Majalah Kedokteran Gigi Indonesia

Vol xx No xx – Month Year

ISSN 2460-0164 (print), ISSN 2442-2576 (online)
Available online at https://jurnal.ugm.ac.id/mkgi
DOI: xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx
(filled in by the journal manager after accepted)

RESEARCH ARTICLES

Effect of different denture cleansers on surface roughness of thermosens

denture base material

Vincentia Alice Natawidjaya*, Sharren Teguh***

*Undergraduate Student, Faculty of Dentistry, Trisakti University, Jakarta, Indonesia

**Department of Prosthodontics, Faculty of Dentistry, Trisakti University, Jakarta, Indonesia
*Jl. Kyai Tapa no. 260, Grogol Petamburan, Jakarta Barat, Indonesia ; * correspondence: sharenteguh@trisakti.ac.id

Submitted: xxxxxxxxxx; Revised: xxxxxxxxxx; Accepted: xxxxxxxxxxxxx

ABSTRACT

Background: Thermosens is among the greatest substitute for removable partial denture base materials because of its various
benefits. To maintain cleanliness and longevity, removable partial dentures (RPDs) should be immersed in denture cleansers.
Alkaline peroxide, alkaline hypochlorite, and chlorhexidine gluconate are a few different types of denture cleansers. Daily
immersion of RPDs in denture cleansers may increase the surface roughness of the denture base. Objectives: To evaluate the
effect of different denture cleansers on surface roughness of thermosens denture base materials. Methods: Experimental
laboratory study using 24 samples, divided into 4 groups; Group I: Distilled water, Group II: Polident, Group III: NaOCl 0.5%,
Group IV: Minosep. The immersion lasted 152 hours and the denture cleansers were changed every 8 hours. A surface roughness
tester was used to measure each sample before and after immersion. The acquired data were analyzed using a one-way ANOVA
comparative test. Results: One-way ANOVA test showed that each group has a significant effect on surface roughness (p<0,05).
The mean ΔRa value in Group I: Distilled water was 0,11 µm, Group II: Polident was 0,26 µm, Group III: NaOCl 0.5% was 0,41
µm and Group IV: Minosep was 0,20 µm. Conclusion: Immersion in alkaline peroxide, alkaline hypochlorite, and chlorhexidine
gluconate can notably increase the surface roughness of the thermosens denture base.

Keywords: Alkaline hypochlorite, alkaline peroxide, chlorhexidine gluconate, denture cleanser, surface roughness, thermosens

INTRODUCTION
One of the major dental health problems is tooth loss which will affect the patient’s mastication, speech,
esthetics, and social interaction.1 Factors such as age, dental trauma, attrition, caries, and periodontal
diseases are the main cause of tooth loss.2 In Indonesia, the usage prevalence of removable partial
dentures (RPDs) is 3,5%, which is greater than complete dentures (1,2%) and fixed dentures (0,8%)
and RPDs are most used by elderly individuals between the age of 55-64 years.3

Over the past years, polymethyl methacrylate (PMMA) became the most reliable material as an RPDs
denture base because of its favorable properties such as esthetic, stability, biocompatibility, and
affordable.4 On the other hand, the disadvantages, such as low physical and mechanical properties,
high polymerization shrinkage, and containing monomers that have the potential to cause allergy, lead
to the introduction of alternative materials, which is thermoplastic materials that are composed of basic
polyamide structure.5

A new material called Thermosens is superior to standard polyamide materials. This material is high in
flexibility and biocompatibility, has lower than 1% volume shrinkage, resistant to fracture, and doesn’t
contain residual monomer, so it is suitable for patients with an allergy to monomers.5,6 However, Jassim
M, et al (2015) argue that thermosens material has higher surface roughness when compared to heat
cure acrylic material because of the large crystals of thermosens making it difficult to produce a smooth
surface.5

To maintain oral mucosal health and denture longevity, the RPDs should be kept clean by either
mechanical or chemical cleaning procedures.7 Although mechanical methods are commonly used, it is
not adequate to clean undercut areas of dentures that easily harbor microorganisms. Furthermore,
elderly patients with physical limitations and poor motoric function may not properly clean the
accumulated microorganisms.8,9 Consequently, the chemical cleaning methods are more effective in
cleaning the undercut areas and easier to use by the elderly patients.10 Based on their chemical
composition, denture cleansers are classified into alkaline peroxide, alkaline hypochlorite,
organic/inorganic acids, disinfectants, and enzymes.11

Ideally, denture cleansers should not alter the oral soft tissue and the denture material, relatively
inexpensive, involve minimal physical effort and must be capable of removing dental plaque.7 However,
daily immersion in denture cleansers can affect both the physical and mechanical properties of denture
base materials. One of the most important properties is surface roughness, and it plays a big role in
the long-term success of any dental prosthesis.12 In prosthetic and dental restorative materials, a
clinically acceptable threshold level of surface roughness (Ra) of 0.2 µm indicates that no further
reduction in plaque accumulation is expected.13

The purpose of this study is to evaluate the effect of immersion in alkaline peroxide, alkaline
hypochlorite, and 0.2% chlorhexidine gluconate solution on the surface roughness of thermosens
denture base material by simulating 5 minutes daily of immersion in 5 years of denture usage.

