A Study to Evaluate and Compare Efficacy of Denture ...€¦ · improved with time. Overdenture and...

7Original Article

A Study to Evaluate and Compare Efficacy of Denture Adhesives in Complete Denture PatientsSupreet Kaur Chhabra1 Sandeep Garg1 Nidhi Mangtani Kalra1

1 Department of Prosthodontics, Maharishi Markandeshwar University, Mullana, Haryana, India

Address for correspondence Supreet Kaur Chhabra, MDS, Department of Prosthodontics, Maharishi Markandeshwar University, Ambala Yamunagar Highway, Mullana, Ambala, Haryana 133207, India (e-mail: [email protected]).

Aim To evaluate and compare the retentive ability of commonly available denture adhesives in completely edentulous patient at different time intervals.Materials and Methods Ten completely edentulous patients were included in the present in vivo study. Complete dentures were fabricated, and retention of maxillary denture was recorded with and without denture adhesives (Fixon Supergrip powder, Fittydent paste, Super Poligrip powder, and Fit Fix powder) at 15 minutes, 1 hour, and 2 hours intervals for all patients. Force at which denture dislodged was recorded with digital force gauge and was considered as retentive value. Data obtained were tabulated and subjected to statistical analysis using SPSS software version 17.5 (Trial version). Intragroup comparison was done using paired t-test. Intergroup comparison was done using analysis of variance (ANOVA) followed by post hoc Tukey’s test. p-Value ≤ 0.05 was considered significant in all tests.Results Mean retention force of maxillary complete denture achieved with all four denture adhesives was significantly better than without adhesive at all time intervals. Intragroup comparison showed that each adhesive exhibited no change (p ≤ 0.05) in retention from 15 minutes to 2 hours interval except Fixon Supergrip powder adhesive which showed significant decrease (p = 0.009) in retention from 1 hour to 2 hours. Intergroup comparison revealed no statistically significant difference in retention of maxillary dentures with different denture adhesives at all time intervals (p ≥ 0.05).Conclusion Within the limitations of the study, it was concluded from the present study that all four adhesives irrespective of their form can be used to improve reten-tion of dentures.

Abstract

Keywords ► denture adhesives ► retention ► dislodging force ► digital force gauge

Dent J Adv Stud 2018;6:7–13

DOI https://doi.org/ 10.1055/s-0038-1671811.ISSN 2321-1482.

©2018 Bhojia Dental College and Hospital affiliated to Himachal Pradesh University

Introduction

Successful rehabilitation of edentulous patient depends upon a well-fitting prosthesis, which not only provides function and esthetics, but also instils psychological confidence to the patient.1–3 Good retention, stability, and support are the prime requisite for a well-fitting prosthesis.2 Patients seeking a prosthetic therapy demand retentive prosthesis irrespec-tive of their oral conditions, which is sometimes difficult to achieve with conventional complete denture therapy.3 Protocols for treating completely edentulous patients have improved with time. Overdenture and implant-supported

prosthesis are a part of such improvements, which provides patient with more retentive and stable prosthesis.4,5 But cost and time requirements for such treatment protocols are more as compared with conventional complete denture, thus, limiting their use. So, the conventional denture remains the main stay treatment for majority of completely edentu-lous patients; thus, the problem of poor retention of dentures is prevalent. Many complete denture-wearer patients resort to other means to improve retention such as using denture adhesives, which are available freely over the counter, cheap, and easy to use.6 Numbers of studies have reported their use and reason for its use. Bates and murphy in their study

THIEME

published onlineSeptember 18, 2018

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Dental Journal of Advance Studies Vol. 06 No. 1/2018

Efficacy of Denture Adhesives in Complete Denture Patients Chhabra et al.

found that 12% females and 10% males were using denture adhesives.7 Wilson et al and Coates have reported 30% and 7 to 33% of denture adhesive users, respectively.8–11

Denture adhesives have been investigated in various stud-ies for their role in retention and stability of denture, bite force, masticatory efficiency, phonation, and effect on quality of life and have shown to improve the overall quality of com-plete denture treatment and patient satisfaction.12–20 There are many in vivo and in vitro studies in literature, which have evaluated specifically the retentive ability and efficacy of different types of denture adhesives both subjectively and objectively, but with varying results.12–15,20–22 Therefore, this study aims to evaluate and compare the retentive ability of four denture adhesives, which are commercially and easily available to the patients.

