Compare the physical properties of the following denture base materials: Self curing acrylic resin Heat curing

acrylic resin Hi-impact acrylic resin Describe their uses in the dental laboratory

Introduction In the past a various materials have been used to produce denture bases. These range from biological materials such as wood, bone and ivory and metals including gold, aluminium and stainless steel. In modern dentistry polymer resins have become the standard for denture base materials, starting with vulcanite and bakelite moving towards Polymethyl Methacrylate (PMMA), todays most used polymer in dentistry (Tandon 2010). In order to carry out its function, a denture base material must possess certain physical properties. These include a high strength, stiffness, hardness and toughness; low value of specific gravity; dimensional stability; resistant to the absorption of liquids, including oral fluids; have an aesthetically pleasing appearance; absence of odour, taste and toxic products; good retention to polymers, porcelain and metals; good shelf life; easy to manipulate; accurate reproduction of surface detail; good thermal conductivity and be radiopaque. (Van Noort 2002, p212) Many of the denture base materials used in the past have not had many of these properties and have been phased out of use. However, we do not have any material that fulfils all of the criteria of the perfect denture base material.

The Uses of PMMA in the Dental Laboratory PMMA has a range of different uses in the dental laboratory, including denture bases, the construction of trays for impression taking, replicating soft tissues on cast metal frameworks, denture teeth, repairing dentures and soft liners (Van Noort 2002). This essay focuses on the use of PMMA on constructing denture bases. In the lab, heat curing acrylic is the most widely used material for constructing denture bases. Acrylic, or poly methyl methacrylate (PMMA), is purchased in a powder form and a liquid monomer, methyl methacrylate (MMA), and then combined together in the laboratory to form the PMMA (acrylic) which is used in denture base construction (McCabe and Walls 2008, p112). Heat cured acrylic is most widely used due to the face that high-impact acrylic is so much more expensive, and also the fact that the self-curing acrylics have properties which make it less suitable, such as the lower strength, poor colour stability, higher susceptibility to creep and higher percentage of residual monomer (Van Noort 2002, p213). Hi-impact acrylic resins have been developed in order to provide an acrylic base with a higher impact factor usually by the addition of elastomers to the PMMA base. The improvement of the impact factor is useful as it means that the denture base is less likely to fracture due to dropping it, for example in a porcelain sink during cleaning. Some patients are more prone to fracturing their dentures, and therefore it is advantageous to construct their dentures out of high impact acrylic resin to reduce the need for repairs. (McCabe and Walls 2008, p121)

Mechanical Properties These properties play a significant part in the functionality of the denture. The denture is subjected to primarily compressive loads (in addition to shear and tensile). This generates stress, which could lead to deformation or fracture. To avoid this, a rigid material would be ideal. However acrylic resins are classified as weak, soft and flexible when compared to alloys for example (McCabe and Walls 2008, p119). There are extensive methods of measuring the mechanical properties of a material. The most relevant in this case are as follows: 1. Flexural (Elastic) Modulus Essentially an indication of the stiffness. A high value ensures that the stresses encountered (biting and mastication) do not permanently deform the denture. An added advantage being that the denture can then be made in relatively thin sections. High Impact and Heat cured acrylic resins have a higher flexural modulus of 2000MPa in comparison to 1500MPa of Self curing acrylic. 2. Flexural Strength The force needed to deform the material to fracture. High Impact and Heat cured acrylic need to meet a requirement of 65MPa, though research has shown that certain types of High Impact acrylic such as Lucitone 199 tend to have higher value in the region of 100MPa (Meng, et al., 2005). Self-Cured resins trail at 60MPa. 3. Impact Strength A measurement of the toughness and ability to resist sudden fracture. This can be a common occurrence, i.e. when dentures are removed for cleaning. High Impact resins are recommended to increase the impact strength of the denture base (Uzun, et al., 2002) 4. Fatigue Strength A measurement of dynamic strength i.e. when enduring cyclic stress, such as in the mouth. High impact resins have a significantly higher fatigue resistance than self-cured resins, and are also higher than heat cured resins though not statistically significant (Gurbuz, et al., 2010). Overall High impact resins show greater strength, stiffness and toughness in comparison to the other two resins due to the development of the formulation which incorporates several monomers to produce a copolymer. Though research suggests that by increasing the impact and flexural strength, the flexural modulus is compromised as it has an inverse relationship (Meng, et al., 2005).

