Professional Documents
Culture Documents
Clinical Implications
erties of resilient liners include resiliency, which is desired over a long period of time, and a good bond to the
denture base.3
Resilient denture liners have been
used in dentistry for more than a cen-
154
Volume 99 Issue 2
Contemporary resilient liner materials can be divided into 2 groups:
acrylic resin-based and siliconebased.1,4 Both groups are available
in autopolymerized or heat-polymerized forms.1 Autopolymerized resilient
liner materials allow the clinician to
reline a removable denture directly,
intraorally. This method is faster than
using heat-polymerized (laboratoryprocessed) systems, and a patient is
not without the prosthesis during the
time required for laboratory procedures.5 However, it is difficult to produce liner materials of the optimum
thickness with the autopolymerized
technique.6 The optimum thickness
has been reported as approximately
2.5 to 3 mm, which is needed to provide good shock absorption.7,8
Acrylic resin-based resilient liner
materials generally consist of polymers and monomers. The composition of the polymers and monomers is
proprietary, but these materials generally include methacrylate polymers
and copolymers, along with a liquid
containing methacrylate monomer
and plasticizers (ethyl alcohol and/or
phthalate).9 These materials undergo
2 processes when immersed in water:
the leaching of plasticizers and other
soluble materials into the water and
the absorption of water by the polymer.9-11 It has been suggested that
the initial softness of the plasticized
acrylic resins results from the plasticizer, which is also responsible for
maintaining material softness.10,11
The plasticizer lowers the glass transition temperature of the polymer to
a value below mouth temperature so
that the modulus of elasticity of the
resilient material is reduced to a satisfactory level.9 Silicone-based resilient
liner materials are similar in composition to silicone-type impression materials, as they are dimethylsiloxane
polymers.12 Polydimethyl siloxane is a
viscous liquid that can be cross-linked
to form an elastic rubber. No plasticizer is necessary to produce a softening effect with this material.12
Definitive and interim resilient
denture liners have differing uses and
should be selected based on the desired service time of the material. Interim resilient liners are acrylic resinbased and may harden at a faster rate
than definitive materials, but they
have other advantages, such as superior elastic quality. Therefore, interim
liners are widely used as tissue conditioners or temporary relines.13
There are several problems associated with the use of resilient denture
liners, including bond failure between
the liner and denture base, colonization by Candida albicans, porosity,
poor tear strength, and loss of softness.2 One of the most serious problems with these materials is bond
failure between the resilient denture
liner and denture base.14 Bond failure
creates a potential surface for bacterial growth, and plaque and calculus
formation.2 Any favorable properties
of a denture liner are useless in the absence of a good bond to the denture
base material. A variety of parameters
affect the bond between the resilient
lining materials and the denture base,
including water absorption, surface
primer use, and denture base composition.15 There are reports on the
bond strength of resilient liners bonded to denture base resin using different methods, such as peel, shear, or
tensile tests.16-27
Long-term softness is another desirable property of resilient liners. Loss
of softness can result in the delivery of
greater occlusal forces to the underlying mucosa and increased clinical
complaints.28 The liner should also
resist the absorption of oral fluids
as well as the release of ethanol and
plasticizer into the saliva. The release
of unpolymerized or soluble products could result in a stiffer, harder
liner material over time. A liner with
a greater degree of conversion, that
is, greater monomer incorporated
into the polymer, would likely demonstrate less absorption and solubility and more stable properties over
time.29-34 This study was performed to
assess the denture base bond strength
and hardness of acrylic resin-based
definitive (Vertex Soft) and interim
(Coe-Soft), and silicone-based definitive (Molloplast-B, Mollosil Plus) resilient liners that were either heat- or
autopolymerized. The null hypothesis
was that chemical composition and
immersion time have no effect on
bond strength or hardness of resilient
denture liners.
155
February 2008
Manufacturer
Lot No.
