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This literature review sought to determine the advantages and relevance could be determined. The selected manuscripts were
disadvantages of denture adhesive use among complete denture reviewed using a standardized manuscript review matrix.
patients. Manuscripts were obtained by searching the National Although denture adhesives improve the retention and function
Library of Medicines PubMed database, Cochrane Collaboration of complete dentures, standardized guidelines are needed for
Library, ADA Center for Evidence-Based Dentistry website, and the proper use, application, and removal of denture adhesives.
EMBASE database. A total of 85 abstracts were reviewed, and Additionally, long-term studies are warranted on the biologic
38 articles that met the inclusion criteria for this review were effects of denture adhesives. There is a need to establish a regular
selected. The inclusion criteria included clinical trials and case recall program for complete denture patients.
series in which 10 or more patients were treated, as well as Received: May 24, 2012
Cochrane Collaboration reviews and in vitro studies where clinical Accepted: July 12, 2012
W
ith complete dentures, retention and stability, rendering a denture adhesives to enhance the
insufficient denture reten- denture loose and non-serviceable to retention, stability, and functionality
tion is a powerful determi- the patient.5 Patients with complete of complete dentures. Definitions for
nant of patient satisfaction.1 Several dentures require unique consider- specific terms are listed in Table 1.8
factors and complex interactions ations due to their compromised
affect the retention and stability of oral anatomy, reduced adaptive Methods
complete dentures in the oral cavity, capacity, and systemic conditions In 2009, the American College of
including atmospheric pressure, inti- or medications that further affect Prosthodontists (ACP) formed a
mate adaptation of both hard and denture retention and stability, all of task force to develop contemporary,
soft tissues beneath the denture base which reduce the patients ability to evidence-based guidelines for the
to the intaglio surface of the pros- successfully wear their prostheses.6 care and maintenance of complete
thesis, accurate peripheral extensions In addition to hard and soft tissue dentures. This task force consisted
of the denture base (determined by alterations over time, these patients of individuals representing the ACP,
physiological movements), and the can be affected by changes in saliva the Academy of General Dentistry,
presence of a thin film of saliva (with quality or quantity (due to medica- the American Dental Association
acceptable viscosity) between the tions or age), diminished bite force, (ADA) Council on Scientific Affairs,
prosthesis and the tissues. Denture and reduced neuromuscular control.7 the American Dental Hygienists
retention can be jeopardized if any While these biologic and physi- Association, the National Associa-
of these factors are compromised. ologic changes compromise denture tion of Dental Laboratories, and
Residual ridge resorption (RRR) is function, new techniques have been GlaxoSmithKline Consumer Health-
a common, lifelong condition that created to enhance both the retention care. As part of this task force, a
plagues complete denture patients and fit of aging prostheses. These comprehensive review about denture
after exodontia and subsequent den- techniques include denture rebasing adhesives was performed by the Uni-
ture placement. RRR occurs rapidly or relining, denture adhesives, and versity of North Carolina faculty and
within 3-12 months after tooth endosseous dental implants. This ACP members.9 Another manual
removal, and continues throughout article will review the advantages and search was performed in May 2012
the patients life.2-4 Alveolar ridge potential problems associated with to include all relevant recent litera-
resorption compromises denture the use of commercially available ture published after 2009.
Table 1. Definitions of terms used in this review.8 Table 2. Denture adhesive composition.
This review evaluated literature careful review of the articles, serve a specific function. Table 2
obtained by searches in the additional reference materials were lists the common components
National Library of Medicines selected from the reference lists of of denture adhesives and their
PubMed database, Cochrane Col- each article and similarly reviewed. respective functions.