Materials and MethodsTen completely edentulous patients with age ranging from 45 to 70 years (mean age: 64.2) of both the genders were selected for the study according to the following inclusion and exclusion criteria. Willing patients who had been com-pletely edentulous for at least 1 year prior to the initiation of the study, having well-formed ridges, without any undercut requiring surgical correction, with no history of cranioman-dibular dysfunction or medical condition were included in the study. Patients with hyperplastic or abused denture- bearing tissues, atrophic ridges, having poor neuromuscular control, suffering from xerostomia, and those with maxillofacial defects were excluded from the study.

All patients received a pair of new complete dentures fabricated using standard technique and recommended materials. Dentures were adjusted for better intraoral fit and comfort followed by standard finishing and polishing procedures and delivered to the patients. Patients were recalled after 24 hours, and any problem associated with denture was rectified. Once the patients were satisfied with their dentures, they were recalled after 15 days for evaluation of maxillary denture retention with and without adhesives.

Preparation of maxillary denture for testing: To prepare the denture for testing, two lines were marked diagonally between the canine and tuberosity points, and at their intersection, a point was located, referred as the geometric center (►Fig. 1). A stainless wire loop was incorporated at this geometric center for application of dislodging force (►Fig. 2).

Testing the retention of maxillary denture: Retention of maxillary denture was checked first without adhesive and then with different adhesives, at three time intervals (15 min, 1 h, and 2 h), on subsequent recalls. Four adhesives used in the study were (►Fig. 3):

• Fit Fix powder (Pyrex Polykem, Roorkee, India) • Fixon Supergrip powder (ICPA Health Products Ltd., GIDC,

Ankleshwar, India) • Fittydent paste (Dr. Reddy Laboratory Ltd., Hyderabad,

India) • Super Poligrip paste (GlaxoSmithKline Consumer Health-

care, L.P., Moon Township, Ireland).

Testing ApparatusThe testing apparatus used in the study is based on prin-ciple stated by Skinner and Chung in 1953 and is modified version of the apparatus used by Kumar and Thombare15 in their study. The basic principle on which apparatus work is the application of force at right angles to denture base. Testing apparatus consisted of one vertical adjustable metal rod supporting three horizontal adjustable metal rods with whole assembly mounted on a wooden stand (►Fig. 4). First horizontal metal rod had an attachment for face-bow (Gnatus), which was used to stabilize and standardize the head position in all the patients. Second horizontal metal rod supported two pulleys, which engaged nylon fishing line with one end attached to stainless steel hook and the other

Fig. 1 Identification of geometric center.

Fig. 2 Incorporation of stainless wire loop at the geometric center for application of dislodging force.

9Efficacy of Denture Adhesives in Complete Denture Patients Chhabra et al.


end attached to digital force gauge. Digital force gauge was further attached to spindle handle by nylon line. Third hori-zontal metal rod supported a cushioned adjustable chin rest.

Method of TestingPatient was seated comfortably with denture firmly seated intraorally with chin resting on chin rest and head stabi-lized using face-bow (►Fig. 5). The apparatus was adjusted vertically at required height and horizontally for engaging the hook of nylon fishing line perpendicular to the wire loop fixed at the center of the palatal portion of denture. A dislodging force was then created and applied at right angle to denture base by rotating the spindle handle in a clock-wise direction. The force was steadily increased until the denture dislodged. Force value at which denture dislodged was recorded as retentive force value. Same protocol was followed when testing with adhesives. For application of powder form of adhesive, uniform sprinkling of the powder was performed over the moist intaglio surface of the denture. For application of paste form of the adhesive, paste was squeezed out from tube and was applied on equally spaced spots on intaglio surface of denture. Once the recording of all the retentive force values of the denture with and without denture adhesives

Fig. 3 Denture adhesives used.Fig. 4 Testing apparatus consisted of one vertical adjustable metal rod supporting three horizontal adjustable metal rods with whole assembly mounted on a wooden stand.

Fig. 5 Patient seated comfortably with denture firmly seated intraorally with chin resting on chin rest and head stabilized using face-bow.

10 Efficacy of Denture Adhesives in Complete Denture Patients Chhabra et al.


was completed, the wire loop (used to engage the hook of nylon fishing wire) was removed from the denture. The denture was finished, polished, and then returned to the patient.

ResultsDescriptive statistical analysis (i.e., mean, standard deviation, and standard error) was done for all groups using statistical software SPSS version 17.5 (►Table 1).

Intragroup comparison was done using paired t-test (►Table 2). p-Value ≤ 0.05 was considered significant in all tests.

