This action might not be possible to undo. Are you sure you want to continue?
RETENTION: DEFINITION: Quality inherent in the denture that resist the vertical forces of dislodgement (e.g. force of gravity, the adhesiveness of foods or the forces associated with the opening of the jaws ).
Factor involved in the retention of the denture –
The factor that affects retention can be classified as, 1. Anatomical factors 2. Physiological factors 3. Physical factors 4. Mechanical factors 5. Surgical factors 6. Psychological factors
1) Anatomical factors –
a) Maximum coverage of the basal seat area b) Quality of the denture bearing area, if the ridges are parallel & well formed better the retention c) Oral – facial musculature d) Neuro – muscular control ORAL & FACIAL MUSCULATURE -
It can supply supplementary retentive forces provided that, - The teeth are position in the neutral zone between the cheeks & tongue. - The polished surface of the dentures are properly shaped For the oral & facial musculature to be most effective in providing retention for complete denture. The following condition must be met,
The denture bases must be properly extended to cover the maximum area possible without interfering in the health & function of the structure that surrounds the denture. The occlusal plane must be at the correct level. The arch form of the teeth must be in the neutral zone between the tongue & cheeks.
2) Physiological factor –
Saliva – - Thick, high mucin saliva is more viscous than watery saliva. - Thick secretion usually do not result in increased retention between watery, serous saliva can be interposed in a thinner film than more cohesive mucin secretions. 3) Physical factors
-Adhesion -Cohesion -Interfacial surface tension -Capillarity or Capillary attraction -Atmospheric pressure -Gravity Adhesion –
- is the physical attraction of unlike molecules for each other - Adhesion acts when saliva wax stick to the bases surfaces of the denture - Effectiveness of adhesion depends on close adaptation of the denture base to the supporting tissue and fluidity of the saliva - Version of adhesion is observed between denture bases and mucous membrane themselves which is seen in patients with xerostomia Cohesion - is a physical attraction of like molecules for each other - is layer of saliva is present in between the denture base And oral mucous membrane Interfacial surface tension – - is a thin layer of fluid that is present between two parallel planes of rigid materials - all denture base materials have higher surface tension than oral mucosa but once coated by salivary pellicle their surface tension reduced Stefan proposed a formula to calculate the interfacial surface tension According to Stefan’s low, F = (3/2 )IIkr H Where, F= Interfacial surface tension
k= Viscosity of the interposed liquid (saliva) r = Circular plates of radius h= thickness V = Velocity Capillary attraction or capillarity –
Definition – “The quality or state because of the surface tension causes elevation or depression of the surface of a liquid that is in contact with a solid “. - Capillarity causes a liquid to rise in a capillary tube because in this physical setting the liquid will maximize its contact with the wall of the capillary tube. The space filled with a thin film of a saliva acts like capillary tube in that liquid seeks to increase its contact with both denture & mucosal surface. - Thus, capillary help to retain the denture.
Atmospheric pressure –
-It is supplied by the weight of the atmosphere Normal =14.7 ib/sq inch. - Atmospheric pressure can act to resist dislodging forces applied to denture if the denture has an effective seal around their borders. This resistance force has been called “suction” because it is a resistance to the removal of the denture from their basal seat. Factor affects the atmospheric pressure, - Perfect peripheral seal - Proper border molding - Selective pressure technique Gravity
Gravity acts as retentive forces for the mandibular denture and a displacive for the maxillary denture when patient is in upright posture. The weight of the prosthesis constitutes a gravisional force that is insignificant in the comparison with the other forces acting on the denture.
MECHANICAL FACTORS undercuts rotational insertion paths parallel walls denture adhesives
Undercuts The resiliency of the mucosa and sub mucosa overlying basal bone allows for the existence of modest undercuts that can enhance retention. - Areas which help in retention of the prosthesis.
Areas which help in retention of the prosthesis - extensive internal adjustment of the denture - less severe undercut of the lateral tuberosities - maxillary premolar areas - distolingual areas - lingual mandibular midbody areas Rotational insertion paths - It provides resistance to vertical displacement. Example, The area inferior to the retro molar pad into which the distolingual extension of the mandibular base can be introduced from the superior and posterior before rotating the anterior segment of the denture down over the alveolar process.
-opposite sequence in the maxilla Parallel walls - Prominent alveolar ridge with parallel buccal and lingual walls may provide retention by increase the surface area because denture and mucosa and maximing interfacial and atmospheric forces. Denture adhesive
Denture adhesives are commercially available nontoxic soluble material (powder, cream or liquid) that is applied to the tissue surface of the denture to enhance denture retention stability and performance. There are two reasons to know about the denture adhesives. To be able to educate all denture wearing patients about the advantages, disadvantages and uses of the product. To identify those patient’s for whom such a product is advisable and/or necessary for a satisfactory denture wearing experience.
