Evolution of denture base materials and reveiw of current ones
Denture Base Materials
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Transcript of Denture Base Materials
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Dental Polymers
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Three Basic Classes Of Materials In Dentistry:
MetalsPolymersCeramics
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Metals
At the atomic level , the atoms are bonded together by metallic bond.-metallic luster.-excellent electrical and thermal conductivity.-ability to be shaped (malleability).-strength, hardness, and high density.-Opaque
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Metals
What is alloy? Mixture of 2 or more metals
What is metal?? Metals versus alloys in dentistry.
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Types of metals in dentistry: Noble (gold, pt, Pd, ….. Semi-noble ( old term).gold is replaced
with silver Non-noble.
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Metals
Preformed metals: Cohesive gold Amalgam Wrought wires
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Metals
Casting metalsThe restoration is fabricated outside the mouth utilizing the lost wax technique.
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POLYMERS
They are widely used in dentistry.Polymers versus plastics???Plastic is any material cabable to be
shaped .Ductile metals considered as plastic
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Polymers:this term means many parts
Polymerisation: process by which the monomer is converted into polymer.
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Polymers
They are bonded by covalent bonding along the backbone, and ionic bonding .
Polymers are prepared in form of dough then shaped into desired shapes.
They harden by:-physical reaction,(cooling, or evaporation). Waxes, -chemical reaction,
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Types Impression materials Cavity Filling Materials Cements Equipments Sealants Temporary Crown & Bridge Restorative
Material. Denture bases
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Ceramics
They are made of metallic oxides. Porcelain. Produced by sintering Glass, produced by melting and
fusion of the oxides.
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ceramics
They are bonded by ionic bonds. No free electron to conduct heat or
electricity. Poor thermal conductor Stable ,biocompatible Transparent Translucency, due to air bubbles Three dimensional crystal structure. Brittle
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Denture Base Resins
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Prosthetic Uses
Denture bases Denture teeth Relining Materials Repair of dentures Provisional acrylic
partial dentures Custom impression
trays Mouth guards
Fluoride and bleaching trays
Facing on esthetical crowns
Provisional restorations
Removable tooth movement devices
Orthodontic retainers
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Denture base function
Distributes pressure over a wider
area
So reducing bone resorption
Retains artificial teeth
Replaces missing tissue
Forms a seal for retention
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Denture Base materials• Carved ivory • Carved Wood• Vulcanite; dark, opaque
(Vulcanised rubber)
• Highly cross-linked Acrylic resin
• Other Resin and plastic alternatives
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Plastic acrylic teeth Bind chemically to the denture Can be adjusted Not cause wear of opposing tooth Good colour match Minor resiliency Wear under high force occlusion May stain with time
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Porcelain (high fusing ceramic)
composite;
X-linked acrylic)
Experimental fiber-reinforced
teeth
Other Teeth Materials
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Maxillofacial prosthesis
Needed After trauma Surgical defects Birth defects
Other materials Silicone rubber Vinyls with
plasticizers
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Acrylic repair
Materials Chemically cured acrylic Light cured acrylic
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Relining MaterialsRelining Materials
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Provisional partial dentures
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Impression trays
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Record bases
Materials Cold-curing acrylic resin Other material
Shellac Vacuum formed vinyl or
polystyrene Baseplate wax.
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Mouth guards
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Orthodontic applications
Removable tooth movement devices Orthodontic retainers
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Facing of crowns Provisional restorations
Other materials:
•Polycarbonate
•Aluminum
•Stainless steel
•celluloid
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Requisites of Dental Resins Can be processed easily using simple
techniques Aesthetics Economical
Charactristics Biological compatibility Physical properties Ease of manipulation Low cost Chemical stabilty in mouth aesthetics
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Terminology
Monomer + monomer = polymer Monomer1 + monomer2 = copolymer Oligomonomer= 2-4 monomers
Poly= manyMono = singleMer = unitOligo =several
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Morphology of spatial arrangements
Linear or chain polymerisation Easily manipulated, stretched, bent,
thermoplastic, Hard e.g. fitting surface of acrylic teeth- better
binding to denture baseBranched polymerisation
Easily manipulated, stretched, bent, thermoplastic, More hard
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Morphology of spatial arrangements
Cross-linked polymerisation Strong, stiff, thermoset, wear
resistant E.g. Denture base materials,
Occlusal surfaces of actylic teeth
Coiled chains Flexible e.g. impression materials
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Morphology of spatial arrangements
Crystalline polymers Very regular arrangement in space:
strong, stiff, absorb less water.
