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JPOR 558 No. of Pages 5

journal of prosthodontic research xxx (2019) xxx–xxx

Contents lists available at ScienceDirect

Journal of Prosthodontic Research

journal homepage: www.elsevier.com/locate/jpor

Original article

Wear of resin denture teeth in partial removable dental prostheses

Thomas Stobera,* , Justo Lorenzo Bermejob , Stefan Ruesa , Peter Rammelsberga
a
Department of Prosthodontics, Heidelberg University Hospital, Heidelberg, Germany
b
Institute of Medical Biometry and Informatics, Heidelberg University Hospital, Heidelberg, Germany

A R T I C L E I N F O A B S T R A C T

Article history: Purpose: To investigate occlusal wear of resin denture teeth in partial removable dental prostheses worn
Received 18 September 2018 by partially edentulous patients.
Received in revised form 12 March 2019 Methods: Thirty patients with partial removable dental prostheses were included in the study. Thirty-two
Accepted 2 April 2019
patients with complete dentures served as a reference group. Occlusal wear after two years was
Available online xxx
evaluated indirectly using gypsum casts and a three-dimensional laser-scanner device. Overall wear of
complete occlusal surfaces and maximum wear of occlusal contact areas were measured. Patient and
Keywords:
prosthesis data were analyzed using univariate and multiple linear mixed models.
Wear
Occlusal wear
Results: Overall wear of denture teeth in partial removable dental prostheses was 91 (SD 85) mm, and
Denture teeth maximum wear of occlusal contact areas was 329 (SD 204) mm (means and standard deviations). Average
Removable dental prosthesis and maximum wear values for teeth in complete dentures were both lower than those for teeth in partial
Complete dental prosthesis removable dental prostheses. However, differences between wear of different types of denture did not
reach statistical significance after adjustment for gender, type of tooth, dental status of the opposing jaw,
and antagonist material. Statistical analysis revealed that wear was greater for denture teeth occluding
with ceramic crowns and/or fixed partial dentures as antagonists.
Conclusions: Resin denture teeth in partial removable and complete dental prostheses are subjected to
clinically important occlusal wear that might destabilize occlusion and cause further problems. Patient-
related factors and dental status affect wear behavior and should be taken into consideration when
treating patients with removable dentures.
© 2019 Japan Prosthodontic Society. Published by Elsevier Ltd. All rights reserved.

1. Introduction
Removable dental prostheses remain a successful treatment
option for partially edentulous patients, in particular for treatment
of free-end saddles [1,2]. Stable occlusion is the foundation of long-
term clinical success for all prosthetic treatments. In this respect,
the wear resistance of denture teeth significantly affects the long-
term success of partial and complete removable dental prostheses.
For this reason, numerous in-vitro [3–9] and in-vivo [10–15]
studies have been conducted on the wear behavior of denture
teeth. Furthermore, many in-vitro studies have used different wear
simulators to examine the wear of composite materials used for
posterior restorations [16–19]. However, laboratory investigations
of wear behavior usually have shortcomings. Contemporary
chewing simulators employ only one or two of several possible
wear mechanisms, and there is limited evidence of a correlation
* Corresponding author at: Department of Prosthodontics, Heidelberg University
Hospital, Im Neuenheimer Feld 400, D-69120 Heidelberg, Germany.
E-mail address: thomas_stober@med.uni-heidelberg.de (T. Stober).
between simulator wear data and clinical wear results [20,21]. It is
therefore useful to study wear behavior in clinical settings.
Recent clinical investigations of the wear of resin denture teeth
have recorded acceptable occlusal stability with a vertical loss of
approximately 150 mm in occlusal stress-bearing areas after one
year [13–15]. However, this means that wear of resin denture teeth
is clearly greater than that of enamel ones, for which annual wear
of 32–51 mm [22] and 60–68 mm [23] has been recorded.
Interestingly, nearly all clinical studies of the wear behavior of
denture teeth have been conducted for patients wearing complete
dentures. Few clinical data are available concerning the wear
behavior of denture teeth in partial removable dental prostheses.
Only one study (with a small number of patients) has been
published on this subject [12]. In their pilot study, Ohlmann et al.
calculated mean wear of 22.8 mm for teeth in partial removable
dental prostheses after six months. However, this calculation was
for the entire occlusal surface, not just the occlusal contact area.
Furthermore, the authors found indications that gender, antagonist
material, and type of denture significantly affect the wear behavior
of resin denture teeth [12].