DiscussionDenture adhesives also known as fixatives or adherents are commercially available products, which have been used as an aid for the improvement of retention and stability of complete dentures.4,5 Earlier denture adhesives were composed of vegetable gums, such as acacia, tragacanth, and karaya. These components absorbed water to swell up and formed a mucilaginous layer, which increased the viscosity of the adhesive, but these denture adhesives were not satisfactory as they were highly soluble so were washed out readily beneath the denture and hence were effective for limited period only.5,16 Modern day adhesives contain either carboxymethyl cellulose (CMC) or polyvinyl ether-meth-ylcellulose (PVM-MA) as an active ingredient, which is responsible for increased viscosity and adhesion when hydrated in presence of water or saliva.6,13,16 The adhesives are available in soluble and insoluble forms. The soluble forms of adhesives are in the form of cream, paste, and powder. Difference between three forms is in the presence or absence of binding agent. Powder contains anti-clumping agent (sil-icon dioxide and calcium acetate), and paste has binding

agents such as petrolatum, mineral oil, and polyethylene oxide. The powder, cream, and paste forms are routinely available over-the-counter and are most frequently used by the patients and prescribed by dentists.6 The insoluble forms of adhesive are available as wafers and pads.

With so many choices of denture adhesives available, selection of adhesive is based on certain attributes like it should have longer duration of action and should be non-toxic, odor free, tasteless, easy to use, economic, biocompatible, and easily available.4,5,23 Four denture adhesives were investigated in present study out of which two were in powder form (Fixon Supergrip and Fit Fix), and two were in paste form (Super Poligrip and Fittydent). The reason of choice was easy availability, cost effectiveness, biocompatibility, and ease of use.12–18,24

Numerous studies have been done to evaluate retention objectively, subjectively or by combination of both, but advantage of objective study is that it is free from influence of patient’s perception. Also, in vivo study has an advantage over in vitro study for being clinically more relevant.3 Thus, present in vivo study was designed to evaluate the retention objectively in the form of force required to dislodge the denture using testing apparatus which was the modification of original design given by Skinner and Chung25 and is similar to the one used by Kumar and Thombare15 with modification. There was addition of a face-bow to the apparatus to stabilize the head position so as to standardize the factor of gravity to achieve accuracy and precision. The digital force gauge used in the study measures the retention force with great accuracy in the smallest fractions (grams). Spindle handle mechanism was used to produce dislodging force since it is reported to be the most convenient and more accurate meth-od for producing nearly accurate dislodging forces by Kumar and Thombare.15

Table 1 Descriptive analysis

Serial number Group N Mean Standard deviation Standard error

1. Without adhesive (control) 10 2003.66 1132.783 358.217

2. Fixon Supergrip15 min

10 3604.532 1505.2713 476.0086

1 h 3594.415 1374.1537 434.5456

2 h 3164.913 1377.7432 435.6807

3. Fit fix15 min

10 3411.749 1103.2312 348.3288

1 h 3299.782 1083.0225 342.4818

2 3082.666 1214.3559 384.0131

4. Fittydent paste15 min

10 3911.666 1133.1351 358.3288

1 h 4226.482 1275.5707 403.3709

2 h 4045.799 1369.6413 433.1186

5. Super Polygrip paste15 min

10 3732.816 1243.9489 393.3712

1 h 3946.433 1012.7837 320.2703

2 h 3888.500 946.4758 299.3019



Table 2 Intragroup analysis using paired t-test

Serial number

Group Pair MD SD SEM p-Value

1 Fixon Supergrip With adhesive (15 min)—without adhesive

1600.8740 1022.1931 323.2458 0.001

With adhesive (1 h)—without adhesive

1590.7570 1049.2263 331.7945 0.001


1161.2550 1050.8892 332.3204 0.007

With adhesive (15 min)—with adhesive (1 h)

10.1170 760.0764 240.3573 0.967


439.6190 618.5271 195.5954 0.057

With adhesive (1 h)—with adhesive (2 h)

429.5020 406.7412 128.6229 0.009

2 Fit Fix With adhesive (15 min)—without adhesive

1408.0910 757.8483 239.6527 0.000


1296.1240 690.6899 218.4153 0.000


1079.0080 877.8294 277.5940 0.004


111.9670 596.7477 188.7082 0.568


329.0830 720.9697 227.9907 0.183


217.1160 820.0141 259.3112 0.424

3 Fittydent paste With adhesive (15 min)—without adhesive

1908.0080 1043.1792 329.8822 0.000


2222.8240 760.7053 240.5561 0.000


2042.1410 874.8437 276.6499 0.000


–314.8160 706.4443 223.3973 0.192


–134.1330 666.3147 210.7072 0.540


180.6830 409.9315 129.6317 0.197

4 Super Poligrip paste

With adhesive (15 min)—without adhesive

1729.1580 1127.1600 356.4393 0.001


1942.7750 918.5971 290.4859 0.000


1884.8420 917.5787 290.1639 0.000

(Continue)

