A COMPARATIVE STUDY ON THE EFFECTS OF THE POLYMER PROSTHETIC BASE PRESSURE OVER THEPROSTHETIC FIELD Prosthetic dentistry

A COMPARATIVE STUDY ON THE EFFECTS OF THE POLYMER PROSTHETIC BASE PRESSURE OVER THE PROSTHETIC FIELD
1. Univ. assist., PhD student, Didactic Dept. Dental Medicine, Apollonia University of Iasi 2. Lecturer, PhD student, Didactic Dept. Dental Medicine, Apollonia University of Iasi 3. Univ. assist., Didactic Dept. Dental Medicine, Apollonia University of Iasi 4. Prof. univ. dr., Didactic Dept. Dental Medicine, Apollonia University of Iasi Contact person: Andor Cigu, email: andortony@yahoo.com

A.T. Cigu1, Ctlina Ciobanu2, t. Ioni3, G. Costin4

Abstract

Partially mobile polymeric prostheses constitute absolutely necessary therapeutical means in all forms of partial edentations. As known, polymeric partial prostheses constitute temporary solutions for the treatment of edentaton states. Nowadays, this treatment includes traditional acrylic prostheses, as well as elastic prostheses made of different material systems. Such a system is Valplast, which uses a polyamide for the realization of the prosthetic base. Both the rigid and the elastic materials are nowadays under debate, different positive or negative opinions being uttered in relation with their utilization. The scope of the present study is to support the intensive application of the elastic materials. Extremely important is the identification of the intrinsic qualities of the materials influencing the behaviour in the oral cavity, especially the effects of pressure upon the biological structures of the prosthetic field. Keywords: rigidelastic polymeric prostheses, pressure of the polymeric prosthetic base, texture, hydrophillicity.

elastic prosthesis acrylic prosthesis temporary prosthesis superpont temporary prothesis made of various polymeric products

INTRODUCTION

The temporary treatment of partial edentations makes use of two types of mobile monomaterial prostheses, completely different as to their structure, namely the rigid and the elastic polymeric prostheses (Valplast, TCS, BioDentaplast, Flexiplast, and Dentalos Polyana systems). Processing of recent statistical data shows the situation plotted graphically in the figure below:

Fig. 1. Utilisation of temporary prostheses made ofvarious polymeric products Source: authors data

The scope of the investigation was a comparative determination of some physico-chemical characteristics known as influencing the behaviour of rigid acrylic prostheses versus the polyiamidic ones from the Valplast system. Also, a minute analysis of the effects of pressure upon the biological structures of the prosthetic field was performed.

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MATERIALS AND METHOD

The main idea of the present investigation was that essential in the appreciation of the behaviour of these types of prostheses for use in the oral cavity remain the problems of stability and manner of transmission of the pressure forces upon the prosthetic field [1,2]. The stability of partial prostheses is closely related to the phenomenon of adhesion. The reduced efficiency of the other natural means of maintainance and stabilization, such as attachment, anatomic retentivity and muscular tonus and of the prosthetic elements, in general such as the simple wire hooks is recognized. Adhesion remains the target of prosthesis maintenance on the prosthetic field, depending, in its turn, on the density of the material, hydrophyllicity, texture, all being the result of polymeric chain arrangement [3,4]. Stabilization of prostheses through the colloidal hydrophyllic suspension created by saliva realizes connections between the contact surface of the prosthetic field and the prosthetic surface. The adhesion effect depends on the initiation of a pH with a normal value and on the dimensional uniformity of the salivary film. In the case of a sufficient amount of liquid at the interface of the gingival mucous membrane with the prosthetic surface and its faithful adaptation on the prosthetic field, the adhesion phenomenon is uniformly distributed over the whole surface of the contact area, being directly proportional with the hydrophyllic qualities of the prosthetic material [5].

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Source: ***SNF FLOERGER, Water-soluble polymers, web address: www.snf-group.com

