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Referensi 11
Referensi 11
complete dentures
Sergio S. Nogueira, DDS,a Robert E. Ogle, DDS,b and Elaine L. Davis, PhDc
School of Dental Medicine, State University of New York at Buffalo, Buffalo, N.Y.
Statement of problem. A clinically significant incisal pin opening may occur after processing complete
dentures if a compression molding technique is used. To recover the proper vertical dimension of occlusion,
a time-consuming occlusal adjustment is necessary that often destroys the anatomy of the artificial teeth. A
new injection molding process claims to produce dentures that require few, if any, occlusal adjustments in
the laboratory after processing.
Purpose. This laboratory study compared incisal pin opening, dimensional accuracy, and laboratory work-
ing time for dentures fabricated by this new injection system with dentures constructed by the conventional
compression molding technique.
Material and methods. Two groups of 6 maxillary and 6 mandibular dentures were evaluated as follows:
group 1 (control), Lucitone 199, compression molded with a long cure cycle; and group 2, Lucitone 199,
injection molded with a long cure. Incisal pin opening was measured with a micrometer immediately after
deflasking. A computerized coordinate measuring machine was used to measure dimensional accuracy of 3-
dimensional variations in selected positions of artificial teeth in 4 stages of denture fabrication. Analysis of
variance (ANOVA) and t tests were performed to compare the groups.
Results. A significant difference was found in pin opening between groups (t test). Horizontal dimensional
changes evaluated with repeated measures ANOVA revealed no significant differences between groups.
However, analysis of vertical dimensional changes disclosed significant differences between the groups.
There was no appreciable difference in laboratory working time for flasking and molding denture bases
between the injection and compression molding techniques when polymethyl methacrylate resin was used.
Conclusion. The injection molding method produced a significantly smaller incisal pin opening over the
standard compression molding technique. The injection molding technique, using polymethyl methacrylate,
was a more accurate method for processing dentures. There were no appreciable differences in laboratory
working time between the injection and compression molding techniques. (J Prosthet Dent 1999;82:291-
300.)
CLINICAL IMPLICATIONS
In this study, a high pressure injection molding system using PMMA provided a pre-
cise replication of the trial denture. This reduced the chances of a significant vertical
dimension change and would therefore decrease the necessity of extensive occlusal
adjustment to correct for processing errors.
Fig. 5. Electronic touch ruby-tipped probe was always posi- Fig. 8. Sagittal view of denture after retrieval from cast in
tioned facing axes of reference points. same spatial position occupied before retrieval from cast.
B
Fig. 9. A, Maxillary change, mediolateral dimension, stage 2 to stage 4. B, Mandibular
change, mediolateral dimension, stage 2 to stage 4.
medial-lateral dimension. The same procedure was real- 3. denture after retrieval from cast, and
ized with the values of the horizontal distances d3 and 4. after storage in water at room temperature for 30
d4 defining a mean value for the anterior-posterior dis- days.
tance. In addition, an arithmetic mean was calculated A custom matrix was made with type IV dental stone
and the mean value was defined for vertical heights h1, in a custom aluminum matrix holder for each maxillary
h2, h3, and h4 of the reference points. and mandibular cast for the purpose of maintaining
Measurements were recorded in 4 stages of com- identical the spatial position of the dentures through-
plete dentures fabrication: out all stages of evaluation (Fig. 6). Before retrieving
1. trial denture before processing, each denture from the cast in stage 3, 2 screws with
2. processed denture on cast, sleeves were fixed with autocuring resin, each one in a
Table I. Mediolateral dimension means (SDs) by group, arch, and phase (n = 6 per cell)
Mean deviation from baseline (mm)*
Stages
Arch 2. Processed denture on cast 3. After retrieval from cast 4. After 30-day storage Average
Maxilla
Compression molding (control) –0.097 (0.012) –0.152 (0.012) –0.128 (0.017) –0.126 (0.012)
Injection molding (long cure) –0.098 (0.016) –0.137 (0.016) –0.100 (0.023) –0.112 (0.016)
Average –0.097 (0.014) –0.144 (0.016) –0.114 (0.024) –0.119 (0.015)
Mandible
Compression molding (control) –0.127 (0.014) –0.132 (0.015) –0.140 (0.030) –0.133 (0.016)
Injection molding (long cure) –0.132 (0.019) –0.122 (0.033) –0.137 (0.033) –0.130 (0.028)
Average –0.129 (0.016) –0.127 (0.025) –0.138 (0.030) –0.131 (0.021)
*Each mean represents a deviation from original baseline measurement.
