Short-term effect of thermoplastic resin removable partial dentures on periodontal health: A randomized cross-over trial.

PURPOSE: This study aimed to compare the short-term effects of thermoplastic resin removable partial dentures (TR-RPDs), referred to as non-metal clasp dentures, with those of metal-clasp-retained RPDs (MC-RPDs) on the periodontal health of abutment teeth. METHODS: A randomized cross-over trial was conducted in 28 partially dentate patients. Participants were randomized into two groups and received MC-RPDs followed by TR-RPDs, or vice versa, for 3 months. Periodontal clinical parameters, such as the plaque index, gingival index, probing pocket depth, tooth mobility, and microbiological status of the abutment teeth, were evaluated at the delivery and 3 months after using each RPD. RESULTS: Of the 28 patients enrolled, 24 (mean age, 67.3 years) completed the trial, and 55 abutment teeth were evaluated. The periodontal condition of the abutment teeth did not deteriorate after 3 months of using both types of RPDs. There was no statistically significant difference in the plaque index, gingival index, probing pocket depth, tooth mobility, and the red complex bacteria between TR- and MC-RPDs (p >0.05). The Periotest value for TR-RPDs was significantly lower than that for MC-RPDs (p <0.05). However, this difference was not clinically significant. CONCLUSIONS: These results suggest that the influence of TR-RPDs on the periodontal health of abutment teeth was limited within 3 months of use.

Cost-effectiveness analysis of prosthetic treatment with thermoplastic resin removable partial dentures.

PURPOSE: The aim of this study was to compare the cost-effectiveness of thermoplastic resin removable partial dentures (TR-RPDs) with metal clasp-retained removable partial dentures (MC-RPDs), from the patients' perspective. METHODS: Patient-reported outcome measures (Oral health-related quality of life [OHRQoL], patient satisfaction, oral appearance) were assessed among 24 partially dentate subjects who completed a randomized crossover trial comparing TR-RPDs and MC-RPDs. The prosthetic treatment fee for patients was used as the direct cost. The cost of achieving a clinically minimum important difference (MID) in Oral Health Impact Profile (OHIP) summary score, and the incremental cost-effectiveness ratio (ICE R) for each outcome measure were determined. RESULTS: OHRQoL, patient satisfaction, and oral appearance was rated higher with TR-RPDs compared to MC-RPDs. The median cost of achieving a MID in OHRQoL with TR-RPDs ($698) was 6.5 times higher than that with MC-RPDs ($107). The ICER was $67 for the OHIP summary score, $195 for the satisfaction score, and $1,169 for the oral appearance rating. CONCLUSIONS: Although TR-RPDs provide better OHRQoL, patient satisfaction, and oral appearance than MC-RPDs, the cost-effectiveness of TR-RPDs was inferior to MC-RPDs from the patients' perspective.

Effect of different materials and undercut on the removal force and stress distribution in circumferential clasps during direct retainer action in removable partial dentures.

OBJECTIVES: This study aimed to evaluate the effect of different materials and undercut on the removal force and stress distribution in the supporting tooth and in the circumferential clasp used in removable partial prosthesis. METHODS: Upper molars prepared for Akers circumferential clasp with retention and opposing arm were modeled, scanned, elaborated with CAD software and the geometries imported in FEA and analyzed. Six different materials were selected for the clasp (Polyamide, Polyoxymethylene, Polyetheretherketone - PEEK, Gold alloy, Titanium and CoCr) and 3 different undercuts (0.25, 0.50 and 0.75mm), totaling 18 groups. RESULTS: The clasps presented greater stress in their structure and potentially greater damage to the dental enamel when made with rigid materials and with more undercut; however, they presented greater ability to remain in position. SIGNIFICANCE: Polyamide with a higher undercut is an esthetic alternative to rigid metallic clasps. It showed promising behavior because it strongly reduces the damage to the enamel, and even with an undercut of 0.75, the retention is lower than for CoCr with a 0.25 undercut, and this retention might still be sufficient. Polyoxymethylene and Polyetheretherketone (PEEK) are not suitable materials for the clasps, because the maximum stress occurring during removal with higher undercuts is higher than the material strength.