Amorphous or glassy polymers Irregular arrangement Behaves as a brittle solid
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Plasticizers effects
Added to stiff, glassy uncross-linked polymersLowers glass transition temperature (Tg)Become
rubber-like, Flexible less brittle Eg. pipe
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Dimensional and thermal changes Expansion on polymerization,
exothermic
Contraction on polymerization 21vol.% If unfilled acrylic resin
6% denture resin
1-3% composites
Expansion on swelling in water
Expansion or warpage on thermal change and reheating
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Types and molecular weight
Addition polymerisation: No by products Polymer mol. wt = Σ mol. wt monomers
Step Growth or Condensation polymerisation:
By products are produced and lost in the final product
Polymer mol. wt ≠ Σ mol. wt monomers
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Stages in Addition Polymerization
4 distinct stages Induction – Activation and initiation Propagation Chain Transfer Termination
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Polymethyl methacrylate (PMMA)
Activation Initiation
Chain Propagation Termination
MMALiquid
PMMAPowder
Old and newpolymer chainsIntertwined at themolecular level.
PMMAPowder
Particle swells
MMALiquid
Acrylic dough (Cohesive gel)
Heat and pressure
(entanglements)
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Induction
To begin : a source of free radicals R R generated by activation of radical
producing molecules using a second chemical ,heat or UV light
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Propagation
The resulting free radical monomer complex then acts as anew free radical center when it approaches another monomer to form a di-mer which also becomes a free radical
This reaction continues……. The growth of polymer chain ceases
when the reactive center is destroyed by number of termination reactions
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Chain Transfer
The active free radical of a growing chain is transferred to another molecule and a new free radical for further growth is created.
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Termination
Most often terminated by direct coupling of two free radical chain ends or by exchange of hydrogen atom from one growing chain to another
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Ideal properties
Natural appearance Easy processing Easy to clean Easy to repair Inexpensive Biocompatible Resistant to
bacterial contamination
High strength, stiffness, hardness, toughness, fatigue resistance
•Low density•Radiopaque •High thermal conductivity•High modulus of elasticity,
impact strength•Abrasive resistance•Dimensionally stable•Accurate reproduction of
surface detail
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Curing methods Chemically cured
Tertiary amine ( dimethyl-p-toludine or sulfinic acid) (accelerator)
Benzoyl peroxide (initiator) Hydroquinone (inhibitor)
Heat cured Heat and pressure control
Avoids porosity Maximizes conversion of monomer to polymer
Light cured Photo-initiators (camphorquinone), Blue light,
Used for: record bases, custom tray, denture repair
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Heat cured acrylic resin Powder ( can have limitless life)
Beads or granules of polymethyl methacrylate Initiator (benzoyl peroxide) Pigments/dyes (colour vitality as cadmium, iron, organic
dyes) Optical opacifiers (tio2/ Zno) Plasticizers (ethyl acrylate (internal), dibutylphthalate
(external) to make dough easier) Synthetic fibres (nylon) Coloured fibres (blood vessels)
Liquid ( in dark bottle, avoid contamination by powder)
Methyl methacrylate monomer Inhibitor (hydroquinone) Crosslinking agent
(diethylene glycol dimethacrylate, (1,4 butylene glycol dimethacrylate)
Bead Polymer
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Chemical cured resin Cure is initiated by a tertiarv amine (e.g.
Dimethyl-p-toluidine or sulfinic acid)
Absence of heat: Lower molecular weight material Lower strength properties Higher residual monomer in the resin Color stability is not as good- yellowing Less contraction on cooling to room temp
Polymer beads are smaller Faster dissolution in the monomer to produce a dough Doughy stage is reached before the addition curing reaction – mix viscosity is high and prevents the adaptation of the mix to
the mould walls or cast -keep readapting
Lowering of the glass transition temperature Less build-up of internal strain Highly susceptible to creep- distortion when in use.