Table II. Anteroposterior dimension means (SDs) by group, arch, and phase (n = 6 per cell)
Mean deviation from baseline (mm)*
Stages
Arch 2. Processed denture on cast 3. After retrieval from cast 4. After 30-day storage Average
Maxilla
Compression molding (control) –0.083 (0.016) –0.087 (0.015) –0.063 (0.013) –0.078 (0.013)
Injection molding (long cure) –0.085 (0.010) –0.077 (0.010) –0.058 (0.013) –0.073 (0.011)
Average –0.083 (0.013) –0.082 (0.017) –0.061 (0.012) –0.076 (0.012)
Mandible
Compression molding (control) –0.063 (0.015) –0.063 (0.012) –0.042 (0.012) –0.056 (0.011)
Injection molding (long cure) –0.072 (0.012) –0.070 (0.015) –0.050 (0.014) –0.064 (0.012)
Average –0.067 (0.014) –0.067 (0.014) –0.046 (0.013) –0.060 (0.012)
*Each mean represents a deviation from original baseline measurement.
Table III. Vertical dimension means (SDs) by group, arch, and phase (n = 6 per cell)
Mean deviation from baseline (mm)*
Stages
Arch 2. Processed denture on cast 3. After retrieval from cast 4. After 30-day storage Average
Maxilla
Compression molding (control) 0.218 (0.071) 0.170 (0.051) 0.192 (0.090) 0.193 (0.046)
Injection molding (long cure) 0.030 (0.065) 0.057 (0.103) 0.042 (0.054) 0.043 (0.054)
Average 0.124 (0.118) 0.113 (0.097) 0.117 (0.105) 0.118 (0.092)
Mandible
Compression molding (control) 0.215 (0.054) 0.238 (0.080) 0.220 (0.094) 0.224 (0.073)
Injection molding (long cure) 0.058 (0.035) 0.015 (0.075) 0.020 (0.072) 0.031 (0.057)
Average 0.137 (0.093) 0.127 (0.138) 0.132 (0.094) 0.128 (0.119)
*Each mean represents a deviation from original baseline measurement.
central incisor tooth, and an additional amount of position in the custom matrix. A positioning device
type IV dental stone was used to fix the screws to the incorporated in the mandibular denture in the position
custom matrix (Fig. 7). This permitted retrieval of the of the central incisors was used before for positioning
denture from the cast without any alteration in position both the waxed denture and the processed denture in
of the denture in relation to the custom matrix (Fig. 8). the same relation to the master cast.13
The screws allow removal of the denture from the cus-
Laboratory working time
tom matrix, for storage in water for 30 days and, after
this period, an accurate return of the denture to its Real laboratory working time and waiting time for
B
Fig. 10. A, Maxillary change, anteroposterior dimension, stage 2 to stage 4. B, Mandibular
change, anteroposterior dimension, stage 2 to stage 4.
RESULTS
flasking and molding was recorded for all maxillary
dentures. Real working time was defined as the time
Pin opening
that the operator was directly involved with the proce- Average pin opening was compared between
dure, such as mixing materials. Waiting time was groups with a separate variance independent t test.
defined as the time that the operator was not directly Results indicated a significant difference between
involved with the procedure, such as setting time of groups (t6 = 8.82, P<.05). The compression molding
materials. Time was not recorded for identical proce- control group showed significantly greater mean pin
dures common to the 2 groups. opening than the injection molding group. Means
B
Fig. 11. A, Maxillary change, vertical dimension, stage 2 to stage 4. B, Mandibular change,
vertical dimension, stage 2 to stage 4.