Retentiveness comparison of individual clasps made from polyamide, acetate resin and cobalt-chrome for removable partial dentures / Comparação da retenção de grampos individuais de poliamida, resina de acetato e cromo-cobalto para próteses parciais removíveis

Objective: This study aimed to evaluate and compare the retention force of individual clasps made from polyamide, acetate resin and cobalt-chrome for removable partial dentures. Material and methods: Three groups of clasps were fabricated: Cr-Co ­ 10 conventional chrome-cobalt metal clasps; Ac ­ 10 clasps with reciprocal arms and occlusal rests in chrome-cobalt and retentive arms in acetate resin; and Poly - 10 clasps with reciprocal arms and occlusal rests in chrome-cobalt and retentive arms in polyamide resin. Through the tensile test, in a universal testing machine, the initial retention force of the specimens was obtained and then clasps were cycled 7200 times, immersed in artificial saliva (60 months of simulated clinical use). After cycling, tensile test was performed. Results: All groups presented a retention decrease after the cycling. Ac presented a large reduction in retentive force (61.43%), followed by Cr-Co (26.5%) and Poly (12.09%). Conclusions: Aesthetic clasps of polyamide can be used in clinical cases where the anterior supporting teeth will not be essential for good retention of the removable partial denture because this clasp showed to be more resistant than the acetate resin. (AU)

Objetivo: Este estudo teve como objetivo avaliar e comparar a força de retenção de grampos individuais feitos de poliamida, resina de acetato e cromo-cobalto para próteses parciais removíveis. Material e Métodos: Três grupos de grampos foram fabricados: Cr-Co ­ 10 grampos metálicos convencionais de cromo-cobalto; Ac - 10 grampos com apoios e braço de oposição em cromocobalto e braços de retenção em resina de acetato; e Poly - 10 grampos com apoios e braço de oposição em cromo cobalto e braço de retenção em resina de poliamida. Por meio do teste de tração, em uma máquina de ensaio universal, a força de retenção inicial dos espécimes foi obtida e então, os grampos foram ciclados 7200 vezes, imersos em saliva artificial (60 meses de uso clínico simulado). Após a ciclagem, o teste de tração foi realizado. Resultados: Todos os grupos apresentaram diminuição da retenção após a ciclagem. Ac apresentou uma grande redução na força retentiva (61,43%), seguida por Cr-Co (26,5%) e Poly (12,09%). Conclusões: Grampos estéticos de poliamida podem ser usados em casos clínicos em que os dentes de suporte anteriores não serão essenciais para uma boa retenção da prótese parcial removível, pois esse grampo mostrouse mais resistente que os de resina de acetato (AU)

Effects of polishing on surface roughness and hardness of glass-fiber-reinforced polypropylene.

Removable partial dentures (RPDs) with resin-clasp retentive parts, which are known as non-metal-clasp dentures (NMCDs), have been used as alternatives for conventional RPDs with metal clasp, in case of aesthetic prosthodontic treatments. In this study, a profilometer and dynamic micro-indentation tests were used to investigate the effects of polishing on the surface properties such as surface roughness (Ra), dynamic hardness, and elastic modulus of high-rigidity glass-fiber-reinforced thermoplastics (GFRTPs) composed of E-glass fibers and polypropylene for NMCDs. The Ra values of the GFRTPs after polishing were significantly lower than those before polishing. The values were close to the Ra threshold level of 0.2, which corresponds to an acceptable surface smoothness for denture base materials. Polishing did not significantly change the dynamic hardnesses and elastic moduli of the GFRTPs. The fiber loading did not greatly affect the micromechanical properties of the GFRTPs because the glass-fiber reinforcement is embedded in the polypropylene matrix.

Glass fiber-reinforced thermoplastics for use in metal-free removable partial dentures: combined effects of fiber loading and pigmentation on color differences and flexural properties.