Meliodent
Conventional (heat-polymerized)
denture base polymer (23.4 g:10 ml)
Heraeus Kulzer,
Hanau, Germany
012087
Vertex Soft
Heat-polymerized acrylic
resin-based resilient liner (2:1)
Vertex-Dental BV,
Zeist, The Netherlands
100001
Autopolymerized acrylic
resin-based resilient liner (1.5 g:8 ml)
GC America,
Alsip, Ill
0101292
Molloplast-B
Heat-polymerized silicone-based
resilient liner
010527
Mollosil Plus
Autopolymerized silicone-based
resilient liner
001003
Product
Coe-Soft
lymerization, each resilient liner specimen was removed from the flask and
trimmed with a sharp blade (No: 15;
Wuxi Xinda Medical Device Co, Ltd).
Each group (n=10) of specimens was
stored in water at 37C for 1 day, 1
week, or 1, 3, or 6 months. Hardness
was determined using a Shore A durometer tester (The Shore Instrument
& Mfg Co Inc, Freeport, NY), which
was calibrated according to ASTM
D2240, and recorded in Shore units.
The differences in the bond strength
and hardness of each resilient liner
material were determined for the 5
test periods and were evaluated statistically using a 2-way ANOVA and the
Tukey HSD post hoc test. All statistical testing was performed at a preset
alpha level of .05.
RESULTS
There were significant interactions
between materials and time periods
with respect to both bond strength
and hardness, as shown by the 2-way
ANOVA (Tables II and III). Mean and
standard deviation values of bond
strength and hardness of resilient
liner materials for the 5 time intervals
are given in Table IV. There were significant differences in bond strength
between the materials at each time
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Volume 99 Issue 2
Table II. Two-way ANOVA results for comparison of bond strength values
SS
df
MS
Group
134.92
44.97
376.29
<.001
Time
19.51
4.88
40.80
<.001
Group x time
1.13
12
.84
7.06
<.001
Error
21.39
179
.12
Total
492.77
199
Source
df
MS
Group
31248.98
10416.33
2763.61
<.001
Time
1890.30
472.58
125.38
<.001
Group x time
935.76
12
77.98
20.69
<.001
Error
678.44
180
3.77
Total
307777.03
200
Source
Table IV. Mean (SD) values of tensile bond strength (MPa) and hardness (Shore units) of resilient liner materials for
5 time intervals (n=10)
Bond Strength
Hardness
Vertex
Soft
CoeSoft
MolloplastB
Mollosil
Plus
Vertex
Soft
CoeSoft
MolloplastB
Mollosil
Plus
1 day
3.50Ca(0.44)
0.45Cb(0.18)
1.58Cc(0.19)
1.20Bd(0.41)
49.08Aa(1.34)
12.37Ab(0.81)
42.28Ac(0.89)
29.33Ad(1.43)
1 week
3.07Ca(0.46)
0.39Cb(0.04)
1.42BCc(0.31)
1.12Bd(0.19)
49.38Aa(1.15)
17.82Bb(1.45)
42.42Ac(1.46)
29.60ABd(2.46)
1 month
2.57Ba(0.29)
0.23Bb(0.05)
1.16ABc(0.12)
1.07Bd(0.58)
51.22Aa(2.98)
20.88Cb(1.31)
43.02Ac(1.44)
31.06Bd(0.87)
3 months
1.91Aa(0.71)
0.22Bb(0.04)
1.10ABc(0.53)
0.77Ad(0.15)
50.88Aa(4.48) 23.01Db(1.43)
43.78Ac(1.84)
33.94Cd(1.26)
6 months
1.70Aa(0.46)
0.11Ab(0.01)
1.03Ac(0.44)
0.50Ad(0.22)
64.08Ba(2.83) 24.02Db(1.28)
46.16Bc(2.15)
34.64Cd(2.06)
Different superscripted uppercase letters indicate statistically different means within each column (P<.001).
Different superscripted lowercase letters indicate statistically different means within each row (P<.001).
resin- and silicone-based groups, respectively. Considering each material separately, the differences in bond
strength with respect to time are also
shown in Table IV. For Vertex Soft,
there were significant differences in
bond strength values between 1 week
and 1 month and also between 1
month and 3 months. For Coe-Soft,
there were significant differences between 1 week and 1 month and also
between 3 months and 6 months. For
Molloplast-B, significant differences
were observed between 1 day and 1
month, and also between 1 day and
6 months. For Mollosil Plus, there
was a significant difference between 1
month and 3 months.