Fig. 2. Atmospheric pressure between the two contact surfaces

To favourize this mechanism, the polymer should permit to a part of its polymeric or molecular chain to behave as a whole in the oral cavity. Generally, for attaining an optimum value, it has been established that the concentration of polymer and monomer should have an equal chemical composition, and the procentage should be optimized either volumetrically or ponderally. In the case of polyamides, these ratios result from the synthesis of the product, our experiment demonstrating their conservation after the technical injection stage [6,7]. The loads between the two contact surfaces may have different positive or negative ionicity, which will determine either static attraction or ionic effect. For each polymer, the manner of bridge formation depends mainly on two parameters: the number of available places for adsorbtion on the surface of the particles contacting the mucous membrane, and the rate of interferential collision of saliva [8,9]. According to the above-described mechanisms, adhesion between the two surfaces is obtained in several successive stages: Creation of polymers contact with the wet medium; Realization of the solid-liquid interface; Adsorption of the two contact surfaces for the formation of a connection bridge; Favorizing of adhesion through collision, and occlusal contact [10-12]. Analysis of these phenomena involved determinations on a number of 10 prostheses: 5 acrylic and 5 polyamidic ones. These prostheses were tested in the laboratories of the Institute of Macromolecular Chemistry of Iasi as to their behaviour, from the viewpoint of density, hydrophyllicity, texture and resistance to pressure. Other determinations, referring to the surface characteristics of the areas contacting the mucous membrane, evidenced the following aspects: the acrylic prosthesis has a porous mucous surface, as due to its reduced density (altered texture) and to the reliefs similar to those of the prosthetic field; the elastic prosthesis showed a less porous surface, a proof of its increased density (corresponding texture) with the same reliefs, similar to those of the prosthetic field.
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A COMPARATIVE STUDY ON THE EFFECTS OF THE POLYMER PROSTHETIC BASE PRESSURE OVER THEPROSTHETIC FIELD

As to the effects of pressure upon the biological structures of the prosthetic field, a double analysis was proposed: The distribution manner of the stressing forces, as a function of the stability of the prosthesis on the prosthetic field; The way in which the prosthesis with a corresponding stability transmits the occlusal stressing forces to the prosthetic field. In partial prostheses, unstable monomaterial areas of different pressure appear at the same stressing, of functional and occlusal type. The postprosthetic clinical picture will not express the correct effects of the biomechanical stress. The modifications produced at mucous and osteo-periostic level will express the altered transmission of the forces, as due to instability, zones with low and high pressure alternating. In the case of prostheses stable on the prosthetic field, the post-prosthetic modifications will express the real effect of the occlusal stresses. In such situations, reduction and absorbtion of pressures by the prosthetic base are achieved by a reduced molecular weight of the prostheses, while the polymeric chains will form a static nature region with a negative charge on the prosthetic field. To acquire a complete image of the behaviour of these two types of prosthesis on the prosthetic field, the determinations made by SNFFLOERGER, Water-soluble polymers, web address: www.snf-group.com, were associated with the publications of Bingjie Sun, Yinan Lin and Peiyi Wu, The Key Laboratory of Molecular Engineering of Polymers (Ministry of Education) and Department of Macromolecular Science, Fudan University, Shanghai 200433, PR China. As to the polyamidic materials examined in the infrared spectrum, there results that half of the molecular component is free, while the other is linked into a compact structure. Such a complex molecular architecture, actually expressing a peculiar texture, justifies the hydrophyllic qualities, the resistance to biochemical attacks and the behaviour to the action of deformation forces. The observation was made that polyamides have a metastable structure to thermal variations. Increased temperatures do not influence the nature of the material, while returning to the initial temperature reduces the physical properties the characteristic elasticity. In practice,
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thephenomenon of Valplast prostheses adaptation is explained by means of temperature. On the primary adaptation of the prostesis, its immersion in a hot bath, at a temperature of 80-100oC up to 1 -1.5 min, renders the polyamidic material of the prosthesis flexible, and, at the temperature of the oral cavity, it is perfectly casted on the surface of the biological support, thus increasing an intimate contact with the mucous membrane. The Valplast literature, Flexible Partials and the www.valplast.info web source define this phenomenon as bioactivity.

The graph illustrates the IR band spectroscopic analysis of a Valplast molecular compound, which shows that this oscillation depends on temperature, having the same characteristics as the polyamine material. This recovery is possible up to 650oC, representing a warranty for materials being not modified in the moment of injection, at 550oC, for the realization of the prosthetic base. For monomaterial prostheses made of acrylated thermopolymerizable prostheses, the data are already known. The qualities of the partially mobile acrylic prostheses depend on the properties of the material, as established by the manufacturer and, to a considerable extent, by the processing technology applied in the dental technique laboratory. The difference from the elastic prostheses lies in the fact that no adaptative maneouvres can be made to them through deformation, the only variant being of mechanical type: polishing and lining. Most of the researchers do not agree with processing of prosthetic polyamidic bases through exposure to UV radiations, which degrade the polymeric chain, forming much smaller molecules, which can be biologically degraded (SNF FLOERGER, Water soluble polymers, web address: www.snf-group.com).
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CLINICAL INVESTIGATIONS

