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COMPARISON OF EFFICIENCY OF POLYMETHYLVINYLETHER-MALEIC ANHYDRIDE (PVM-MA) BASED DENTURE ADHESIVE AND CARBOXYMETHYL CELLULOSE (CC) BASED DENTURE ADHESIVE.

Byline: MUHAMMAD SAJJAD, SHOAIB RAHIM and SAAD KHAN

ABSTRACT

The purpose of this study was to compare the efficiency of polymethylvinylether-maleic anhydride (PVM-MA) and carboxymethyl cellulose (CC) based denture adhesives.

A Randomized control trial was conducted in the Department of Prosthodontics, Armed Forces Institute of Dentistry over a period of 06 months. Sixty edentulous patients reporting to the department of Prosthodontics, were divided randomly into two groups. New complete dentures were fabricated for each patient. Patients in control group were prescribed Bony Plus Superior(r) (PVM-MA based denture adhesive) and patients in experimental group were prescribed Fittydent(r) (Carboxymethylcellulose based denture adhesive) for two weeks. After two weeks, patients in each group were recalled. Efficiency of the denture adhesives was assessed in terms of retention, ability to chew, duration of effectiveness and improvement in speech and responses entered in the questionnaire.

The mean +- SD was recorded as 62.72 +- 6.44. No significant difference between efficiency of both groups, the PVM-MA based (Control Group) and CC based (Experimental Group) denture adhesive, was observed. (p = 0.524).

Within the limitations of this study, no significant difference was found between the efficiency of both denture adhesives.

Key Words: Efficiency, denture adhesive, polymethylvinyl-maleic anhydride, carboxymethylcellulose.

INTRODUCTION

Compete dentures constitute one of the most important treatment modalities in Prosthodontics.1 However the main problem posed by complete dentures is retention and stability.2 Several factors and complex interactions affect the retention and stability of complete dentures in oral cavity, including atmospheric pressure, intimate adaption of both hard and soft tissues beneath the denture base to the intaglio surface of the prosthesis, accurate peripheral extensions of the denture base and the presence of a thin film of saliva between the prosthesis and the tissues. Denture retention can be jeopardized if any of these factors are compromised.3

In addition, alveolar ridge resorption compromises denture retention and stability, rendering a denture loose and non-serviceable to the patient.4 While these biological and physiological changes compromise denture function, new techniques have been created to enhance both the retention and fit of aging prostheses. These techniques include denture rebasing or relining, denture adhesives, and endosseous dental implants.5

Denture adhesives are widely used by patients wearing removable prostheses as aid for increased retention and stability of dentures.6,7 According to surveys, about 30% of denture wearers have used adhesives at some time.8 It has been shown that using denture adhesives significantly reduces the displacement of the mandibular and maxillary compete dentures during chewing, biting, and speaking. Also, in occasional situations, denture adhesives are frequently required e.g. in conditions such as immediate restorations, complicated prostheses-obturators, dry mouth, the difficult and demanding patient, poor ridge anatomy and relations or a single complete denture.1

Denture adhesives were first patented in the early part of 1913. Historically, the dentists have been reluctant towards the routine prescription of these agents as it was believed to reflect the inadequacies in denture fabrication.1,8 However, the attitude of dental professionals has shifted over the recent years and the denture adhesives are now accepted as useful adjunct to denture treatment.8,9 Apart from their role in improving the retention of the dentures, denture adhesives are now believed to improve chewing ability and help the patient in adjusting to the new prosthesis which is both physically and psychologically a difficult task.8,10

The basic component of denture adhesives is the adhesive itself which can be plant gums (karaya, tragacanth) or polymers, both natural (carboxymethyl cellulose) and synthetic (polyvinyl acetate).2,9 In a previous study done on experienced denture wearers it was found that retention of their dentures was much better (87% and 37%) using either of denture adhesive pastes based on polymers (either natural or synthetic).6

In this study, the efficiency of polymethylvinylether-maleic anhydride (PVM-MA) based denture adhesive was compared with carboxymethyl cellulose (CC) based denture adhesive in new complete denture wearers. No such study was done previously in Pakistan. This study will help the dental surgeons to manage adaptation problems faced by patients using new complete denture, which in turn adds to the self-confidence of the elderly which is of utmost important in saving them from social isolation due to loss of teeth.

Hypothesis

There is no significant difference in the efficiency of polymethylvinylether-maleic anhydride (PVM-MA) based denture adhesive was compared with carboxymethyl cellulose (CC) based denture adhesive in new complete denture wearers.

METHODOLOGY

A Randomized control trial was conducted in the Department of Prosthodontics, Armed Forces Institute of Dentistry over a period of 06 months (March 2013-September 2013). Non-probability consecutive sampling technique was used. Approval from AFID's Ethical Committee was obtained prior to collection of data. A total of sixty patients were selected consisting of both genders between age group of 45-75 years and a period of Edentulism of at least 02 months for both arches and with no previous history of denture adhesive use.