157
February 2008
The highest bond strength was observed for specimens stored in water
for 24 hours, followed by specimens
stored for 1 week. The bond strength
values of the specimens became lower
as the storage time increased. The
lowest bond strength values for all
resilient liner materials were observed
after 6 months of storage. With respect to the different types of material, the reduction was greater in the
autopolymerized versus heat-polymerized resilient liner materials (1.59
MPa). The mean bond strength (SD)
of acrylic resin-based resilient liners
(3.50 (0.44) MPa) was significantly
greater than that of silicone-based
liners (1.58 (0.19) MPa) in the heatpolymerized category after 1 day. The
change in bond strength over time for
the acrylic resin-based resilient liner
materials was greater than that of the
silicone-based liners materials (1.59
MPa) within both the heat- and autopolymerized groups.
There were significant differences
in hardness between the materials at
each time period, as shown in Table
IV. The results of the hardness test
demonstrated that the mean hardness
(SD) of the heat-polymerized resilient
liners after 1 day (49.08 (1.34) Shore;
42.28 (0.89) Shore) was significantly
(P<.001) greater than that of autopolymerized liners (12.37 (0.81) Shore;
29.33 (1.43) Shore) in the acrylic
resin- and silicone-based groups, respectively. Differences in hardness
for each material over time are also
shown in Table IV. For Vertex Soft and
Molloplast-B, there was a significant
difference between 3 months and
6 months. For Coe-Soft, there were
significant differences between 1 day
and 1 week, 1 week and 1 month, and
also between 1 month and 3 months.
For Mollosil Plus, there were significant differences between 1 day and
1 month, 1 month and 3 months,
and also between 3 months and 6
months.
The lowest hardness values were
seen in the specimens stored in the
water for 24 hours, followed by the
specimens stored for 1 week. Hard-
DISCUSSION
The results of the study support rejection of the null hypothesis because
chemical composition and immersion
time affected both the bond strength
and hardness of the resilient denture
liners examined. Adequate softness of
resilient liner materials and sufficient
bond strength between the resilient
denture liners and denture base material are required for long-term clinical
use.2,15,28 As reported in other studies,
bond strength and softness values of
resilient denture liners were found to
vary according to chemical composition.1,19,26,28
In the current study, the bond
strength of 4 resilient denture liners was determined by a tensile test,
and softness of the resilient denture
liners was measured as resistance to
indentation in a material for the 5
test periods. These tests apply different forces than those to which the
resilient denture lining materials are
subjected clinically; however, this in
vitro study could provide preliminary
information regarding the materials,
based on bond strength and hardness
test results.
The definitive heat-polymerized
acrylic resin-based Vertex Soft liner
had the greatest bond strength compared with the other materials at 24
hours, because the chemical composition of Vertex Soft is similar to
that of the PMMA denture base polymer.26 This result is in agreement with
those of others,3,13,15-17 who reported
that heat-polymerized acrylic resinbased resilient liner materials have
the greatest bond strengths to acrylic
resin-based dentures. Related to similar chemical compositions, a chemical bond forms between the acrylic
resin-based liners and the PMMA
denture base polymer.3 Since silicone
liners have little or no chemical bond
to PMMA, an adhesive is needed to
bond the liner to the polymerized
denture base. Consequently, the bond
strength of silicone denture base liners depends on the tensile strength of
the liner materials, as well as the adhesive used.19
The interim autopolymerized
acrylic resin-based Coe-Soft liner has
a similar chemical composition to
PMMA, but it demonstrated the lowest bond strength at day 1, which was
in agreement with the findings of Sertgoz and Aydin.19,20 This result indicated that heat-polymerized liners have a
greater bond strength than autopolymerized products. This may have been
due to the mode of polymerization of
this resilient liner material.