Natural Appearance The acrylic resin compromises the polished surface of the denture; hence it is essential for it to have a natural appearance. Along with the functionality the aesthetics is the basis of the success of a denture. (May et al., 1996) The denture base should exhibit sufficient transparency (taking into consideration the three dimensions of colour: hue, chroma and value) and be capable of being pigmented to match the appearance of the natural oral tissues. The patients skin tone is also taken into consideration. There are a variety of shades available depending on the brand of the resin (rather than type of resin). For example Enigma which uses high impact acrylic resin offers an impressive range of 8 colour tones (May et al., 1996).

Another key factor contributing to natural appearance is the ability of the denture base to maintain the colour over time. Colour stability of high impact resins is superior to that of heat and self-cured resins (May et al., 1996).

Low Value of Specific Gravity The denture should, ideally, have a low density, or a low value of specific gravity (the density of the material in comparison to the density of water). This is in order to prevent the displacement of the upper denture due do gravity. Therefore, it is favourable for the acrylic to be as light as possible. (McCabe and Walls 2008, p110) Acrylic resins are composed of light elements; including hydrogen, carbon and oxygen. This means that acrylic resins have a low value of specific gravity, of approximately 1.2g/cm3. As they have a low density, the displacement of the upper denture due to gravity is minimised. (McCabe and Walls 2008, p119) Heat cured resins (including high impact acrylic) tend to have a higher density than the self-cure resins. This is because the method of curing is not as efficient in self-curing acrylic, and so produces a material with a lower molecular weight. (Van Noort 2002, p213)

Absence of odour, taste or toxic products Biocompatibility is the materials ability to remain inert biologically in its environment. It is an essential requirement for any material which is designed for use in the human body. Creating a biocompatible material is extremely complex, and incorporates biological interactions, patient risks, clinical trials and expert engineering. (Bhola R. et al 2009) Toxicity, unpleasant odours and smells come as a result of poor biocompatibility. In order for the material to avoid being toxic or irritating to the oral environment, the material must be biocompatible; therefore, it should be preferably insoluble in bodily fluids, including saliva. Toxicity usually comes as a result of the breakdown of the material over time releasing products which are toxic or irritants. Therefore, the taste and odour should remain neutral over time, as any unpleasant odours or tastes could indicate the materials instability. (Bhola R. et al. 2009) High-impact acrylic, heat-cured acrylic and self-cure acrylic all have low levels of toxicity and neutral odours. All three acrylics have a low oral toxicity. However, there are a small number of patients who report to have allergic contact stomatitis after wearing dentures with acrylic bases. This has been attributed to the residual MMA monomer which can leak from the bases, especially if the acrylic is under cured. Even patients who dont experience an allergic reaction from the base may still experience some irritation from the denture if there are high levels of monomer in the base. Longer curing cycles can help combat the high levels of residual monomer. There are also limits which are set to limit the amount of residual monomer which can be present in the base, usually 2.2% for heat curing and high impact acrylic, and 4.5% for self-curing acrylic. Self-curing acrylic usually therefore has a higher percentage of MMA monomer present, and therefore increases the risk of cytotoxicity, allergic reaction and irritation. (Jorge et al. 2003)