PURPOSE: The purpose of this study was to investigate the combined effects of fiber loading and pigmentation on the color differences and flexural properties of glass fiber-reinforced thermoplastics (GFRTPs), for use in non-metal clasp dentures (NMCDs). METHODS: The GFRTPs consisted mainly of E-glass fibers, a polypropylene matrix, and a coloring pigment: the GFRTPs with various fiber loadings (0, 10, and 20mass%) and pigmentations (0, 1, 2, and 4mass%) were fabricated by using an injection molding. The color differences of GFRTPs were measured based on the Commission Internationale de l'Eclairage (CIE) Lab color system, by comparing with a commercially available NMCD. The flexural properties of GFRTPs were evaluated by using a three-point bending test, according to International Standards Organization (ISO) specification number 20795-1. RESULTS: The visible colors of GFRTPs with pigment contents of 2mass% were acceptable for gingival color, and the glass fibers harmonized well with the resins. The ΔE* values of the GFRTPs with pigment contents of 2mass% obtained by using the CIE Lab system were lowest at all fiber loadings. For GFRTPs with fiber contents of 10 and 20mass% at 2mass% pigment content, these GFRTPs surpassed the ISO 20795-1 specification regarding flexural strength (> 60MPa) and modulus (> 1.5GPa). CONCLUSIONS: A combination of the results of color difference evaluation and mechanical examination indicates that the GFRTPs with fiber contents of 10 or 20mass%, and with pigment contents of 2mass% have acceptable esthetic appearance and sufficient rigidity for NMCDs.

Color stability of glass-fiber-reinforced polypropylene for non-metal clasp dentures.

PURPOSE: The purpose of this study was to investigate the color stability of a glass-fiber-reinforced thermoplastic (GFRTP), for use in non-metal clasp dentures (NMCDs). METHODS: GFRTPs composed of E-glass fibers and polypropylene with 2 mass% of pigments were fabricated using injection molding. According to our previous study on the optimum fiber content for GFRTPs, we prepared GFRTPs with fiber contents of 0, 10, and 20 mass% (GF0, GF10, and GF20). Commercially available NMCD and PMMA materials were used as controls. The color changes of GFRTPs at 24h, and at 1, 2, and 4 weeks of coffee immersion at 37°C were measured by colorimetry, using the Commission Internationale de l'Eclairage (CIE) Lab system. The color stabilities of the GFRTPs were evaluated in two units: the color difference (ΔE∗) and National Bureau of Standards (NBS) units. RESULTS: After immersion, none of the GFRTPs showed visible color change. From the colorimetry measurement using the CIE Lab system, the ΔE∗ values of the GFRTPs were 0.65-2.45. The NBS values of the GFRTPs were 0.60-2.25, all lower than the threshold level of 3.0, demonstrating clinically acceptable color changes. On the other hand, an available polyamide-based NMCD material exhibited "appreciable" color change, as measured in NBS units. CONCLUSIONS: The results indicate that the GFRTPs showed clinically acceptable color stability and might be satisfactory for clinical use. Therefore, GFRTPs are expected to become attractive materials for esthetic dentures.

Effect of fiber content on flexural properties of glass fiber-reinforced polyamide-6 prepared by injection molding.

The use of non-metal clasp denture (NMCD) materials may seriously affect the remaining tissues because of the low rigidity of NMCD materials such as polyamides. The purpose of this study was to develop a high-rigidity glass fiber-reinforced thermoplastic (GFRTP) composed of E-glass fiber and polyamide-6 for NMCDs using an injection molding. The reinforcing effects of fiber on the flexural properties of GFRTPs were investigated using glass fiber content ranging from 0 to 50 mass%. Three-point bending tests indicated that the flexural strength and elastic modulus of a GFRTP with a fiber content of 50 mass% were 5.4 and 4.7 times higher than those of unreinforced polyamide-6, respectively. The result showed that the physical characteristics of GFRTPs were greatly improved by increasing the fiber content, and the beneficial effects of fiber reinforcement were evident. The findings suggest that the injection-molded GFRTPs are adaptable to NMCDs because of their excellent mechanical properties.