The bond strength values of all
the resilient liner materials were lower
with increasing duration of immersion. These results agree with those
of other investigators,14,21,22 who suggested that water storage reduced resilient liner bond strength. The lower
bond strength may result from the
swelling and stress formation at the
bond interface, or from a change in
the viscoelastic properties of the liner,
rendering the material stiffer and better able to transmit external loads to
the bond site.
The acrylic resin-based liners
demonstrated a greater reduction in
bonding strength values compared
to the silicone products during the 6month immersion test. These findings
support those of Jepson25 and Mese,26
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Volume 99 Issue 2
who reported that water storage reduced the liner strength of acrylic
resin-based products more than that
of silicone-based products. Moreover,
the bond strength values of autopolymerized products showed greater
reduction than those of heat-polymerized materials over the course of the
current study. These findings agree
with those of Mese26 and Waters,27
who reported that water storage reduces the bond strength of autopolymerized liners more than that of heatpolymerized materials.
The definitive heat-polymerized
acrylic resin-based Vertex Soft liner
had the greatest hardness compared
with the other materials at 24 hours
after immersion. These results concur
with those of Dootz,17,24 who suggested that heat-polymerized acrylic resin-based resilient liner materials have
the greatest hardness. Vertex Soft liner
and heat-polymerized silicone-based
Molloplast-B liner were harder than
the interim autopolymerized acrylic
resin-based Coe-Soft liner and definitive autopolymerized silicone-based
Mollosil Plus liner. The results confirm
those of Polyzois1 and Gregory,34 who
reported that heat-polymerized liners are harder than autopolymerized
products.
The hardness values of all the resilient liner materials evaluated were
higher with increased duration of
immersion. The hardness values of
the acrylic resin-based Vertex Soft
and Coe-Soft liners showed greater
change than those of the silicone
products. The results of the current
study are in agreement with those of
other researchers,30-32 who reported
that water storage increased resilient
liner hardness in acrylic resin-based
products more than in silicone-based
products. The initial softness was due
to the quantity of plasticizer in the liquid, since plasticizers are responsible
for maintaining the softness of the
acrylic resin-based resilient liner materials. Leaching of plasticizers causes
hardening of the acrylic resin-based
resilient liners as the duration of immersion increases.7,10 Silicone-based
resilient liners have superior elastic recovery, and their softness is controlled
by the amount of cross-linking in the
rubber; thus, no plasticizer is necessary to produce a softening effect.1 In
addition, the hardness values of the
Coe-Soft and Mollosil Plus liners demonstrated greater change than those
of the Vertex Soft and Molloplast-B
liners over the duration of the current
study. These findings agree with those
of Qudah12 and Hekimoglu,33 who
reported that the mechanical properties of autopolymerized resilient liners
are affected more by immersion compared with heat-polymerized resilient
liner materials.
According to the results of the present study, hardness values of resilient
liner materials were higher in conjunction with increased duration of water
storage, but bond strength values
were lower. Factors such as processing methods, water absorption, and
bonding agents require further investigation to predict which materials will
provide the best clinical service. Hardness, weight change, tensile strength,
tear strength, and color stability are
additional properties of resilient denture liners that warrant investigation.
Selection of a particular liner cannot
be based on any single property. Material selection is influenced not only
by the properties offered but also by
the particular treatment situation.
The results of the present investigation support a common trend
reported in previous studies14,16,18,25;
namely, heat-polymerized siliconebased resilient liners have more optimal properties. Heat-polymerized
acrylic resin-based resilient liners
have good properties initially, but deteriorate with long-term use, and autopolymerized resilient liners have a
useful, but limited, role. However, further investigation is needed for longer
periods, along with clinical studies
to assess whether other physical or
chemical properties are influenced by
the processing procedure or time involved.
CONCLUSIONS
Within the limitations of this
study, the 4 resilient liners tested demonstrated significantly higher hardness values, to varying degrees, after
water immersion, according to their
chemical compositions and increased
immersion time. Furthermore, bond
strength values of the resilient liner
materials were significantly lower over
time.
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