Mucosal pathology is obvious in patients with acrylic prosthesis, evidencing installation of a post-prothetic pathology at periodontal and muco-periostic level, manifested as some congestive, edematious zones while, at the periphery of the prosthetic field, hypertrophic areas could be seen. In numerous cases, decubit lesions, requiring removals of material from the prosthetic base, occurred in the first days. The same phenomena appear in elastic prostheses, as due to the compulsorily uniform thickness. The margins of prosthesiss base are thin, comparatively with the thickened ones of the acrylic prostheses, producing immediate prejudices at the periphery of the prosthetic field, due to increased compressivity phenomena. The difference between the two types of prostheses is given by the better maintenance of the health condition of the mucous-bone support in elastic prostheses. The effect of elastic prostheses is defined as bioactivity. That is why, a correct follow up is absolutely necessary, as the patient will better accept the elastic prosthesis even under an abnromally higher occlusal pressure. In time, installation of a pathology different from that of the acrylic prostheses is favourized. In the case of classical acrylic prostheses, if adaptation is initially correct, the patient does not feel other subjective symptoms, apart from some discomfort while, at the level of the mucous membrane, pseudo-keratinization occurs. The high atrophy rate and occlusal wearing favourize the rapid installation of cranio-mandibulary malocclusions and malrelations. In the case of elastic prostheses, a precocious subjective symptomatology is manifested, the patients complaining of instability in occlusion, fatigue muscular pains during mastications, usually 5 minutes after beginning the alimentation process. Also, intense pains appeared in side by side pulsion movements, in the retro-articulary space and in the area of the temporo-mandibulary ligament. Intense pains at the level of the mylohioidian and digastric muscles were felt on palpation. After a minute examination, an abnormal stress of the temporo-mandibular joint was observed,
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as well as modification of the functional muscular individual pattern. In time, this symptomatology is improved.

An incorrect realization of the occlusion plan of prostheses be them elastic or acrylic produced the same symptoms as those described when discussing the effects of the prosthetic base upon the biological support. To attain the static and dynamic stability of prostheses, necessary for a comparative study, special attention has been paid to the rehabilitation through prosthesizing of the cranio- mandibular relation, as well as to the occlusal one. As known, a mobile prosthesis is morpho-functionally integrated at the level of the stomatognate system if a triple prosthetic base-prosthetic field equilibrium is obtained at both occlusal level and at the level of the temporo-mandibulary joint.

Fig. 4. Elastic Valplast prosthesis: mixed maxillary treatment, the prosthesis frontally conjuncted with Ceramage composite and the mobile termino-terminal prosthesis and partial edentation, intercalated mandibularly, combined prosthesis (conjunct and elastic prosthesis), in a 62 year-old patient

RESULTS AND DISCUSSION

The realized, cited determinations, associated with the results of the clinical observations evidence wholly different characteristics in the two types of prostheses, listed in the table below with the following experimental
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parameters: texture, hydrophillicity and resistance to pressure. These parameters influence the stability of the prosthesis on the prosthetic field, dictating the forms of pressure exercised upon the biological support.

CONCLUSIONS

Analysis of the intrinsic qualities of the materials forming the prosthetic bases and of the effects produced at the level of the prosthetic field by partially mobile prostheses evidence the superiority of the elastic ones, as due to their physico-chemical characteristics and processability. Such qualities influence directly the biological behaviour in the relation of the elastic prosthesis with the tissues of the prosthetic field. However, prolongued analysis shows that occlusal-articulary modifications appear for both types of prostheses. Essentially, the elastic prosthesis represents an advantageous alternative in the temporary therapy of edentation situations.

1. Ash M., Ramfjord S., Ocluzia, Ed. a IV-a, Philadephia, 1995. 2. Bell W., Dental Ocluzia, J. Dental. Med., 1992. 3. Magne, Pascal, P.D., Dr. Med&Beslser, URS, Prof., Dr. Med. Dent, Restauraciones de porcelena adherida en los dientes anteriores, Metodo Biomimetico, Ed. Quintessence, S.L., Barcelona, 2004. 4. Vasile Burlui, Catalina Morarasu, Gnatologie, Editura Apollonia, Iasi, 2000. 5. Vasile Burlui, Norina Forna, Gabriela Ifteni, Clinica si Terapia Edentatiei Partiale Intercalate Reduse, Ed. Apollonia, Iasi, 2001. 6. Costin George, Tehnologia Aparatelor Gnatoprotetice Amovibile, Ed. Apollonia, 2002. 7. SNF FLOERGER, Polimeri solubili in apa, adresa web: www.snf-group.com 8. Hasegawa T. (2010) in: Kumar C. (ed.) Structural characterization technique of molecular aggregates, polymer and nano-particle films in nanomaterials for life sciences, vol. 5, Wiley-VCH, Weinheim, pp. 397-417. 9. Griffiths P.R., De Haseth J.A. (2007) Fourier transform infrared spectrometry, 2nd ed. Wiley, Hoboken. 10. Everall N.J., Chalmers J.M., Griffiths P.R. (2007) Vibrational spectroscopy of polymers: principles and practice. Wiley, Chichester. 11. Ray B., Okamoto Y., Kamigaito M., Sawamoto M., Seno K., Kanaoka S., Aoshima S. (2005) Polym J, 37:234-237. 12. Stuart B. (2002) Polymer Analysis, Wiley, Chichester.

References

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