up visit a thorough oral examination was made by two prosthodontists. Patients were encouraged to comment on the experience with their denture(s). Responses to specific questions relating to such factors as peculiar tastes; methods of cleaning the dentures; and history of fractures, repairs, and relines were recorded. Dentures were also examined for stains, discoloration, fractures, repairs, and surface characteristics. Each prosthesis was photographed to record the color of the denture base and the degree of staining. Close-up 2-inch X 2-inch Kodak Ektachrome color slides were also made. Two radiographs 2M inches X 3 inches of the denture outside the patient’s mouth were also made with a control chip lying beside the denture to serve as a contrast for later evaluation. The control chip was a rectangular flat piece processed with the radiopaque resin having the following four graded thicknesses: 1.4 mm, 2.5 mm, 4 mm, and 5.3 mm. The radiographic technique was standardized to 70 kV(p), 15 mA, and 0.35 second with a target-film distance of 12 inches. The denture was placed directly on the film. In order to provide a reliable basis for comparison, 17 dentures from 10 patients were photographed to serve as a control group. These patients were also randomly selected with the requirement that their denture(s) had to have been made at the MCV Dental School Clinic during the 1973 to 1975 period with other denture base resins. No denture history was taken and no clinical oral examination made.
RESULTS *Assistant Professor,Department of Removable Prosthodontics. **Professor and Chairman, Department of Removable Prosthodontits.
Twenty-two patients responded to the 5-year recall appointments, and 38 removable radiopaque dentures
APRIL
1904
VOLUME
51
NUMBER
4
RADIOPAQUE
DENTURE
BASE RESIN
Table I. Classification
of the dentures Studied group
Control group
22 38
10 17
17 10 2 9
8 2 1 6
Total No. of patients Total No. of hentures Type of denture MaxillaTy complete denture Mandibular complete denture Maxillary partial denture Mandibular partial denture
Table II. Comparison of the denture bases
of surface characteristics
5%of dentures judged positive Studied group
Control scrouu
7.00 13.15 23.68 44.73
23.53 23.53 17.64 52.94
Rough surface Discoloration Texture change Stain, calculus
were subsequently evaluated. A tabulation of these dentures is shown in Table I. The patients’ experiences with the radiopaque dentures were generally positive. Eighteen patients said that they were comfortable and satisfied with their radiopaque dentures. Of the four patients who complained of difficulties, one did not wear his radiopaque dentures at all and had another set of dentures made outside the school clinic 3 months later. No patient noticed any peculiar taste while wearing a radiopaque denture. Three patients complained that their radiopaque dentures were hard to clean. Five patients had radiopaque dentures that had fractured and been repaired once, while another patient reported having had the same experience twice. Two patients had one artificial tooth missing from their radiopaque dentures; one patient had two teeth missing. Three patients had their maxillary dentures relined. One patient cleaned her dentures with Clorox. No patient complained of acute pain of denture origin. Oral examination revealed that most patients demonstrated pink, firm denture basal seats. Three patients had localized red irritations over their denturebearing mucosa. Two patients demonstrated severe generalized mechanical trauma with epulis fissurata over their ridges. No tumorlike lesion, chronic ulcerlike lesion, or allergic reaction of oral tissue was noticed in any of the patients. Radiographically, all the studied dentures showed minimum radiopacity roughly equivalent to that of the thinnest part of the control chip (Fig. 1). Apparently
THE JOURNAL
OF PROSTHETIC
DENTISTRY
Fig. 1. Radiographs of radiopaque dentures after 5 years of service alongside control chip. A, Maxillary denture. B, Mandibular denture. the thickness of the denture base had a major effect on radiopacity. The thicker the denture base, the more radiopaque. The physical appearance of the radiopaque denture bases was very much like that of bases processed with conventional heat-cured radiolucent resins. From the records on the color slides, efforts were made to detect any appreciable difference between the dentures of the studied group and those of the control group. Table II is a summary of these comparisons, which revealed little meaningful interpretation. The stains on the radiopaque dentures were basically extrinsic in nature and could readily be polished off with a wet rag wheel and pumice powder.
CONCLUSION Denture bases processed with a radiopaque resin behaved much the same as those processed with conventional radiolucent heat-cured denture base resins. They were firm, tasteless, pink, and reasonably satisfying to the patients. Because 100% of the dentures in this
457
-E&40 ET AL
study still show at least minimum opacity after 5 or more years of in vivo service, it seems appropriate to conclude that the denture base resin used in this study was efkctive in maintaining radiopacity without significant clinical complications.
7.
RRFERENCES
8.
1. Schncide, S. S., and Roistacher, S.: Aspiration of denture base materials. J kKxSTHET DENT 25~493, 1971. 2. Chandler, H. H., Bowen, R. L., and Paffcnbarger, G. C.: The need for radio-opaque denture base materials: A review of the literature. J Biomed Mater Res 5~245, 1971. 3. Braucr, G. M.: The desirability of using radiopaque plastics in dentistry--A status report, The Council on Dental Materials, Instruments, and Equipment. J Am Dent Assoc 102:347, 1981. 4. Chandler, H. H., Bowen, R. L., and Paffcnbargcr, G. C.: Development of a radiopaque denture base material. J Biomcd Mater Rcs 5~253, 1971. 5. Elaay, R. P., Pearson, G. O., and Irish, E. F.: Clinical and
458
6.
9. 10 Il.
hrstologic cv.aluation of commercially prcpamd radiopaw denture matcrial. J PR~STHET DENY !25:251. 1971. Chandler. H H.. Bowen, R. L., and Paffcnbargcr, G. C.: Radiopaquc denture base materials technic denture. J Biomcd Mater Rcs 5:359, 1971. Stafford, G. D., and MacCulloch, W. T.: Radiopaquc denture base materials. Br Dent J 131:22, 1971. Combe, E. (!.: Further studies on radio-opaque dcnturc-base materials. J Dent 1:93, 1972. Primack, J. E.: Radiopaquc denture matertab. J PFXXTHET DENT 28~363, 1972. McCabe. J. F.: A radiopaquc denture material. J Dent 4211, 1976. Guide to Dental .Matcrials and Devices, ed 8. Chicago, 1976-1978. .Amcrican Dental Association, p 153.
Rtymnl reyuest.~ 4.0: DR. DING H. Ts/,o MEDICAL COLLEGEOF VIRGINIA SCHWI. OF DENT.STRY, Box 566 RICHMOND, VA 2.3298
APRIL
1984
VOLUME
51
NUMBKR
4