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Light activated materials Components:
Urethane dimethacrylate { matrix} Acrylic copolymer Silica (filler) to control rheology
Forms Sheets Ropes
Curing Light chamber- 400-500 nm Photo-initiators (camphorquinone), Teeth added in a second exposure over
the base
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Used for Record bases Custom tray Denture repair
Hardness and impact strength ≈ heat cured resin
Elastic modulus < heat cured resin; deform under mastication
Less shrinkage (3%) better fit Less residual monomer
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Auto-polymerizing/cold cure acrylic Reducing agent (tertiary aromatic amine or
barbituric acid derivative, NN’-dimethyl-p-toluidine) reacts with peroxide at room temp.
Excellent detail reproduction To be able to pour in mold, balanced size mol. wt,
plasticizers and x-link agents Reversible hydrocolloid (agar) mold can’t resist
teeth movement during pouring Hydro pressure flask reduces air bubbles and
monomer porosities Difficult to dewax, less monomer binding to teeth Shortcomings:
residual monomer ↓ Cross link densities Creep Variety of products
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High-impact acrylic A rubber phase is added (phase inversion)
Uniformly distributed
Rubber cored polymer
Types Butadiene + styrene = polystyrene butadiene rubber
Butadiene + MMA
PMMA + polystyrene butadiene rubber + poly(2,3-dibromopropyl methacrylate) for opacity
PMMA = lucitone 199
Lightly xlinked or no cross linking agent is added
Rubber has a craze inhibitory effect
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Experimental types of acrylic Added Bis-GMA and fiber
Flexural strength ≈ ceramics Can be used as lingual bars and connectors
Experimental (mwt polyethylene fiber-reinforced) Neutral color
Low density
Biocompatibility
Surface treated to enhance fabrication
Time consuming
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Types of acrylic
Other (polystyrene,epoxy, SS)
PMMA Adhesion to Metal- use adhesive primers untreated porcelain teeth with
organo silane compounds
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Setting reactionMixing of powder and liquid cause monomer
diffusion and softening of the surface of the powder producing the following gelling stages:
Ratio P/L (2/1 wt %, 1.6 -1 vol %) Sandy - initial melting of beads (not used) Stringy or sticky - entanglements with swollen
beads and thickened interstitial monomer(not used)
Dough - gelation (used) Rubbery - monomer penetrates to the core of
beads, plasticizing them, ↓Tg (not used)
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Manipulation issues
P/L Inadequate filling by monomerWeak material properties Porosity
↓P/LExcessive polymerisation shrinkagePoor fit Light color as powder holds the pigments
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Manipulation issues Curing before monomer diffuse to bead (before
dough stage)↓ flexural strengthcracks between linear polymerised interstitial gel and cross linked beadsMore shrinkage contraction by the loss of pressure produced by the dough to compensate for it
Curing in dough stage monomer penetrate the beads dissolves beads allows cross-linking agent to penetrate interpenetrating polymer network IPN.
Packing in the rubber stage Less extrusion of excess acrylic from flask Extra pressure in the mould
Fracture the cast less flow around teeth Dislodgment of teeth into mould
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Manipulation issues Control of color
Pigments position Inside beads surface of beads
polymer should be added to the monomer slowly so it will not washed off by too rapidly
Blood vessel resembling Fibers aggregate in the bottom of bottle
Shake powder well before use
Mould Lining resin may penetrate rough plaster and adhere a separating medium must be employed
solution of sodium alginate tin foil.
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Manipulation issues
Control of Processing strains Shrinkage in restricted mould cause internal strain On release of stress (flask opening) it may give
Crazing Warpage Distortion
These are reduced by the slightly extra packed material that flow into shrinkage spaces when temperature is higher than Tg (heated flask)
Manipulation further reduces strains by Using acrylic teeth Cooling the flask slowly
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Flasking steps
Flasking Dewaxing Putting a separating medium Placing acrylic dough Packing Heat curing
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Flasking for heat cured resin
Flasking options with acrylic dough: Trial-packing, trimming, repacking Packing-only Poured resin (e.G., Lucitone fas-por) Injection moulding
Heat and pressure control Aim to produce radicals and initiate polymerization Reaction is thermally activated and generates
heat as well Reaction conversion is about 98 to 99.5% MMA: tbp = 100c (p= 1 atm); 140c (p= 2 atm)
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Heat curing cycles Fast cycle
Cure at 71-72°C for 30-90 min 100°C for 30 min.