Components and mechanism of action - they enhance retention through optimizing interfacial forces by
Increase the adhesive & cohesive properties &viscosity of the medium lying between the denture & its basal seat. Eliminating voids between the denture base and its basal seats. Hydrated adhesives are more cohesive than saliva.
- Gum based adhesives are highly water soluble, particularly in hot liquid such as coffee, tea and soups and therefore washout readily from the beneath denture - Synthetic materials presently dominate the denture adhesive market. - The most popular and successful products consist of mixture of the salts of short acting carboxymethyl cellulose and long acting polyvinyl methyl ether maleate or gentrez. - In presence of water carboxyl methyl cellulose hydrates and quick onset ionic adherence to both denture and mucous epithelium. - Gentrez salts also display molecular cross linking resulting in a measurable increase in cohesive behavior. - Other components of denture adhesives are petrolatum, mineral oil, poly ethylene oxide included in creams to bind the materials and to make their placement easier - Silicone dioxide and calcium sterate are used in powder to minimize clumping. - Menthol and peppermint oil are used to flavoring, red dye for color, sodium borate and methyl paraben or polyparaben as preservatives. INDICATION AND CONTRAINDICATION Indication
When well made complex denture do not satisfy a patients perceived retention and stability expectation. Patient who have xerostomia due to medical side effects a history of head and neck irradiation, systemic disease or disease of the salivary gland which impaired retention. Patient with cerebrovascular accident (stoke) or partially or wholly paralyze oral musculature. Patient who have undergone respective surgery for removal of oral neoplasia
- Patient who have lost intraoral structuters integrity due to trauma Contraindication - Retention of improperly fabricated prosthesis - Poorly fitting prosthesis PATIENT EDUCATION - It is necessary for the dentist educate the patient with denture about denture adhesive- They are use abuse, advantages, disadvantages & choices. - Choices between cream & powder largely subjective - Effect of the powder formulation is not last as effect of cream formulation. - Powder used in small quantity, it is to clean out denture& tissues. - Powder cream products there is appro. 0.5 to 1.5 g per denture unit material should be used. - For powder sprayed denture should cleaned & then moistened lightly with water being inserted... - For cream two approaches are possible - Patient must be instructed that daily removal of adhesive product from tissue surface of the denture. - Patient need to be educated about the limitations of denture adhesives. - Pain& soreness signals a need for professional management. - Denture patients need to be recalled annually for oral mucosal evaluation & prosthesis assessment. SURGICAL FACTORS - Vestibuloplasty - Zygomaticoplasty
- Tuberoplasty PSYCHOLOGIC FACTORS - As patient tolerance - Patient education.
Definition; The quality of a denture to be firm, stable or constant and to resist displacement by functional stresses & not to be subject to change of position when forces are applied. Factors affecting stability; (1) Vertical height of the residual ridge - A parallel well rounded vertical ridge form offers better stability than resorbed ridge.
Quality of soft tissue covering the ridge Firm resilient tissue is able to withstand masticatory forces better stability than thin or flabby tissues.
(3) Quality of impression - An impression should be accurate& should duplicate all the details without any voids. The impression should make of dimensionally stable materials & should poured immediately
Occlusal plane - The occlusal plane should be oriented parallel to the ridge maintaining adequate interocclusal distance this enhance stability. (5) Teeth arrangement - The teeth should be arranged in balanced occlusion & neutral zone. (6) Counter of the polished surface - From the cusped to the posterior aspect of the denture surface slope slightly inward creating space for buccal corridor. The overall contour of the denture should be in terms with the neutral zone concept.
Definition: The resistance to vertical forces of mastication, occlusal forces & other forces applied in a direction towards the denture bearing area.
“Maximum coverage provides the ‘snowshoe ‘effect which distributes applied forces over wide an area as possible. “ Confining the occlusal forces to stress bearing areas & reliving the non stress bearing areas will aid to improve support’’
Factors affecting stability & support (1) Maximum coverage of the basal seat within the limit of the heath & functions of the supporting &limiting tissues. (2) Borders that are in harmony with the anatomic & physiological limitations of the oral structures. (3) A physiologic type of border moulding procedure (4) Proper space ensured in tray for final impression material. (5) Selective pressure technique for final impression. (6) Ideal impression material to be used depending on clinical situation. (7) A guiding mechanism for correct positioning of the impression tray in the mouth. (8) The tray& final impression should be of dimensionally stable materials. (9) The completed final impression form is similar to the external form of the completed denture. (10) Accurately fitting final impression tray.