MATERIALS AND METHODS

In this experimental laboratory study, 24 Vertex Thermosens denture base samples were prepared and
divided into 4 groups for surface roughness testing. The solutions used were commercially available
bleach (Bayclin), which was diluted 1:10 with distilled water to obtain an alkaline hypochlorite solution
with a concentration of 0.5%, and two commercially available denture cleansers such as alkaline
peroxide (Polident) and 0.2% chlorhexidine gluconate (Minosep).

To make the samples, rectangular-shaped wax patterns (15 x 15 x 2 mm) were sprued, invested, and
casted in the master mould producing a mould space. Granules of thermosens were melted at 290°C
for 25 minutes, then injected into the mould space. All the flasks were allowed to cool at room
temperature for 5 minutes before opening. After that, the samples were removed, finished, and polished.

The samples were distributed into 4 groups (n=6); Group I: Distilled water as control, Group II: Polident,
Group III: NaOCl 0,5%, and Group IV: Minosep. 3 ml of each solution was used to ensure that the
sample is completely submerged. The immersion lasted for 152 hours to represent the denture usage
for 5 years with 5 minutes daily of immersion. The solutions were changed every 8 hours.

A surface roughness tester (Surtonic S-100 series, Taylor Hobson) was used and calibrated at an
evaluation length of 4 mm, a cut-off value of 0.08 mm, 400 µm percussion of measure, and at a speed
of 0.5 mm/s to measure the surface roughness of each sample before and after the immersion to obtain
the ΔRa (roughness differences). The stylus was moved across the sample’s surface three times in
three different areas. The mean Ra was calculated from three lines as the mean roughness of the
sample.

The data obtained were subjected to statistical analysis by one-way ANOVA, Paired-T test to determine
the difference of data before and after immersion, and Tamhane’s post-hoc test for pairwise
comparison, using the statistical program SPSS.
RESULTS
Table 1 presents the surface roughness value of each group before and after the immersion. The result
showed that 5 minutes of daily immersion for 5 years in alkaline peroxide, alkaline hypochlorite, and
0.2% chlorhexidine gluconate increased the surface roughness of the thermosens denture base
material. Table 2 presents the mean ΔRa and standard deviations of each group.

Table 1. The surface roughness value of each group before and after the immersion

Solution Surface roughness value before immersion Surface roughness value after immersion
Distilled water 0,201±0,083 0,310±0,101
Alkaline peroxide 0,256±0,049 0,511±0,103
Alkaline hypochlorite 0,250±0,053 0,663±0,114
Chlorhexidine gluconate 0,395±0,176 0,595±0,171

Table 2. Mean ΔRa (µm) and standard deviations for each group

Solution Mean±SD
Distilled water 0,108±0,064
Alkaline peroxide 0,255±0,068
Alkaline hypochlorite 0,413±0,115
Chlorhexidine gluconate 0,200±0,152

The Shapiro-Wilk normality test showed the data are normally distributed with a p-value > 0.05. The
Levene’s homogeneity One-way ANOVA showed a statistically significant difference of the surface
roughness of the thermosens between groups. Table 3 showed the paired T-test results, which revealed
a significant difference between before and after immersion in each group (p<0.05). Further analysis
by Tamhane’s post-hoc test indicated immersion in alkaline peroxide and alkaline hypochlorite
statistically showed a significant difference when compared to the control group. On the other hand,
there was no significant difference between 0.2% chlorhexidine gluconate and the control group, and
between the treatment groups.

Table 3. Paired T-Test to show the significant difference between before and after immersion in each group

Mean±SD Sig. (2-tailed)

Pair 1 Pre-test Distilled Water 0.20±0.08 0.009
Post-test Distilled Water 0.31±0.10
Pair 2 Pre-test Alkaline Peroxide 0.25±0.04 <0.001
Post-test Alkaline Peroxide 0.51±0.10
Pair 3 Pre-test Alkaline Hypochlorite 0.25±0.05 <0.001
Post-test Alkaline Hypochlorite 0.66±0.11
Pair 4 Pre-test Chlorhexidine Gluconate 0.39±0.17
0.0023
Post-test Chlorhexidine Gluconate 0.59±0.17

DISCUSSION
Denture cleaning is an important procedure to maintain a patient’s oral health, denture longevity, and
overall quality of life. Ideally, denture cleansers should be safe for both oral mucose and denture
material, relatively inexpensive, require minimal effort, and can remove dental plaque effectively.7,14
Daily use of denture cleansers can affect the physical and mechanical properties of denture base
material.12 There are several kinds of chemical denture cleansers, such as alkaline peroxide, alkaline
hypochlorite, and 0.2% chlorhexidine gluconate.

