Adhesives in Complete Denture Therapy
Successful complete denture therapy must involve both technical excellence during prosthesis fabrication and effective patient management prior to and following complete denture placement. Satisfying the expectations of all patients for optimal denture retention and stability is often beyond the technical skills of even the most accomplished practitioners. A substantial number of complete denture wearers remedy perceived inadequacies in denture retention and stability with denture adhesives.84 Discussing and implementing the judicious use of denture adhesives may help to satisfy the expectations of specific patients and achieve their intended treatment goals.
It is appropriate to prescribe a denture adhesive to augment retention and stability of conventional complete dentures.85-94 Adhesives are indicated for routine use when appropriately fabricated complete dentures do not satisfy stability and retention expectations of the patient.51 Denture adhesives may also prove psychologically beneficial95,96 when the patient requires supplemental retention and stability, particularly during times of public interaction. Denture adhesives are not indicated to provide retention for ill-fitting prostheses, nor are excessive amounts of adhesive indicated under any circumstances.97
When properly managed, adhesives enhance the interfacial surface tension between the denture base and supporting soft tissues by:
improving the adhesive, cohesive, and viscosity characteristics of the interfacial film layer, particularly in saliva-deficient patients, and
eliminating voids occurring in the interfacial space due to inaccurate adaptation of the denture base to the denture-bearing tissues.51
In addition to improved retention and stability, denture adhesives have been shown to reduce mucosal irritation, reduce food debris accumulation beneath the denture base, decrease excess food particles, decrease mal odors, improve chewing efficiency, increase bite force, improve functional load distribution across the denture-bearing tissues, and facilitate the psychological well-being of the patient.51,95,99-103 For patients with xerostomia, the use of a well-hydrated denture adhesive provides a cushioning or lubricating effect, reducing frictional irritation of the supporting soft tissues and preventing further tissue dehydration.54,104
The composition of most modern denture adhesives includes constituents that promote bioadhesion via carboxyl groups once the adhesive is hydrated. Two commonly employed active ingredients in denture adhesives are poly [vinyl methyl ether maleate] and carboxymethylcellulose. The physical chemistry of these adhesive constituents is discussed in detail elsewhere.51,95,105 Once placed on the intaglio surface of the denture, the adhesive material must be substantially hydrated in order to achieve optimal performance.
Following complete denture fabrication and prior to definitive placement of the prostheses, it is prudent to reemphasize to the patient the anticipated outcome of therapy. For patients with favorable anatomic, physiologic, and psychological factors, including extensive denture wearing experience, the anticipated outcome of complete denture therapy may be favorable. Conversely, for individuals who display compromised anatomic oral conditions, poor muscular control, psychological indifference, or a lack of successful denture experience, a fair or guarded prognosis is likely more realistic. Discussing reasonable expectations with the patient prior to placing complete dentures may prepare them for an otherwise disappointing experience.
It is appropriate to prescribe adhesive to augment retention and stability of conventional complete dentures. Anticipating suboptimal stability and retention in the presence of compromised patient factors, e.g., xerostomia, is justified. Informing patients the proper use of a limited amount of denture adhesive can supplement existing denture stability and retention is both clinically acceptable and a prudent patient management technique. The need for denture adhesive is not necessarily an indication of suboptimal therapy, or admission of failure by either the dentist or patient.
Most denture wearers, at one time or another, have attempted to use adhesive to facilitate comfortable denture wear and function. Unfortunately, the concept that “more is better” does not hold true for denture adhesives. Table 1 presents an approach to appropriate denture adhesive application and prosthesis placement the authors find useful. It is equally important to educate patients regarding an effective method for adhesive removal from denture surfaces and oral tissues on a regular basis. Appropriate denture and oral hygiene should be accomplished by edentulous patients at least two times each day, as described and illustrated in Table 2.
Immediately prior to the daily adhesive application it is suggested that the patient massage all the oral tissues with a oscillating rotating electric toothbrush with water in the mouth to promote hydration and increase oxygen levels into the tissues creating the optimal tissue environment (Figure 11).