https://doi.org/10.1016/j.jpor.2019.04.004
1883-1958/ © 2019 Japan Prosthodontic Society. Published by Elsevier Ltd. All rights reserved.

Please cite this article in press as: T. Stober, et al., Wear of resin denture teeth in partial removable dental prostheses, J Prosthodont Res (2019),
https://doi.org/10.1016/j.jpor.2019.04.004
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2 T. Stober et al. / journal of prosthodontic research xxx (2019) xxx–xxx
Table 1. Characteristics of study participants and their dental prostheses.
Partial dental prosthesis (study group)
Number of patients 30
Gender (female %) 40.0
Mean age of patients (years) 68.8 (SD 6.9)
Jaw (maxilla %) 53.3
Kennedy classification (%) Kennedy class I: 73.3
Kennedy class II: 20.0
Kennedy class III: 6.7
a
If participants were edentulous in both jaws, only the upper denture was included in the study.
The main objective of our study was to investigate occlusal wear
of resin denture teeth in partial removable dental prostheses and to
compare these results with those for complete dentures. The null
hypothesis was that wear behavior would not be affected by
denture type. We also evaluated the effects of patient-related
factors and the dental status of the opposing jaw on this wear.
2. Materials and methods
Thirty patients receiving new partial removable dental pros-
theses with double-crown attachments were recruited for this
study. Double-crown-retained removable dental prostheses have
proved a successful treatment option for partially edentulous
patients [24,25]. All study participants had to sign a consent form.
The local university review board approved the study protocol
(ethical approval no. 084/2003). The mean age of participants was
68.8 years (SD 6.9, range 47–83), and 40% were female. Thirty-two
patients with new complete dentures who were edentulous in one
or both jaws were recruited as a reference group. These
participants had a mean age of 65.2 years (SD 11.6, range 44–
86), and 65.6% were female. Sixteen patients received a complete
denture in the maxilla only, one patient in the mandible only, and
15 patients in both the maxilla and mandible, depending on their
dental status. To reduce patient-related effects for patients
receiving two dentures, only the denture in the maxilla was
analyzed. Further characteristics of the participants and their
dental prostheses are summarized in Table 1.
The dentures were fabricated according to standard prosthetic-
denture treatment protocols. For patients receiving complete
dentures in both jaws, dentures were adjusted in centric occlusion
and in accordance with the principle of bilateral balanced
occlusion. Denture teeth in both groups were made from poly
(methyl methacrylate) with 14% inorganic fillers (Vitapan; VITA
Zahnfabrik, Bad Säckingen, Germany). Removal of pressure spots
and/or occlusal adjustments was performed within four weeks of
incorporation.
Occlusal wear was evaluated indirectly using impressions and
gypsum casts of the dentures. Impressions made from vinyl
polysiloxane using the dual-viscosity technique (Flexitime Putty
and Flexitime Correct Flow; Kulzer, Germany) were prepared four
weeks (baseline — t0) and 24 months (t1) after incorporation.
Before taking impressions, all denture teeth were examined for
calculus, stains, or foreign debris and, if necessary, cleaned using an
ultrasonic cleaning system. The casts were made from gypsum
type-IV dental stone (GC Fujirock EP Pearl White; Leuven,
Belgium).
The extent of wear was determined using a laser-scanner device
(Willytec Laserscan 3D; SD Mechatronik, Feldkirchen-Westerham,
Germany). The main steps of this now commonly used method,
first described by Mehl et al. [26], are briefly summarized below.
The occlusal surfaces of the posterior denture teeth were
digitized indirectly using a laser scanner on gypsum casts. All