Oral health-related quality of life in patients with non-metal clasp dentures: a randomised cross-over trial.

We investigated the efficacy of non-metal clasp dentures (NMCDs) with regard to the oral health-related quality of life (OHRQoL) and compare the findings with those for conventional metal clasp-retained dentures (MCDs). This single-centre, randomised controlled, two-phase, open label, cross-over trial included 28 partially dentate individuals. The patients were randomised to receive MCDs followed by NMCDs, or the opposite sequence (n = 14 in each group); each denture was worn for 3 months. OHRQoL was evaluated using the Oral Health Impact Profile-Japanese version (OHIP-J) at entry (T-entry; before treatment with the first denture) and at 3 months after treatment with each denture (T3). An examiner evaluated denture stability, oral appearance and surface roughness before denture delivery (T0) and at T3 and denture hygiene at T3. A total of 24 patients completed the trial. There were no complications related to the dentures, abutment teeth or denture-bearing mucosa during the follow-up periods for both dentures. The mean OHIP summary score was lower for NMCDs than for MCDs, and the difference (9 points) was greater than the minimal important difference (6 points), indicating the difference was clinically relevant. The effect size was medium (0·70). Statistical analyses with linear mixed models found a significant effect of the denture type on the OHIP summary score and scores for the Oro-facial appearance, Oro-facial pain and Psychological impact domains (NMCD < MCD; P < 0·05). The results of our study suggest that NMCDs allow for better OHRQoL compared with MCDs.

Fabrication and physical properties of glass-fiber-reinforced thermoplastics for non-metal-clasp dentures.

Recently, non-metal-clasp dentures (NMCDs) made from thermoplastic resins such as polyamide, polyester, polycarbonate, and polypropylene have been used as removable partial dentures (RPDs). However, the use of such RPDs can seriously affect various tissues because of their low rigidity. In this study, we fabricated high-rigidity glass-fiber-reinforced thermoplastics (GFRTPs) for use in RPDs, and examined their physical properties such as apparent density, dynamic hardness, and flexural properties. GFRTPs made from E-glass fibers and polypropylene were fabricated using an injection-molding. The effects of the fiber content on the GFRTP properties were examined using glass-fiber contents of 0, 5, 10, 20, 30, 40, and 50 mass%. Commercially available denture base materials and NMCD materials were used as controls. The experimental densities of GFRTPs with various fiber contents agreed with the theoretical densities. Dynamic micro-indentation tests confirmed that the fiber content does not affect the GFRTP surface properties such as dynamic hardness and elastic modulus, because most of the reinforcing glass fibers are embedded in the polypropylene. The flexural strength increased from 55.8 to 217.6 MPa with increasing glass-fiber content from 0 to 50 mass%. The flexural modulus increased from 1.75 to 7.42 GPa with increasing glass-fiber content from 0 to 50 mass%, that is, the flexural strength and modulus of GFRTP with a fiber content of 50 mass% were 3.9 and 4.2 times, respectively, those of unreinforced polypropylene. These results suggest that fiber reinforcement has beneficial effects, and GFRTPs can be used in NMCDs because their physical properties are better than those of controls. © 2016 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 105B: 2254-2260, 2017.

Retentive force comparison between esthetic and metal clasps for removable partial denture / Comparação da força retentiva entre grampos estéticos e metálicos para prótese parcial removível