Alkaline peroxide is the most commonly used denture cleanser since it has the ability to eliminate biofilm
without leaving an unpleasant aftertaste or odor.15 About 5.25% sodium hypochlorite solution is an
effective method for removing adherent microorganisms. However, the high concentration may damage
the denture base material.12 A finding by de Freitas Fernandes, et al (2013) showed that hypochlorite
in low concentration (0.5%) is also effective in eliminating microorganisms.14 Thus, in the present study
0.5% alkaline hypochlorite was used for the immersion procedure. Oussama, et al (2014) found that
immersion of dentures for a few minutes daily in 0.2% chlorhexidine gluconate caused a significant
reduction in the amount of denture plaque.11

The result of the present study accepts the hypothesis of the study because immersion in several
denture cleansers did affect the surface roughness of thermosens denture base material significantly.
Previous studies showed that the threshold value of surface roughness to prevent microorganisms
retention is 0,2µm.13 In the present study, as shown in Table 1, the initial surface roughness of each
group is equivalent to or exceeded the 0.2 µm threshold. The reason may be due to the size of the
crystals of thermosens which are larger when compared to heat cure acrylic denture base material,
making it difficult to produce a smooth surface.5 Also, the technician may experienced some difficulties
in polishing due to the small size of the samples.

As shown in Table 2, there was a significant difference between before and after the immersion in
distilled water, alkaline peroxide, alkaline hypochlorite, and 0.2% chlorhexidine gluconate. This finding
was in line with Ozyilmaz, et al (2019) as they found that the immersion of polyamide denture base in
several denture base cleansers affect the surface roughness of the denture base significantly.9 The
result also showed a significant difference of immersion in distilled water. This finding may be due to
the polar tendency of polyamide material, which can easily form hydrogen bonds.16

The high peroxide content and level of oxygenation in alkaline peroxide can be a damaging factor for
denture base materials, as a result, there was a significant difference of immersion in alkaline
peroxide.12 As for alkaline hypochlorites, they have a high pH level and are acting directly by causing
the dissolution of the polymer structure in the organic matrix.17 Immersion in chlorhexidine gluconate
0.2% also showed a significant difference in surface roughness. The pH level of 2% chlorhexidine
gluconate alone ranges between 5-7, which is an optimal pH value for its antimicrobial effect.18
However, the present study used 0.2% chlorhexidine which is a diluted form. Hence, it will have higher
pH values. In addition, Pisal N, et al (2022) stated that chlorhexidine gluconate also has a high ionic
concentration, which may cause the release of soluble components. Consequently, it can increase the
surface roughness of the thermosens denture base.19

Tamhane’s post-hoc test showed that there was no significant surface roughness difference between
the immersion in chlorhexidine gluconate and the control group. This finding is consistent with
Jeyapalan K, et al (2017) which indicated that immersion in chlorhexidine gluconate 0.2% showed the
least change in roughness values, thus statistically insignificant.20

It should be considered that this study has its limitations regarding the measurements using a contact-
based surface roughness tester. Micro asperities smaller than the stylus tip diameter cannot be
measured by contact surface roughness measuring devices, moreover, the samples can be damaged
by surface wear.21 The analysis of a surface in non-contact devices such as 3D or an optical
interferometer is more reliable and accurate.

CONCLUSION
Within the limitations of this study, it can be concluded that the daily usage of alkaline peroxide, alkaline
hypochlorite, and chlorhexidine gluconate for 5 years can notably change the surface roughness of
thermosens denture base. The immersion in 0.2% chlorhexidine gluconate caused the least increase
in thermosens denture base surface roughness, followed by immersion in alkaline peroxide, and
alkaline hypochlorite.