premolars and molars were scanned separately. The default
settings for the scanning process were adjusted as follows: The
Please cite this article in press as: T. Stober, et al., Wear of resin denture teeth in partial removable dental prostheses, J Prosthodont Res (2019),
https://doi.org/10.1016/j.jpor.2019.04.004
Complete dental prosthesis (reference)
32
65.6
65.2 (SD 11.6)
96.9a
n.a.
n.a.
n.a.
number of light lines was increased from 400 to 700 and the step
distance was 30 mm. The data records were then analyzed for
wear-induced surface changes using the surface-analysis software
Match 3D, Version 1.6 (Willytec; SD Mechatronik). The extent of
wear was calculated by superimposing the baseline (t0) and follow-
up (t1) scans using reference-free 3D superimposition [26]. To
prevent wear zones or cast artifacts from impairing superimposi-
tion, a threshold value of 30 mm was defined. The superimposi-
tion process of the two corresponding scans was automatic and
was accepted if the standard deviations were less than 20 mm. The
entire occlusal surface of each premolar and molar denture tooth
was analyzed, whereby the surface-analysis software was used to
calculate overall wear of the entire occlusal surface and maximum
wear of the occlusal contact area. The 2% quantile was used to
eliminate outliers.
Statistical analysis was conducted using SAS version 9.4 (SAS
Institute Inc.; Cary, NC, USA). Univariate and multiple linear mixed
models were used to evaluate possible effects of the following
variables on the extent of wear: denture type, gender, age, tooth
type, jaw, dental status of the opposing jaw, and antagonist
material. The study participant was included as a random effect to
account for the correlation of interpatient data. Probability values
smaller than 0.05 were considered statistically significant.
Assuming standard deviations equal to 85 mm for the overall
wear of denture teeth and 204 mm for the maximum wear of
occlusal contact areas, the study was able to detect true differences
of 24 mm for overall wear and 56 mm for maximum wear with 80%
statistical power (n = 303 teeth in complete and n = 157 teeth in
partial dental prosthesis, unpaired t-test).
3. Results
Results were obtained for 30 participants wearing partial
removable dental prostheses (157 denture teeth). After 24 months,
overall wear of the complete occlusal surface of denture teeth was
91 (85) mm, and maximum wear of the occlusal contact areas was
329 (204) mm (mean values with standard deviations). In the
reference group of 32 edentulous participants with complete
dentures (303 denture teeth), overall wear was 64 (73) mm and
maximum wear was 255 (171) mm. Statistical analysis conducted
using a univariate linear mixed model revealed that occlusal wear
of partial dentures was significantly greater than that of complete
dentures (Table 2: overall wear data; Table 3: maximum wear
data). Because wear was analyzed by means of a multiple linear
mixed model, however, the significant effect of denture type was
lost.
Several patient-related factors (gender, age, tooth type, jaw,
dental status of the opposing jaw, antagonist material) were also
included in the statistical analysis. The results for these are shown
in Tables 2 and 3. Use of the univariate linear mixed model revealed
statistically significant effects on the extent of wear for gender,
tooth type, dental status of the opposing jaw, and antagonist
material. Occlusal wear values of denture teeth with a natural
tooth, crown, or fixed partial denture antagonist were greater than
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Table 2. Overall wear of complete occlusal surfaces of the denture teeth. Results from statistical analysis using univariate and multiple linear mixed models (including patient
as a random effect).