Objetivo: Este estudo teve como objetivo avaliar a retenção do grampo de resina de acetato quando comparado ao grampo metálico. Material e métodos: Para isso, 10 grampos metálicos Co-Cr convencionais (Ackers) e 20 de resina de acetate foram confeccionados. Os grampos de resina de acetato foram constituídos por braços de oposição, suporte e retenção feitos de CoCr. Dos 20 grampos estéticos, 10 tiveram a espessura do braço de retenção diminuídos para torná-los mais estéticos. A força de retenção inicial dos espécimes foi testada em uma máquina de teste universal através de teste de tração. Depois disso, os espécimes foram submetidos a 7.000 ciclos, cada um, em uma máquina adaptada, imersos em saliva artificial, por 36 meses, simulando uso clínico de uma prótese parcial removível. Os dados foram tabulados para análise estatística da eficácia de retenção. Resultados: Após ciclagem, os grampos de resina de acetato de 3 mm de espessura e 2 mm de espessura perderam mais retenção do que os grampos metálicos. O tipo de material (p = 0,0000) e a ciclagem (p = 0,0039) mostraram um efeito significativo, mas a interação material / ciclagem (p = 0,1436) não. Conclusões: Portanto, os grampos estéticos apresentaram força de retenção inferior à dos grampus metálicos. No entanto, os grampos estéticos podem ser utilizados em casos clínicos que requerem retenção mínima. (AU)

Objective: This study aimed to evaluate the retention of acetate resin clasp as when compared to metal clasp. Material and methods: For this purpose, we constructed 10 conventional Co-Cr metal clasps (Ackers) and 20 acetate resin clasps. The acetate resin clasps had the opposition, support and retaining arms made of Co-Cr. Of the 20 esthetic clasps, 10 had the thickness of the retention arm decreased to make it more esthetic. The initial retentive force of the specimens was tested in a universal testing machine through tensile test. After that, the specimens were subjected to 7,000 cycles, each one, in an adapted machine, immersed into artificial saliva, for 36 months of simulated clinical use of a removable partial denture. Data were tabulated for statistical analysis of the retention effectiveness. Results: After cycling, 3-mm-thick and 2-mmthick acetate resin clasps lost more retention than metal clasps. The material type (p=0.0000) and cycling (p=0.0039) showed a significant effect, but the material/cycling interaction (p=0.1436) did not. Conclusions: Therefore, esthetic clasps presented retention force lower than that of metal clasps. Notwithstanding, the esthetic clasps can be used in clinical cases requiring minimum retention. (AU)

Assessment of clasp design and flexural properties of acrylic denture base materials for use in non-metal clasp dentures.

PURPOSE: The purpose of this study was to investigate the possibilities of utilizing new acrylic denture base materials in resin clasps using three-point flexural tests and cantilever beam tests. METHODS: Seven non-metal clasp denture (NMCD) materials and four acrylic denture base materials were used for three-point flexural tests and six NMCD materials and three acrylic denture base materials were used for cantilever beam tests. The flexural strength, elastic modulus, and 0.05% proof stress were measured by three-point flexural tests according to International Organization for Standardization (ISO) 20795-1. And load at 0.5mm deformation, elastic modulus were measured by Cantilever beam tests. RESULTS: For the three-point flexural tests, only materials that met the conditions for both flexural strength and elastic modulus were the polycarbonate Reigning N (REN) and the acrylics Acron (AC), Pro Impact (PI), Procast DSP (PC) and IvoBase High Impact (HI) which are required in ISO 20795-1, Type 3 denture base materials. And for cantilever beam tests there was no significant difference between PI and either EstheShot (ES), EstheShot Bright (ESB), REN or Acry Tone (ACT) in load at 0.5mm deformation, and no significant difference between PI and either Lucitone FRS (LTF), ES, ESB, REN or ACT in elastic modulus. CONCLUSIONS: The results thus suggested that some of the acrylic materials used as denture base materials may also be usable for NMCDs, and that the flexural properties of the acrylic material PI resemble those of ES, ESB and ACT, meaning that similar clasp designs may also be feasible.

Clinical application of removable partial dentures using thermoplastic resin. Part II: Material properties and clinical features of non-metal clasp dentures.