Radiopacity The denture base should be capable of detection using normal diagnostic radiographic techniques. Patients occasionally swallow dentures and fragments are sometimes inhaled, especially when involved in violent accidents, such as a car crash. The type of denture most commonly ingested or aspirated is a maxillary partial consisting of a palatal piece to which is attached one or more anterior teeth. It may or may not have clasps. Ingestion or aspiration of the foreign body commonly occurs when either broken or ill-fitting dentures are being worn. (Chandler, et al, 2004). Dentures constructed from acrylic resin are radiolucent, because C, O and H atoms are poor X-ray absorbents. This is a disadvantage, because if the denture is swallowed or inhaled, it is hard to detect using normal techniques. Most dental materials are not radiopaque. Incorporation of atoms with a higher atomic number than the carbon hydrogen and oxygen will increase the radiopaque property. There have been different methods of trying to increase the radiopacity of materials. One method was to incorporate inorganic salts such as barium sulphate. However, there were problems with establishing the correct concentration. At 8% there was not enough radiopacity produced, and at 20%, even though sufficient radiopacity would be reached, the mechanical properties would be weaken. Better results would be with the addition of co-monomers containing heavy metals, like barium acrylate, or halogen like tribromophenylmethacrylate. But obviously the improved outcome would come with a higher cost of production (McCabe, et al, 2008).

Retention to polymers, porcelain & metals

It is important that the denture base material is retentive to polymers and porcelain, as artificial teeth are made from these materials. There are two methods of retaining teeth in the denture base. Either by using a mechanical undercut with no chemical bonding, or by micromechanical retention. Mechanical bonding is the polymerisation of the denture base material into the vent holes of internal voids in the surface of the tooth. Micromechanical retention is when a denture base polymerizes around the existing polymer network of the denture tooth (Rahn, et al, 2009). A clinical study shows that self-cured PMMA adheres to polymers better than heat-cured PMM (Vallittu, et al, 1995). The strength of the bond can be improved by grinding grooves on the joint surface of an acrylic tooth. Another study shows that the use of interpenetrating polymer network acrylic resin improves the bond strength (Clancy, et al, 1989).
Dimensional Stability

Dimensional stability is the ability of a material to not change its shape when conditions change, for example: heat, moisture, pressure and other stresses. Changes due to moisture or pressure are particularly important for denture base materials because the dentures spend most of their time in the patients mouth surrounded by saliva, and are under pressure during mastication.

Under masticatory load the dentures can be distorted, this is called creep and is a problem because then the dentures do not form a good a seal as they should are less stable and retentive. Self-cure resins are more susceptible to creep than heat-cured and high impact resins because of its lower density and higher residual monomer content (Van Noort 2002, p212). All three types of acrylic resins are resistant to absorbing and reacting with oral fluids, as stated earlier in this essay. Therefore, there is little significant difference in their dimensional stabilities in this respect. High impact acrylic resin is significantly more resistant to fractures than heat and selfcures acrylic resins, and is more dimensionally stable in this respect.
Easy Manipulation

The working times and setting times of the materials are very important, therefore, it is beneficial that the acrylic resins are as easy to manipulate as possible to ensure you maximise the use of these times. You want the working and setting times to be reasonable, too quick and the technician may not have finished the prosthetic, but too slow would be a waste of time. The resin is set when the material becomes polymerised. Self-curing acrylic resins have a working time of 3-5 minutes at a room temperature of 23C 2 and an average setting time of approximately 10 minutes, but this can vary depending on the room temperature. Polymerisation in self-curing acrylic resins is initiated by tertiary amines. The resin also contains hydroquinone, an inhibitor that prolongs working time by destroying free radicals (www.newstetic.com). Heat curing and high impact acrylic resins have the same working and setting procedure: They have a working time on about 10 minutes but this varies depending on the temperature of the room, however during this time it must have a pressure of 1500-2000psi applied to it. Polymerisation in heat curing acrylic resins requires several stages; firstly, it must be kept in a water bath at 73C for 90 minutes, followed by 30 minutes in the water bath at 100C. You then remove the acrylic from the water bath, and leave it at 23C for 30 minutes. Finally, you place the acrylic back into the water bath for another 15 minutes at 23C. Other heat curing acrylics can be polymerised in 10 minutes by microwave heating (www.newstetic.com). There is no significant difference in the plasticity of the three resins during their working times. The three types of acrylic resin have reasonable working times but the setting times of high impact and heat cure acrylic resins are much longer than the self-cure acrylic resins.