After obtaining the informed consent (Annexure-C), patients were divided randomly into two groups based on table of random numbers. New complete dentures were fabricated for each patient according to the standard protocol and checked for accuracy by the trainee researcher. Every patient was asked to wear the new complete denture for two weeks for adaptation. After two weeks, the patients were reviewed for any complaint and necessary adjustments were made. Patients prescribed with Bony Plus Superior(R) (PVM-MA based denture adhesive) constituted the Control Group and patients prescribed with Fittydent(R) (Carboxymethylcellulose based denture adhesive) constituted Experimental Group. After two weeks, patients in each group were recalled. Efficiency of the denture adhesives was assessed in terms of retention, ability to chew, duration of effectiveness and improvement in speech and responses entered in the questionnaire. Follow up was ensured by taking telephone contact.

All the data was entered into SPSS version 20 for analysis. Frequency and percentage was calculated for gender, efficiency and distribution of patient's responses to the questions. Age was expressed as mean +- SD. Inferential analysis was done using chi-square test to compare the efficiency of two denture adhesives in terms of retention, ability to chew, duration of effectiveness and improvement in speech p value of <0.05 was considered as statistically significant.

RESULTS

This randomized controlled trial was designed to compare the efficiency of PVM-MA based denture adhesive, Bony Plus Superior and CC based denture adhesive, Fitty dent. Out of sixty patients 60% (n=36) were males and 40% (n=24) were females (Fig 1). The Mean +- SD Age of patients selected for this study was 62.72+-6.44 years. Efficiency of the two denture adhesives was compared in terms of retention, chewing ability, duration of effectiveness and speech.

RETENTION

Regarding the retention of lower denture, 76.67% of the patients in control group (PVM-MA based) and 80% of the patients in experimental group (CC Based denture adhesive) were satisfied with the retention the lower denture. Chi square test showed no statistically significant difference between the two denture adhesive pastes on lower denture retention (p= 0.754). Regarding the upper denture retention, all the sixty patients were satisfied when using denture adhesive creams. p value cannot be calculated as there was no observations in outcome variable "no satisfaction". (Table 1)

TABLE 1: SATISFACTION WITH DENTURE RETENTION

Response###Group###Total###P value

###PVM-MA based adhesive n=30###CC based adhesives n=30

No###7###6###13

###23.3%###20.0%###21.7%

###0.754

Yes###23###24###47

###76.7%###80.0%###78.3%

TABLE 2: SATISFACTION WITH CHEWING ABILITY

Response###Satisfaction with chewing ability###Total###P value

###PVM-MA based adhesive n=30###CC based adhesives n=30

No###2###0###2

###6.7%###.0%###3.3%

###0.492*

Yes###28###30###58

###93.3%###100.0%###96.7%

Satisfaction with chewing Ability

The chewing ability of 93.33% of the patients in control group (PVM-MA based) and 100% of the patients in experimental group (CC Based) was reported. However, no significant difference was found between the two adhesives on chewing ability (p=0.492). (Table 2)

Duration of Effectiveness

A total of 73.3% of the patients in control group (PVM-MA based denture adhesive) and 53.3% of the patients in experimental group (CC Based denture adhesive) reported effectiveness of denture adhesive of more than 6 hours. However, no significant difference was found between the two groups (p= 0.108).

Improvement in Speech

All the patients in both groups were satisfied with their speech. P value cannot be calculated as there are no observations in outcome variable" no satisfaction".

Efficiency Score

Comparison of efficiency score between the two groups showed no statistically significant difference between the PVM-MA based (Control Group) and CC based (Experimental Group) denture adhesive (P= 0.524).

DISCUSSION

Complete dentures constitute one of the most important and conventional treatment modalities for edentulous patients in Prosthodontics. However, they require an adequate retention and stability for patient satisfaction and success of the prosthesis. Therefore, improving retention and stability of complete dentures, especially mandibular denture is of considerable interest both for general practitioners as well as prosthodontic community.

The present study was set out to compare the efficiency of two denture adhesive in terms of improvement in retention of upper and lower complete dentures, improvement in chewing ability, duration of effectiveness and improvement in speech. The results of this study are in agreement with other studies that have employed similar as well as different test methods and adhesive formulations, that adhesive use can augment the retention, stability, and function of ill-fitting as well as well-fitting conventional dentures. Uysal H et al,11 in a similar study found that 70% of the participants were satisfied with the retention of their dentures using denture adhesives, while 66% reported improvement in their masticatory ability with the use of denture adhesives. Also, in 68% of participants the retention effect lasted for more than 2 hours.

Similarly, Kulak et al6 in his study found that 80% and 63% of the participants were satisfied with upper and lower denture retention, respectively. While improvement in chewing ability was reported by 67% of the participants. In another study, Koronis S et al,8 found that improvement in retention of complete denture was reported by 65% of the particiapnts, while improvement in masticatory ability was found in more than 70% of the participants. Furthermore, they remain active for more than 2 hours in 75.5% of the participants.