laboration Library, ADA Center for Of the original 85 articles, only
Evidence-Based Dentistry website, 38 manuscripts met the inclu- Ideal characteristics of
and EMBASE database. Key words sion criteria for this review: eight denture adhesives
included, either singularly or in prospective controlled trials, eight The authors believe that an ideal
various combinations, the terms cross-sectional cohort studies, seven denture adhesive should be for-
dentures, retention, stabil- in vitro studies, six multiple arm mulated so that it is not toxic to
ity, adhesives, toxicity, and cross-over studies, five case series, the systemic or oral health of the
adaptation. The inclusion criteria three randomized controlled trials, patient (regardless of short- or long-
included clinical trials and case and one retrospective study. term use); it is incapable of promot-
series in which 10 or more patients ing bacterial or fungal growth; it
were treated, Cochrane Collabora- Results improves the dentures retention,
tion reviews, and in vitro studies for Composition of denture stability, and functionality (that
which clinical relevance could be adhesives is, the ability to chew foods); it
determined. Based on this criteria, Denture adhesives are available is easy for the patient or primary
a total of 85 article abstracts were in various formulations including caregiver to apply and remove; it
obtained and reviewed. Selected powders, liquids, creams, or pads/ has an acceptable aroma (or no
full-text manuscripts were reviewed wafers. While the exact composition aroma), taste, and consistency;
using a standardized manuscript of commercially available denture it does not alter or degrade the
review matrix (Fig. 1) and summary adhesives may vary, they all contain intaglio surface of the denture base;
information was provided. After a the same generic materials that it does not modify the occlusion of
Table 3. Summary of methods and findings of studies that evaluated denture adhesives and their effects
on denture retention, stability, and bite force.12-30,37
the dentures; it maintains adhesive not use denture adhesive, as they edentulous patients over a 10-year
capabilities for 8-12 hours; and it is believed they satisfactorily managed period and found that only 15% of
cost-effective for the patient. their dentures without it. Among the the completely edentulous patients
remaining denture wearers, 20.5% with existing complete dentures
Prevalence of adhesive usage did not know denture adhesive acknowledged using denture adhe-
Little published data exists regarding existed, 32.9% used denture adhesive sive. There was a direct correlation
the prevalence of denture adhesive in the past, and only 6.9% use between complete denture dissat-
use. An Australian study evaluated denture adhesive on a regular basis.10 isfaction and denture adhesive use,
146 patients wearing dentures More recently, Divaris et al reviewed which the authors attributed to poor
and found 52% of the patients did the charts of 2,526 completely fit and function of the dentures.11
Advantages of using the studies were short in duration and without adhesives). In this last
denture adhesive (that is, same day evaluation) and group of studies, denture adhesives
Twenty studies were identified and examined only maxillary dentures. improved the retention and stability
reviewed; nineteen of them were Some trials randomly allocated of the prostheses investigated.12-22
clinical trials that focused on the patients to various experimental A number of studies indicated that
use of denture adhesives relative groups (depending on the number the improvement in retention and
to denture retention, stability, of adhesives investigated). Other stability was more pronounced in
movement, bite force, ability trials lacked a control group, but old or ill-fitting dentures when
to chew test foods, and patient were crossover in design (that is, compared to new prostheses.22-25
satisfaction (see Table 3). Most of comparing the same dentures with However, a 1994 study by Grasso
Table 4. Summary of methods and findings of studies that evaluated denture adhesive effects on cytotoxicty and
microbial colonization.
correctly, or whether the dentures the adhesive. Sato et al compared (70C) for two minutes; each patient
possessed acceptable retention, the ability of edentulous patients repeated the technique five times.
stability, fit, or occlusion. Both to remove a cream adhesive and Although repeating the process five
studies indicated that neurological an experimental gel adhesive from times did not remove the cream
detriments resulted solely from the maxillary soft tissues and the adhesive, the experimental gel adhe-
excessive zinc consumption found intaglio surface of the maxillary sive was removed successfully using
in denture adhesives.47,48 denture.12 The adhesive was colored a single-stage cleaning method.12
with 0.4% indigo carmine to facili- Uysal et al evaluated four adhesives
Application and removal of tate visual identification in removal. according to several categories (reten-
adhesives from the intaglio The study used a standardized five- tion, function, cleansibility, and so
surface of dentures stage method to assess the patients forth).15 The authors applied all the
To date, no studies have evaluated ability to remove the adhesive from adhesives to a group of 32 patients
effective application of denture the maxillary soft tissues. Each stage with newly relined dentures and
adhesive on the intaglio surface of utilized an undetermined mouth instructed the patients to use their
the denture. However, three studies rinse, followed by the application dentures with the adhesive for 24
have analyzed effective removal of of cotton gauze or a hot water rinse hours and clean the dentures using
the patients method of choice (which Correct application of denture be removed. To spread the adhesive,
was not disclosed in the study). adhesives the patient should bite firmly for
Patient perceptions were tallied and Several denture adhesive manu- 20-30 seconds; again, any additional
analyzed and the authors reported facturers have encouraged and excess that expresses into the tongue
that 20-30% of patients found it dif- recommended specific methods and or cheek spaces should be removed.
ficult or extremely difficult to remove instructions for properly applying Dentists should avoid using too
the adhesive from the denture base denture adhesive to the denture much denture adhesive or applying
and oral tissues; however, the authors base. The denture should be cleaned it incorrectly (Fig. 4).