Overall wear Level n Mean Univariate linear mixed model Multiple linear mixed model

Variable Difference 95% CI p-Value Difference 95% CI p-Value

Type of denture Complete 303 63.5 Ref. Ref.
Partial 157 90.6 27.1 12.2 42.0 0.0004 7.9 17.5 33.3 0.54
Gender Female 249 59.7 Ref. Ref.
Male 211 88.0 25.4 11.2 39.6 0.0005 18.9 3.6 34.3 0.02
Age 65 years 198 62.3 Ref. Ref.
>65 years 262 80.6 13.2 1.5 27.9 0.08 6.1 9.0 21.3 0.43
Jaw Maxilla 287 71.2 Ref. Ref.
Mandible 173 75.2 3.1 11.5 17.7 0.68 7.5 9.1 24.1 0.37
Type of tooth Premolar 255 78.8 Ref. Ref.
Molar 205 65.1 14.6 28.8 0.4 0.04 10.3 24.4 3.8 0.15
Dental status of No antagonist 7 22.7
opposing jaw Complete denture 215 58.9 Ref. Ref.
Partial denture 144 67.6 8.7 7.2 24.6 0.28 17.2 3.3 37.7 0.10
Natural tooth a/o crown a/o FDP 94 115.8 56.9 38.6 75.1 0.000000002 44.5 11.7 100.7 0.12
Antagonist material No antagonist 7 22.7
Enamel 42 100.5 Ref. Ref.
Metal alloy 15 96.6 3.9 48.1 40.3 0.86 7.4 37.8 52.5 0.75
Ceramic 33 144.5 44.0 9.8 78.2 0.01 44.4 9.2 79.5 0.01
Resin denture tooth 363 63.0 37.5 61.5 13.6 0.002 9.4 49.8 68.7 0.75

Table 3. Maximum wear of occlusal contact areas of the denture teeth. Results from statistical analysis using univariate and multiple linear mixed models (including patient as
a random effect).

Maximum wear Level n Mean Univariate linear mixed model Multiple linear mixed model

Variable Difference 95% CI p-Value Difference 95% CI p-Value

Type of denture Complete 303 254.6 Ref. Ref.
Partial 157 329.0 74.4 39.0 109.8 0.00004 37.7 29.7 105.1 0.27
Gender Female 249 240.6 Ref. Ref.
Male 211 326.4 78.5 45.0 112.0 0.000005 55.4 19.3 91.5 0.003
Age 65 years 198 251.0 Ref. Ref.
>65 years 262 301.9 38.2 3.2 73.2 0.03 19.8 15.8 55.4 0.28
Jaw Maxilla 287 277.4 Ref. Ref.
Mandible 173 284.2 4.6 30.3 39.4 0.80 13.0 25.9 52.0 0.51
Type of tooth Premolar 255 282.9 Ref. Ref.
Molar 205 276.3 8.8 42.7 25.2 0.61 3.7 29.3 36.8 0.82
Dental status of No antagonist 7 154.4
opposing jaw Complete denture 215 246.6 Ref. Ref.
Partial denture 144 261.9 15.2 22.3 52.8 0.43 41.3 9.8 92.4 0.11
Natural tooth a/o 94 393.2 146.6 103.4 189.7 0.00000000007 86.4 47.9 220.7 0.21
crown a/o FDP
Antagonist material No antagonist 7 154.4
Enamel 42 369.7 Ref. Ref.
Metal alloy 15 324.9 44.8 148.8 59.3 0.40 27.7 133.8 78.4 0.61
Ceramic 33 465.1 95.4 14.9 175.8 0.02 103.9 21.4 186.5 0.01
Resin denture tooth 363 253.3 116.4 172.8 60.0 0.00006 19.2 158.6 120.2 0.79