Several other studies also showed significant improvement in retention and stability of complete dentures when adhesives were used.12-14 However, it must be emphasized that population groups studied cannot be regarded as a representative of a larger spectrum of edentulous denture wearing experiences with an equally large spectrum of different patient mediated perceptions. As far as duration of effectiveness is concerned, Rendell JK et al15 reported that the retentive capacity of denture adhesives is lost over time, mostly when hot beverages are consumed. Floystrand F et al16 found a correlation between the dissolution of denture adhesive and subsequent loss of bond strength. Ozcan M et al17 reported that denture adhesives are efficient during periods of up to 8 hours.

Regarding the retention of lower denture, in our study a slightly higher satisfaction is displayed by PVMMA based group (76.67%) compared to CC based group (80%) but this difference is not statistically significant.

In comparison, a study by Kulak et al, showed a much higher satisfaction with PVM-MA based denture adhesive which was statistically significant in comparison to the CC based denture adhesive.6 Whereas for the retention of upper denture, higher satisfaction was displayed by PVM-MA based group (80%) compared to CC based group (57%) in the study by Kulak. However, our study found that all participants in both group were equally and fully satisfied (100%) with the retention of their upper denture. Both studies displayed no statistically significant difference.

The present study showed an improvement in chewing ability with use of both the denture adhesives. However, Kulak et al reported a significant difference in chewing ability with two denture adhesives with PVM-MA based denture adhesive performing better in comparison to the CC based formulation. Speech is an important oral function which is related to optimal performance of complete oral prosthesis. However, this aspect has not been previously studied in the literature. The present study evaluated the improvement in speech with two different denture adhesive formulations and found an overall improvement if speech with denture adhesive use.

There is always a possibility of misuse of denture adhesives especially, if the patients continue to wear ill-fitting dentures with the aid of adhesives for a long time. Also, there are some precautions associated with the use of zinc-containing adhesives.18 Therefore, complete denture wearers must be advised of the risks of prolonged use of zinc-containing adhesives. The denture adhesives can be an efficient adjunct to the complete denture therapy provided that it is prescribed by the dentist along with the proper education of the patient.19

CONCLUSION

Within the limitations of this study, it is concluded that majority of the patients were satisfied with the retention of both upper and lower dentures. Also, chewing ability and speech were improved significantly with denture adhesives. However, no significant difference was found between the efficiency of both denture adhesives.

REFERENCES

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2 Manes JF, Selva EJ, De-Barutell A, Bouazza K. Comparison of the retention strengths of three complete denture adhesives. Med Oral Patol Cir Bucal 2011; 16:132-36.

3 Marchini L. Patients' satisfaction with complete dentures: an update. Braz Dent Sci. 2014;17(4):5-16.

4 Papadiochou S, Emmanouil I, Papadiochos I. Denture adhesives: a systematic review. J Prosthet Dent. 2015;113(5):391-97.

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10 Figueiral MH, Fonseca PA, Pereira-Leite C, Scully C. The effect of different adhesive materials on retention of maxillary complete dentures. Int J Prosthodont 2011; 24:175-77.

11 Uysal H, Altay OT, Alparslan N, Bilqe A. Comparison of four different denture cushion adhesives-a subjective study. J Oral Rehabil 1998; 25: 209-13.

12 Adisman IK. The use of denture adhesives as an aid to denture treatment. J Prosthet Dent 1989; 62: 711-15.

13 Berg E. A clinical comparison of four denture adhesives. Int J Prosthodont 1991; 4: 449-56.

14 Psillakis JJ, Wright RF, Grbic JT, LamsterIB. In practice evaluation of a denture adhesive using a gnathometer. J Prosthodont 2004; 13: 244-50.

15 Rendell JK, Gay T, Grasso JE, Baker RA, Winston JL. The effect of denture adhesive on mandibular movements during chewing. J Am Dent Assoc 2000; 131: 981-86.

16 Floystrand F, Koppang R, Williams VD, Orstavik J. A method for testing denture adhesives. J Prosthet Dent 1991; 66: 501-04.

17 Ozcan M, Kulak Y, de Baat C, Arikan A, Ucankale M. The effect of a new denture adhesive on bite force until denture dislodgment. J Prosththodont 2005; 14: 122-26.

18 Felton D, Cooper L, Duqum I, Minsley G, Guckes A, Haug S, et al: Evidence-based guidelines for the care and maintenance of complete dentures. J Am Dent Assoc 2011;142:1-12.

19 Kalra P, Nadigar R, Shah FK. An investigation into the effect of denture adhesives on incisal bite force of complete denture wearers using pressure tranducers - a clinical study. J Adv Prosthodont 2012; 4:97-102.
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Publication:Pakistan Oral and Dental Journal
Article Type:Report
Date:Mar 31, 2017
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