REFERENCES
1. Siagian K v. Kehilangan sebagian gigi pada rongga mulut. e-CliniC. 2016;4(1):1.
2. Anshary MF, Cholil, Arya IW. Gambaran pola kehilangan gigi sebagian pada masyarakat Desa
Guntung Ujung kabupaten Banjar. Dentino J Ked Gi. 2014;2(2):139.
3. Badan Penelitian dan Pengembangan Kesehatan RI. Laporan Nasional RISKESDAS 2018.
2018.
4. Gad MM, Fouda SM, Al-Harbi FA, Näpänkangas R, Raustia A. PMMA denture base material
enhancement: A review of fiber, filler, and nanofiller addition. Vol. 12, International Journal of
Nanomedicine. Dove Medical Press Ltd.; 2017. p. 3801. doi: 10.2147/IJN.S130722
5. Jassim MM. Evaluating some mechanical and physical properties of vertex thermosens denture
base material in comparison with heat cure acrylicdenture base material. International Journal
of Science and Research. 2015;6(5):394. doi: 10.21275/ART20172925
6. Chuchulska B, Yankov S, Hristov I, Aleksandrov S. Thermoplastic materials in the dental
practice: a review. International Journal of Science and Research. 2017;6(12):1074. doi:
10.21275/ART20178727
7. D CM, Azhagarasan NS, miglani S, S MH, Hari Prasad A. Microbiological evaluation of the
effectiveness of commercially available denture cleansing agents. Int J Drug Dev & Res.
2011;3(3):160.
8. Degirmenci K, Hayati Atala M, Sabak C. Effect of different denture base cleansers on surface
roughness of heat polymerised acrylic materials with different curing process. Odovtos -
International Journal of Dental Sciences. 2020 May 19;22(3):283. doi: 10.15517/ijds.2020.41900
9. Ozyilmaz OY, Akin C. Effect of cleansers on denture base resins’ structural properties. J Appl
Biomater Funct Mater. 2019 Jan 1;17(1):2. doi: 10.1177/2280800019827797
10. Fergus C, Santos M, Soo S, Petridis H. The effect of different chemical intra-oral prostheses
cleansers on the surface properties of parylene-coated PMMA. Dent Mater J. 2017;36(2):129.
doi: 10.4012/dmj.2016-254
11. Oussama M, Ahmad H. Materials and methods for cleaning dentures. International Journal of
Dental Clinics. 2014;6(2):19.
12. Porwal A, Khandelwal M, Punia V, Sharma V. Effect of denture cleansers on color stability,
surface roughness, and hardness of different denture base resins. The journal of indian
prosthodontic society. 2017;17(1):62. doi: 10.4103/0972-4052.197940
13. Abuzar MA, Bellur S, Duong N, Kim BB, Lu P, Palfreyman N, et al. Evaluating surface roughness
of a polyamide denture base material in comparison with poly (methyl methacrylate). J Oral Sci.
2010;52(4):578. doi: 10.4103/0972-4052.197940
14. de Freitas H, Paranhos O, Peracini A, Pisani MX, De V, Oliveira C, et al. Color stability, surface
roughness and flexural strength of an acrylic resin submitted to simulated overnight immersion
in denture cleansers. Brazilian Dent J [Internet]. 2013;24(2):152. Available from:
http://dx.doi.org/10.1590/0103-6440201302151
15. Rahn AO, Ivanhoe JR. Textbooks of complete denture 6th edition. 6th ed. Connecticut: People’s
Medical Publishing House; 2009. 19–20 p.
16. Nabil Helaly M, Mohamed Alam-Eldein A, Mohamed El-Sheikh A. Effect of Two Cleansing
Agents on Water Sorption and Solubility of Two Thermoplastic Denture Base Materials.
Universal Journal of Materials Science. 2018 Aug;6(4):115–8. doi: 10.13189/ujms.2018.060401
17. Estrela C, Estrela CRA, Luis Barbin E, César J, Spanó E, Marchesan MA, et al.
Mechanism of action of sodium hypochlorite. Braz Dent J. 2002;13(2):113–7. doi:
10.1590/s0103-64402002000200007
18. Abo El Naga A, Yousef M. Evaluation of different restorative materials after exposure to
chlorhexidine. Journal of American Science [Internet]. 2012;8(3):629. Available from:
http://www.americanscience.orghttp://www.americanscience.org.84
19. Pisal NS, Shah NC, Gandhi NN, Dedania MS, Rao AS. Effect of Chlorhexidine Mouthwash,
Povidoneiodine Gargles and Herbal Mouth Sanitiser on Colour Stability and Surface Roughness
of Conventional Nanohybrid CompositeAn In-vitro Study. Journal of Clinical and Diagnostic
Research. 2022;16(5):18. doi: 10.7860/jcdr/2022/52969.16369
20. Jeyapalan K, Kumar JK, Azhagarasan NS. Comparative evaluation of the effect of denture
cleansers on the surface topography of denture base materials: An in-vitro study. J Pharm
Bioallied Sci. 2015 Aug;7(Suppl 2):S548-53. doi: 10.4103/0975-7406.163536
21. Janiszewska-Olszowska J, Tomkowski R, Tandecka K, Stepien P, Szatkiewicz T, Sporniak-
Tutak K, et al. Effect of orthodontic debonding and residual adhesive removal on 3D enamel
microroughness. PeerJ. 2016;2016(10). doi: 10.7717/peerj.2558