that of denture teeth occluding with removable partial or complete
dentures. Antagonist material also had a significant effect on wear,
which was greatest for denture teeth occluding with ceramic
crowns and/or fixed partial dentures. Furthermore, multivariate
analysis (multiple linear mixed model) was conducted to detect
any possible associations or interactions between variables. In
contrast to the univariate analysis, the multivariate analysis
showed that only gender and antagonist material significantly
affected wear. In particular, wear differences by the dental status of
opposing jaw estimated using multiple linear regression (overall
44.5 mm and maximum 86.4 mm for “Natural tooth a/o crown a/o
FDP” vs. “Complete denture”) did not reach statistical significance,
probably due to the confounding effects of gender and antagonist
material.
4. Discussion
The main result of our study is that occlusal wear of denture
teeth in partial dental prostheses was statistically comparable to
that of denture teeth in complete dental prostheses, thus
confirming the null hypothesis. We also proved that antagonist
material significantly affects the extent of wear. Nonetheless,
because sample sizes for some categories were small (e.g., only 15
metal-alloy crown antagonists were included), some results
should be interpreted with caution.
The wear recorded for complete dental prostheses after two years
(overall wear: 64 mm; wear in occlusal contact areas: 255 mm) are in
agreement with the results of previous clinical studies using the
same research method. Schmid-Schwap et al. observed vertical loss
of 121–221 mm for posterior denture teeth in occlusal contact areas
after one year [13]. Heintze et al. recorded wear of approximately
200 mm for complete dental prostheses after two years of clinical
service [15]. In both studies, the denture teeth investigated primarily
contained poly(methyl methacrylate) with cross-linked organic
filler particles [13,15]. Our own previous study—which used the same
denture teeth as this study (a matrix of poly(methyl methacrylate)
and 14% inorganic fillers)—suggested maximum occlusal wear of
226 mm in occlusal contact areas after two years [14].