Resistance to absorption of oral fluids The absorption of biological fluids is a problem for denture base materials. They are constantly in a wet environment and if given the chance water will be absorbed into the material until it reaches equilibrium whilst other constituents may be lost from the material due to their solubility creating more opportunity for the absorption of fluids. absorption of water changes the strength of the resin and its physical and mechanical properties such as the dimensions and weight of the denture. Saliva is not just pure water but is a suspension of a large number of biological factors (both human a microbiological). Increased oral fluid absorption can be associated with colonization and plague formation by bacteria and other

microbes. Acrylic denture base materials are susceptible to water sorption and loss of soluble factors. However, there is no difference between self curing, heat curing and high impact acrylic's water sorption and solubility properties, they are all as susceptible as each other (Kurtulmus 2010). One experiment states that the absorption of self curing, heat curing and high impact acrylic is20.23g/mm3, 19.68g/mm3, and 19.07g/mm3 respectively (Tuna, S., et al, 2008). All of these values conform to ISO 1567:1999 which states that the absorption of a denture base material should not exceed 32ug/mm3 to be considered to be fit for purpose. Good thermal conductivity The dimensional accuracy of a denture base material is very important to it's function. It is well established that the better the adaption of the denture base to the supporting oral tissue the better the retention and stability of the denture. this is due to the denture being fixed to the supporting tissue by suction. The better the denture base is adapted to the oral tissues the more air is excluded, at the periphery of the denture the adaption to the supporting tissue is especially important as a poor fit will allow air into the space between the denture and tissue reducing suction and therefore retention and stability. In a study that measured the dimensional accuracy of multiple self cure, heat cure and high impact acrylics used for dental applications it was found that the dimensional accuracy of all of the different acrylics was good after processing. The amount of contraction observed in all of the cases was less than 0.6% (Stafford 1983). Another study found that after 3 months in the mouth the shrinkage of autopolymerised and heat cured acrylic was within 0.3% of each other showing that the dimensional accuracy is retained whilst it is working in the mouth (Mirza 1961).

Accurate reproduction of surface detail

The ability to accurately reproduce the surface detail of the oral tissues is very important to the function of a denture base material. It is well established that the better the adaption of the denture base to the supporting oral tissue the better the retention and stability of the denture. this is due to the denture being fixed to the supporting tissue by suction. The better the denture base is adapted to the oral tissues the more air is excluded, at the periphery of the denture the adaption to the supporting tissue is especially important as a poor fit will allow air into the space between the denture and tissue reducing suction and therefore retention and stability. In a study that measured the dimensional accuracy of multiple self-cure, heat cure and high impact acrylics used for dental applications it was found that the dimensional accuracy of all of the different acrylics was good after processing. The amount of contraction observed in all of the cases was less than 0.6% (Stafford 1983). Another study found that after 3 months in the mouth the shrinkage of autopolymerised and heat cured acrylic was within 0.3% of each other showing that the dimensional accuracy is retained whilst it is working in the mouth (Mirza 1961). Summary No real difference between the self-cure, heat cure and high impact acrylic in terms of oral fluid absorption; thermal conductivity; dimensional accuracy; retention to polymers, porcelains and metals; natural appearance; radiopacity or the absence of taste, odour and toxic products. There are differences in dimensionally stability: high impact resins are more resistant to fracture and selfcure resins are more likely to creep. There is no significant difference between the resins manipulation but high impact and heat cured acrylic resins have a much longer setting time than self-cure resins. Selfcure resins are more likely to result in an allergic reaction than heat cure acrylics because of the greater residual monomer content. There is little difference in natural appearance but high impact acrylic resins are less prone to colour loss than heat and self-cure resins. Self-cure acrylics have a lower density than heat-cure and high impact acrylics.

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