Slow cycle = cure at 71-72°c for 10 hrs [A slow cycle is better with larger
amounts of material.] [Generally, slow cures result in
better dimensional accuracy.] Other cycles are done as
recommended by manufacturers
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Heat curing cycles
Rapid heating: Excess radical release Extra xlinking and branching of
interstitial polymer More residual monomer Reduced toughness Heat builds up from exothermic rxn Porosity
Loss of strength Bad esthetics (opaque and cloudy color) Possible fouling
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Heat curing cycles
Slow : Sufficient radical release Adequate x-linking and branching between
high mol.wt polymer chains Increased toughness Sufficient radical ends increase monomer
incorporation in growing chains X-linking agents polymerized, reducing
their plasticizing effect (in their non bound state) and reduce creep
Produce an annealing effect easing stresses produced from shrinkage, reducing crazing and distortion
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Heat curing cycles
Pressure control Places compressive force Compensates for polymerization shrinkage Increase flow of dough around teeth, more
monomer wetting and surface dissolution, stronger bond
Oozes out excess dough Some hybrid systems begin polymerization
from one side to allow dough to cover for shrinkage
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Heat curing cycles
Microwave curing Uses a microwave Flasks are non metalic Reduced time
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Denture Radiolucency
Problems when accidents displace fractured segments Lungs Skull stomach
Salts and fillers reduce esthetics, strength Organo-metalics are toxic
Bromine containing organics lack heat stability, must be added in quantities that plasticize the denture, causing creep and water sorption
Phase separating bromo-polymer in beads reduce the previous effects
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Mechanical properties
Failure to Moderate strengths: impact resistant denture is low Low elastic and flexural modulus lack of fracture toughness 30% of denture repairs involve midline fractureswhich are most prevalent among upper dentures. dropped denture does not necessarily break
instantly a crack continue to grow and failure due to flexural
fatigue. Failure due to poor quality processing
Lack of bonding between the resin and the acrylic teeth and weak interface
Crazes due to processing faults or exposure to solvents is another possibility.
Creep Reduced by cross linking Heat cured < cold cured
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Internal denture porosity
InherentInherent porosityporosity: : Not seen by vision 1-2% of residual
monomer Leaks Replaced by fluids
Minimized byMinimized by Use heat cured
resin Pack denture under
correct pressure Use correct P/L Use the glaze after
polishing
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Internal denture porosity
Irregular porosityIrregular porosity: : Seen by vision Not regular on
denture surface P/L heterogeneity Air incorporation
(spherical pores)
Minimized byMinimized by Use correct P/L Add liquid first Mix well Cover the mix before
dough stage Can use the vibrator
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External denture porosity
Irregular surface Irregular surface deficienciesdeficiencies: :
Seen by vision Insufficient pressure Dough was not
molded correctly by hand leaving surface blisters and pores
Insufficient dough
Minimized byMinimized by Mold dough by
hand into small areas
Place sufficient material in flask
Pack under correct pressure
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External denture porosity
Irregular porosityIrregular porosity: : Shrinkage by
polymerisation (5-8% vol or 0.2 -0.5% linear)
Further shrinkage by cooling to room temperature
Can compensated for by the post dam technique
Minimized to byMinimized to by Pack under pressure Slight extra denture
material can overcome shrinkage and maintain pressure (single packing)
Pack in dough stage
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Internal denture porosityGaseous porosity
Seen by visionVolatisation of monomer by Localized MMA boiling
Common in thicker portions
Minimized byMinimized by Avoid high
processing temperatures
Avoid extra monomer than recommended for P/L
Raise heat slowly and evenly around the flask
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Gaseous porosity
Avoid high processing temperatures
0
20
40
60
80
100
120
140
160
0 10 20 30 40 50 60 70 80 90 100
Tem
pera
ture
0 C
Time (min)
Correct cycles
Incorrect cycle
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Crazing Area of localised region of high plastic
deformation which may fill by voids Crazed region can still support stress As the voids in the crazed region grow, they become
separated only by thin fibrils of polymer Fibrils fail and a crack is formed Crack will grow under an externally applied load Cause denture failure by brittle fracture.