12 Efficacy of Denture Adhesives in Complete Denture Patients Chhabra et al.


Force was applied at the center of denture as Colón et al concluded in their study that center of the denture (middle portion) was considered the most reliable position for the testing of the retention.26

In the present study, the retention of well-fitting maxillary denture was evaluated. Reason of choice for well-fitting maxillary complete denture was to achieve precision in evaluation of effectiveness of denture adhesives. Kapur27 and Salman and Ibrahim12 also shared the similar opinion for use of well-fitting denture for the testing of retention. Kumar and Thombare15 and Pachore et al22 used only the denture bases for evaluation of retentive ability of the denture adhesives.

Results of the present study revealed that all forms of denture adhesives (powder and paste) showed improved retention val-ues in comparison to that of without adhesives at all time in-tervals (15 minutes, 1 hour, and 2 hours) (►Table 1). This is in accordance with Panagiotouni et al,28 Chowdhry et al,14 Ghani and Picton,29 Kumar and Thombare,15 and Salman and Ibrahim.12 The retentive forces of powder form of adhesive (Fixon Super-grip, Fit Fix) decreased with time and for paste form (Fittydent, Super Poligrip) increased up to 1 hour and then decreased for 2 hours, but the change in retention was statistically insignificant (p > 0.05) (►Tables 1 and 2 ) except for Fixon Supergrip, which showed significant reduction in retention from time period of 1 to 2 hours (p = 0.009). Results are in accordance with Ghani and Picton.29 Although, Fit Fix was also the powder form of adhesive, it showed no statistically significant change in effectiveness from baseline to 2 hours probably due to the difference in com-position to that of Fixon Super Grip.

The intergroup analysis showed that there was no statistically significant difference in retentive ability of all denture adhesives at all time intervals (p > 0.05). This is in accordance with Salman and Ibrahim,12 but the results were contrary to other studies done by Pachore et al,22 Kumar and Thombare,15 Chowdhry et al,14 and Berg et al30 where paste form of denture adhesives performed better compared with the powder form as the powder form dissolves in saliva and loses its effectiveness with time while paste form has an oily medium, which does not dissolve easily in saliva.

Variation in the results of present study from other studies may be due to difference in testing apparatus, study design, difference in brands of denture adhesives used, difference

in quantity and quality of saliva, degree of anxiousness, and apprehension of patient.

Thus, from the present study, it is suggested that denture adhesives can be prescribed to the patients to enhance denture retention irrespective of their form. Though results are favorable, there is further scope to evaluate effectiveness of denture adhesives in poorly resorbed ridges or patients with poor neuromuscular control.

LimitationsThere are certain limitations of the present study, which are as follows:

• Limited time interval of the study, i.e., effectiveness of denture adhesives was evaluated only up to 2 hours. Lon-ger time interval is required to know the actual time till denture adhesives will remain effective.

• Evaluation of retention was done only for maxillary den-ture. The apparatus used in the present study cannot be used to measure retention in mandibular denture.

• Apparatus used to test retention could apply force only in caudal direction, which is not the case in actual clinical condition.

ConclusionWithin the limitations of present study, the following conclu-sions were drawn:

• All denture adhesives improved the retention of dentures in comparison to control group (without adhesives) at all time intervals.

• Each adhesive exhibited statistically insignificant change (p > 0.05) in retention values throughout studied time interval (15 minutes–2 hours) except Fixon Supergrip powder adhesive, which showed significant decrease (p = 0.009) in effectiveness from 1 hour to 2 hours.

• Among all adhesives, at each interval, Fittydent paste ex-hibited the highest mean retentive force followed by Super Poligrip paste and Fixon Supergrip powder and the lowest by Fit Fix powder, but the difference was not statistically significant (p > 0.05).

Table 2 (Continued)

Serial number

Group Pair MD SD SEM p-Value


–213.6170 577.6944 182.6830 0.272


–155.6840 632.9490 200.1560 0.457


57.9330 105.7916 33.4542 0.117

Abbreviations: MD, mean deviation; SD, standard deviation; SEM, standard error of mean.Note: When p-value is less than or equal to 0.05, the tests are significant which is being highlighted by bold letters.



It can be suggested from the present study that all four adhesives, irrespective of their form, can be used to improve retention of complete dentures in edentulous patients, espe-cially in the initial period of adjustment.

Conflict of InterestNone.

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