This position paper reviews physical and mechanical properties of thermoplastic resin used for non-metal clasp dentures, and describes feature of each thermoplastic resin in clinical application of non-metal clasp dentures and complications based on clinical experience of expert panels. Since products of thermoplastic resin have great variability in physical and mechanical properties, clinicians should utilize them with careful consideration of the specific properties of each product. In general, thermoplastic resin has lower color-stability and higher risk for fracture than polymethyl methacrylate. Additionally, the surface of thermoplastic resin becomes roughened more easily than polymethyl methacrylate. Studies related to material properties of thermoplastic resin, treatment efficacy and follow-up are insufficient to provide definitive conclusions at this time. Therefore, this position paper should be revised based on future studies and a clinical guideline should be provided.

Clinical application of removable partial dentures using thermoplastic resin-part I: definition and indication of non-metal clasp dentures.

This position paper proposes a definition and naming standard for removable partial dentures (RPDs) using thermoplastic resin, and presents a guideline for clinical application. A panel of 14 experts having broad experience with clinical application of RPDs using thermoplastic resin was selected from members of the Japan Prosthodontic Society. At a meeting of the panel, "non-metal clasp denture" was referred as the generic name of RPDs with retentive elements (resin clasps) made of thermoplastic resin. The panel classified non-metal clasp dentures into two types: one with a flexible structure that lacks a metal framework and the other having a rigid structure that includes a metal framework. According to current prosthetic principles, flexible non-metal clasp dentures are not recommended as definitive dentures, except for limited cases such as patients with a metal allergy. Rigid non-metal clasp dentures are recommended in cases where patients will not accept metal clasps for esthetic reasons. Non-metal clasp dentures should follow the same design principles as conventional RPDs using metal clasps.

Scratch test of thermoplastic denture base resins for non-metal clasp dentures.

PURPOSE: Several thermoplastic denture base resins have been introduced for the fabrication of non-metal clasp dentures. Although the surface of these materials is easily damaged, the surface roughness and characteristics of scratches created have not been evaluated. The purpose of this study was to evaluate the surface roughness of thermoplastic resins using a scratch test for the development of future materials. METHODS: Four thermoplastic (polyamide: Valplast(®); VLP and Lucitone FRS(®); FRS, polyethylene terephthalate: EstheShot(®); ES, and polyester: EstheShot Bright(®); ESB) and two conventional acrylic (Heat-polymerizing: Urban(®); HC, and Pour type auto-polymerizing: Pro-Cast DSP(®); PR) denture base resins were examined. Eight specimens, approximately 10mm×10mm×30mm in size, of each material were fabricated. Scratch test was performed by a scratch tester with a diamond indenter of 10-µm radius and cone angle 90°, applying a constant load of 500mN, and 2-mm-long scratches were made. The scratch marks were studied under 3D laser measuring microscope and cross-section profiles at approximately 0.5mm, 1.0mm, and 1.5mm from the starting point were extracted and measured with analysis software. Data from 24 cross-section profiles in each denture base material were analyzed. RESULTS: The maximum depths of ES, ESB and FRS were greater than VLP, PR and HC, and the scratch widths of ES, ESB, FRS and VPL were greater than PR and HC. CONCLUSIONS: The results showed that the surface of thermoplastic denture base resins was easily damaged compared to polymethyl methacrylate.

Corrective therapy for different kinds of open bite malformations / 中华医学美学美容杂志

Objective To investigate the effects of a corrective tr ea tment on open bite malformations, such as gnash their teeth, nail-biting, tongu e thrusting, impacted tooth, cross bite with improper correction, open bite defo rmity resulted from premature shedding of deciduous tooth and molar cysts. Methods We used dental resin technology: acid etching the teeth, adh ering metal clasps to the teeth by means of composite resin, and applying elasti c bands for intermaxillary traction to correct the cross bite. Results We had treated 22 patients, age ranged from 7-30, with the malformatio ns resulted from different kinds of reasons, and obtained significant results. Conclusion With cooperation of the patients, simple corrections for open bite with sticky clasp and occlusion with elastic band are easy to car ry on, with short period of treatment time, and every patient gets prominent out come. It is effective, prior to commonly-used corrective therapy and deserves t o be widely used.