Caused by Internal strains in flask Heat (due to polishing) Differential contraction around porcelain teeth Attack by solvents such as alcohol
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Crazing Avoid internal strain during polymerisation
Slow cooling of the flask Use single trial packing Use cross linked polymer types
Avoid extra stress during function Use acrylic rather than porcelain teeth Do not overheat on polishing Keep denture away from solvents Avoid denture drying Polish after each adjustment Use glazes for surface
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Dimensional changes on processing
Expansion on heating flask; heat evenly Expansion on polymerization,
exothermic Contraction on polymerization (21vol.%); Contraction on cooling to room
temperature; Expansion on swelling in water; Expansion on thermal change to 32c.
Net result– should be near zero
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Warpage on drying
Contraction on evaporation of absorbed water
Don’t leave denture outside the mouth dry
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Adverse reactions to PMMA
Most common in dental laboratories
Associated with regular contact with monomer when handling the dough
Must avoid direct contact
Rubber gloves may not provide sufficient protection
Barrier creams can help
Irritant contact dermatitis
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Adverse reactions to PMMA
Allergic contact dermatitis Usually associated with
release of residual monomer Benzoic acid
Types Immediate Delayed hypersensitivity
(type IV) Heat cured resin <
chemical cured
Must ensure full cure of
denture
Avoid relining procedures
May use an extra cycle of
polymerisation – but
denture may warp
May need to consider
alternative material such as
polycarbonate if Delayed
hypersensitivity
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Adverse reactions to PMMA
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Thermal properties
Low Thermal conductivity
during denture processing heat cannot escape – prone to gaseous porosity
isolates from any sensation of temperature – throat burns
High Coefficient of Thermal Expansion
Porcelain teeth may be lost due the differential expansion and action
Warpage if denture is cleaned with hot water
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Water Sorption
PMMA will absorb water by polar nature (1.0-2.0% wt)
May compensate for processing shrinkage Weeks of continuous immersion in water to
reach a stable weight
Solubility Solvents (e.G. Chloroform, alcohol) Xlinked are insoluble in most of fluid intakes Weight loss will occur, due to leaching of the
Monomer Pigments and dyes.
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Ideal properties achieved?
Natural appearance Easy processing Easy to clean Easy to repair Inexpensive Biocompatible Resistant to bacterial contamination
x High strength, stiffness, hardness, toughness X Low density Radiopaque X High thermal conductivity X Dimensionally stable X Accurate reproduction of surface detail
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Injection molded plastic Types Polycarbonates Nylon
Advantage: Consistent mwt Substitute acrylics in sensitive patients
Disadvantage Must use dry mold, slow heating and cooling Under filled molds by inadequate spruing or underheating Low melt temp cause high injection forces, moving teeth in
mold Cost of equipment Difficult to attach to teeth Small market segment Can explode if high heat and wet molds Overheating cause depolymerization, oxidation,
porosties Loss of strength Bad esthetics (opaque and cloudy color) Possible fouling
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Polycarbonates
Tough plastic Injected in dry molds A high melt viscosity
Problems in binding to teeth
May de-polymerize explosively in the presence of heat and water
No cross linking – Poor solvent resistance Poor craze resistance
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Nylons and polyamides
Polyamide = diacid + diamine
Conventional nylon failed Excessive water sorption
Poor creep resistance
Biodegradation
Glass (beads or fibers) reinforced nylon Less water sorption
Fibers better in stiffness(≈ acrylic) than beads
Fibers may irritate patient if denture fitting surface was abraded
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Cellulose product
Camphor used as plasticiser Warpage in mouth Camphor leached out
Loss of color Taste Blistering Staining
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Phenol Formaldehyde (Bakelite)
Difficult to process Lost its color with function
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Vinyl resins
Low resistance to fracture Fatigue failure
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Denture base reprocessing:
Hard and soft tissue changes every 5-8
years
Require modifying denture base:
Relining resurfacing of the tissue
surface
Rebasing replacement of entire
denture base
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Soft denture lining material
Uses: After surgery Immediate dentures Sores Undercuts which are not removed by surgery Ill fitting denture
can be done In lab Chair side
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Ideal lining material properties Durability: but hardens in short time(1-4w, 1-3 y) Dimensional stability Resistance to fouling Water absorption Osmotic presence of soluble material Resistance of Biodegradation Could it bond old acrylic Inhibit candida growth
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Lining materials–acrylic based
Glassy MMA + high conc. of plasticizers Plasticizers:
Free: diffuse out reducing the resiliency Bound in cured matrix – failed clinically
Has lower rate of polymerization Phase separation Water accumulate in plasticizer rich phase Soluble impurities cause more osmotic pressure Swells and distorts Discoloration Bad taste Exothermic rxn Bad taste
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Lining materials–acrylic based
Soft acrylics that have ↓Tg EMA (ethylmethacrylates)
Beads coploymer Ethyl methacrylate + isobutyl methacrylate Ethyl methacrylate + ethoxyethyl methacrylate
Have unpleasant odour
Monomer MMA Tg > room temp Less irritant to patients Isobutyl methacrylate Tg < room temp (polished after
placing in iced water), Dimensional instability
Plasticizer in monomer trapped in beads (25-50%) Phthalate ester – leach out by time Avoid heat, strong bleaching agents that reduce
resilience
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Lining materials–acrylic based
Soft acrylics that have ↓TgHydroxy EMA
Water is the plasticizer Swelling of liner may make it distort Ions enter and may crystallize inside matrices thus
hardening the liner
Polymerisable plasticisers Beads ploymer
Ethyl methacrylate + isobutyl methacrylate or Monomer
Alkyl maleate orAlkyl itaconate + Tridecyl methacrylate + 2-diethylhexyl maleate, ethylene glycol dimethacrylate
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Tissue conditionersDiffer from soft lining material by the following
Different viscoelastic properties Flowable on insertion responding to
Masticatory forces Lingual forces Border moulding forces
Increase viscosity on setting Flows slowly responding to persistent heavy
masticatory forces after setting Useful to fill space after tissue swellings resolve Can be used as a functional impression
Reaction Gel formation not polymerization Alcohol swells beads and ↓ their Tg Beads become tacky by entanglements and cohesive
strength
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Tissue conditioners
Differ from soft lining material by the following Composition
Old- plasticine Old- chewing gum Ethyl methacrylate copolymers Or small mwt polymers
Plasticisers:
ethyl alcohol or
aromatic esters (butylphthalyl butylglycolate)
hemical cleaning damages the liner
Use plain soap and water
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Tissue conditioners
Differ from soft lining material by the following Alcohol problems:
Leak and replaced by water- so harden days up to 14
days
High conc. Can give a sting sensation
Can give a false positive on breathalyser test
Reduce leach of plasticisers by glazing or semiset MMA
Very susceptible to infection
Incorporate antimicrobials as
silver zeolite
itraconazole
Chemical cleaning damages the liner
Use plain soap and water
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Silicon - RTV
Room temperature vulcanizing silicones (RTV) Polymethyl siloxane polymer It sets by crosslinking of existing polymers
Heat Tetraethyl silicate
Condensation minimal xlinking Poor tear resistance Poor abrasion resistance Poor adhesion to denture
Use adhesive or coupling agent Osmotic pressure effects
Buckling and swelling with water Poor resistance to cleansers Biocompatible Dimensional stability May foul by Candida
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Silicon – Heat cured
More xlinking Poor tear resistance Adequate adhesion to denture
Can use siloxane methacrylate as a binder to heat cured additional silicon
Resistant to aqueous environment and Osmotic pressure effects
better resistance to cleansers Poor tear resistance Poor abrasion resistance
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Denture base hygiene
1. Clean with toothbrush and warm soap-and-water2. Use low abrasive cleaners
2. Avoid oxidizing or Cl-containing materials• Bleaching the color• Reduces strengths of denture• Reduces fatigue resistance
3. Diligently clean both the top and tissue-borne surfaces 4. Clean with benzalkonioum