did not assess the degree of cleaning and the intaglio (tissue side) surface
performed by the patients.15 of the denture dried. Next, denture Discussion
Berg compared the perceptions of adhesive should be applied in small Complete edentulism remains a
32 patients concerning 10 factors increments, each one approximately prevalent health issue.49,50 Although
related to one denture adhesive the size of a pea or a pencil eraser contemporary treatment modalities
formulated by a pharmacy (contain- (Fig. 2). Three pea-sized increments (such as implant-supported and
ing tragacanth powder) and three of denture cream should be placed retained prostheses) improve the
commercially available adhesives.17 on the edentulous ridge of the man- treatment outcome for edentulous
The four adhesives were applied dibular denture. Next, three to four patients significantly, conventional
and used for one day; at that point, increments of denture cream should complete dentures remain the pri-
patient interviews were conducted. be placed on the anterior ridge, pos- mary method for restoring edentu-
Unfortunately, the authors did not terior border, and the palatal of the lous arches.51 Complete dentures are
verify whether or not the patient maxillary denture midline (Fig. 3). retained in the oral cavity by a series
could successfully remove the den- When powder adhesives are used, of complex interactions involving
ture adhesive from the denture base one should wet the denture base atmospheric pressure, intimate
and the tissues underlying the pros- with water, apply a thin film of the adaptation of the underlying den-
theses, focusing instead on patient adhesive to the entire intaglio sur- ture-bearing tissues to the intaglio
perceptions.17 Only the study by face, and shake off any excess; when surface of the prosthesis, a thin
Sato et al evaluated a patients ability pad adhesives are used, the correct film of saliva of acceptable viscosity
to remove adhesive effectively from size pad should be positioned onto present between the tissues and
the denture base and oral tissues.12 the denture and any excess material prosthesis, and accurate peripheral
There are no longitudinal studies on that extends beyond the borders extensions of the denture borders
the potential consequences of adhe- trimmed. Each denture should be based on physiological movements.
sive accumulating on soft or hard seated separately, held firmly in place However, following exodontia,
oral tissues, illustrating the need for for 5-10 seconds, and any excess both hard and soft denture-bearing
additional research in this realm of material expressed into the tongue or tissues are remodeled constantly via
denture adhesive use. cheek space during insertion should the process of RRR. Although they
are fabricated to meet the demands overall function, thus improving the 8. The glossary of prosthodontic terms. J Prosthet
of edentulous patients, the reten- edentulous patients QoL. There is a Dent 2005;94(1):10-92.
9. Felton D, Cooper L, Duqum I, Minsley G, Guckes
tion, stability and functionality of paucity of evidence concerning the A, Haug S, Meredith P, Solie C, Avery D, Chan-
complete dentures are affected by effect of long-term (that is, for more dler ND; American College of Prosthodontists;
RRR. Multiple methods can be uti- than six months) use of dental adhe- Academy of General Dentistry; American Dental
Association Council on Scientific Affairs; Ameri-
lized to overcome RRR, including sive. Denture adhesives should be can Dental Hygienists Association; National
dental implant therapy, overdenture used according to the manufacturer Association of Dental Laboratories; GlaxoSmith-
attachments anchored to natural recommendations, following specific Kline Consumer Healthcare. Evidence-based
guidelines for the care and maintenance of
teeth, denture adhesives, and den- guidelines for application and complete dentures: A publication of the Ameri-
ture relines and rebases. removal to prevent potential misuse. can College of Prosthodontists. J Am Dent Assoc
Denture adhesive material func- When prescribing and using denture 2011;142 (Suppl 1):1S-20S.
10. Coates AJ. Usage of denture adhesives. J Dent
tions by swelling and gelling upon adhesives containing zinc, one 2000;28(2):137-140.
insertion to fill the space between should be aware of their potential 11. Divaris K, Ntounis A, Marinis A, Polyzois GL, Poly-
the soft tissues and denture base. for adverse systemic effects. Based on chronopoulou A. Patients profiles and percep-
tions of complete dentures in a university dental
Removing zinc from denture this literature review, dentists should clinic. Int J Prosthodont 2012;25(2):145-147.
adhesive formulations has reduced develop and implement long-term 12. Sato Y, Kaiba Y, Hayakawa I. Evaluation of den-
neurological problems related to maintenance and recall programs for ture retention and ease of removal from oral
mucosa on a new gel-type denture adhesive.
denture adhesive toxicity. Unfor- edentulous patients. Nihon Hotetsu Shika Gakkai Zasshi. 2008;52(2):
tunately, no longitudinal studies 175-182.
of more than six months duration Author information 13. Pradies G, Sanz I, Evans O, Martnez F, Sanz M.
Clinical study comparing the efficacy of two
have been performed to evaluate Dr. Duqum is a clinical assistant denture adhesives in complete denture patients.
patient comfort, tissue changes, professor, Department of Prosth- Int J Prosthodont 2009;22(4):361-367.
or denture serviceability. The odontics, School of Dentistry, 14. Kulak Y, Ozcan M, Arikan A. Subjective assess-
ment by patients of the efficiency of two den-
short-term functionality of denture University of North Carolina at ture adhesive pastes. J Prosthodont 2005;14(4):
adhesives is regarded as beneficial; Chapel Hill, where Ms. Powers 248-252.
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son of four different denture cushion adhe-
information available concerning Dr. Cooper is the Stallings distin- sivesA subjective study. J Oral Rehabil 1998;
extended use of these materials, guished professor and graduate 25(3):209-213.
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