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Regarding the wear behavior of partial removable dental
prostheses, only one clinical study (with a small number of
subjects) is available for comparison with our findings. Ohlmann
et al. calculated overall wear of 22.8 mm for the complete occlusal
surface area of partial removable dental prostheses after six
months [12]. Assuming a linear increase, this is equivalent to
occlusal wear of approximately 91 mm after two years—identical to
the results presented here. It should be noted that the results here
relate to partial removable dental prostheses with double-crown
attachments. The use of different anchoring elements, such as
clasps, might produce different results.
Nearly all clinical wear studies, including ours, have found that
occlusal wear of denture teeth varies greatly between patients [10–
15,27]. One possible explanation for this is that wear processes in
the oral cavity result from a complex interaction of mechanical
forces (e.g., bruxism) and several other factors (e.g., erosion,
corrosion processes, and nutritional habits). The effect of patient-
related factors on the extent of wear is, however, disputed.
With regard to gender, our study indicates that wear is greater
for males than females. This is in agreement with the results of
Ohlmann et al. [12], who also studied occlusal wear for a group of
patients wearing partial and complete dental prostheses. However,
no study of patient cohorts wearing only complete dental
prostheses has found a significant effect for gender on occlusal
wear [11,13,14]. Only Heintze et al. have reported that wear tends to
be greater for men [27]. One possible explanation is that an effect
of gender on occlusal forces has not been found for edentulous
subjects [28]. Among dentate subjects, in contrast, significantly
greater bite forces have been proven for men [29]. Furthermore, it
has been shown that the bite forces of complete-denture wearers
are lower than those of wearers of partial removable dental
prostheses [30].
Another point of discussion is the effect of age on the extent of
occlusal wear. Our study found no significant difference between
subjects younger than 65 years old and those older than 65 years
old. Previous studies have found that wear tends to decrease as a
person’s age increases; lower occlusal forces were attributed to a
reduction in muscle activity as a result of aging [13,27].
In agreement with previous results, a noticeable effect on
occlusal wear was found for dental status and antagonist material
[12,14]. Our data clearly show that wear of denture teeth increases
by a factor of 1.5 (wear in occlusal contact areas) to 2 (overall wear
of complete occlusal surface) when natural teeth and/or crowns
and/or fixed dental prostheses are in occlusion, compared with
complete dentures. Wear is further increased by ceramic antago-
nist occlusal surfaces. These findings (increased wear of antago-
nistic natural teeth and/or crowns and/or fixed dental prostheses)
can also be attributed to varying bite forces. Bite forces of subjects
with partial and/or complete denture prostheses are much smaller
than those of subjects with natural dentition [30]. A lack of
periodontal receptors among edentulous subjects might also result
in less wear. In this context it should be noted that the surface
structure of antagonists—in particular roughness—strongly affects
wear behavior [31,32]. It is usually recognized that ceramic
restorations should be polished thoroughly to minimize their
abrasive effect. The use of diamond-impregnated polishers and
diamond polishing paste as a final polish are recommended for this
purpose.
The effect on wear of tooth type (premolar vs. molar) remains
unclear. Our results are indicative of slightly higher overall wear
rate for premolars (14.6 mm, univariate p = 0.04), but the difference
did not reach statistical significance in the multiple linear mixed
model (p = 0.15). Other studies have reported that volumetric wear
depends on tooth type, although differences decreased substan-
tially after results were adjusted for tooth surface [13].
Please cite this article in press as: T. Stober, et al., Wear of resin denture teeth in partial removable dental prostheses, J Prosthodont Res (2019),
https://doi.org/10.1016/j.jpor.2019.04.004
Finally, the clinical relevance of our results must be addressed.
The following ‘physiological’ enamel–enamel-generated wear of
natural premolars and molars after two years have been reported:
54–91 mm [22], 75–115 mm [23], and 40–80 mm [33]. In compari-
son, our study suggests wear rate is three to four times greater for
denture teeth (255–329 mm) than for natural ones, which might be
clinically relevant. The clinical relevance of the reported differ-
ences between the wear of denture teeth in partial removable
dental prostheses and that in complete dental prostheses is open to
question, however. Nevertheless, the wear resistance of denture
teeth should be as high as possible because a partial removable
dental prosthesis should restore chewing function, esthetics, and
speech for many years to come. It should also prevent migration of
the remaining teeth. To prevent the destabilization of occlusion,
the wear of denture teeth should, ideally, be similar to the
‘physiological’ wear of natural teeth.
The suitability of the method used to measure wear in our study
has been verified in previous clinical studies [12–14]. It is regarded
as a valid method [34] with high reproducibility and accuracy of
10–15 mm [26]. Nonetheless, it is important to note that the
algorithm of the underlying matching process tends to underesti-
mate actual wear, because both positive and negative values are
considered when calculating differences. Changes in the dimen-
sions of impressions, expansion of stone gypsum replicas during
setting, and scanner accuracy are further weaknesses of the
method. All these factors are inherent errors and might contribute
to slight differences between wear values when compared with
other studies. Notable positive aspects of the study are the
prospective study design with a control group and the 24-month
follow-up period after denture placement. Weaknesses are the
small number of participants and small sample sizes of some
subgroups; because this reduced the power of statistical analysis,
some significant factors might not have been detected.
5. Conclusion
Wear of dentures measured in this study after two years of
clinical use should be regarded as clinically important because
such wear might destabilize occlusion, thus resulting in other
problems. Wear tends to be greater for partially edentulous
patients wearing removable dental prostheses than for patients
wearing complete dentures. However, the differences did not reach
statistical significance. Within the limitations of this study, it can
be concluded that the antagonist material affects occlusal wear of
denture teeth. This should be taken into account when treating
patients with removable dentures.
Declaration of interest
Financial support was used to compensate patients for their
additional effort attending follow-ups. The authors have no other
financially beneficial arrangements with Kulzer and/or Wieland
Dental.
Acknowledgments
We thank Heraeus Kulzer (now Kulzer), Germany and Wieland
Dental, Germany for financial support. We also thank Hazel Davies,
copy editor, for English-language revision, and Clemens Schmitt for
assistance with measurement of wear.
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