(standard deviations) were 1.16 (0.23) and 0.31 ments at all subsequent stages were converted to devi-
(0.06) mm, respectively. ations from this zero point. Analyses were conducted
for each dimension separately. Because the baseline val-
Dimensional accuracy
ues were all zero, with no variability, these values were
Dimensional changes from baseline to the 3 pro- excluded from all analyses. Descriptive statistics are pre-
cessing stages were measured in mediolateral, antero- sented in Tables I through III and in Figures 9, A
posterior, and vertical dimensions. Data were recoded through 11, B. Multivariate repeated measures analyses
to reflect changes from an arbitrary baseline. That is, all of variance (ANOVA) were used to determine dimen-
baseline values were converted to zero and measure- sional change across time by both group and arch.
Mediolateral dimension
Constant 1 — F1, 10 = 5.24† F2, 9 = 22.22‡ F2, 9 = 62.46§
Group 1 F1, 10 = 0.007 F1, 10 = 0.003 F2, 9 = 2.06 F2, 9 = 1.34
Within 10
Total 12
Anteroposterior dimension
Constant 1 — F1, 10 = 10.27|| F2, 9 = 66.81¶ F2, 9 = 0.09
Group 1 F1, 10 = 0.11 F1, 10 = 1.58 F2, 9 = 0.61 F2, 9 = 0.52
Within 10
Total 12
Vertical dimension
Constant 1 — F1, 10 = 0.18 F2, 9 = 0.75 F2, 9 = 0.08
Group 1 F1, 10 = 47.30# F1, 10 = 0.88 F2, 9 = 0.03 F2, 9 = 2.12
Within 10
Total 12
*y1 = Total score, across arch and phase (used to test group main effect); y2 = difference score, mandibular minus maxillary arch; y3 = difference score, phase 2
minus phase 3; y4 = difference score, phase 3 minus phase 4; y5, y6 = arch by phase interaction scores. First row (Constant) displays within-subject main effects
and interactions. Second row (Group) displays between-subject main effects and interactions between within-subject and between-subject factors.
†P=.045.
‡P<.001. Univariate results significant for both y3 (F
1, 10 = 35.02, P<.001) and y4 (F1, 10 = 9.10, P=.013).
§P<.001. Univariate results significant for both y3 (F
1, 10 = 100.61, P<.001) and y4 (F1, 10 = 50.00, P<.001).
||P=.009.
¶P<.001. Univariate results significant for y4 (F
1, 10 = 102.45, P<.001) but not y3 (F1, 10 = 0.032, P=.58).
#P<.001.
Contrasts were set up to allow univariate comparisons Table V. Means of real and waiting working time for each
between stages 2 and 3 and between stages 3 and 4. A test group for flasking and processing maxillary dentures
significance level of .05 was used for all analyses. Compression molding Injection molding
higher precision for the injection molding technique. 2. The injection molding system was the more accu-
In the dimensional accuracy portion of the study, sig- rate method for processing dentures.
nificant change in tooth position occurred in the hori- 3. There were no appreciable differences in labora-
zontal dimensions from stage 2 to 3 and, for the medi- tory working time between the injection and compres-
olateral dimension, from stage 3 to 4. Overall warpage sion molding techniques. However, the injection
was greater in the maxillary arch than the mandibular molding system would save time in construction of
arch for the anteroposterior dimension, but greater dentures because of the smaller incisal pin opening and
change on the mandibular arch for the mediolateral a reduction in time for post-processing adjustments.
dimension. In addition, there was a significant interac-
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CONCLUSIONS DR SERGIO S. NOGUEIRA
DEPARTAMENTO DE MATERIAIS ODONTOLÓGICOS E PRÓTESE
The results of this study indicated a significantly FACULDADE DE ODONTOLOGIA DE ARARAQUARA - UNESP
RUA HUMAITA 1680
higher degree of accuracy for the injection molding CEP 14801-903, ARARAQUARA, SAO PAULO
technique for processing dentures over the standard BRAZIL
compression molding technique. On the basis of the FAX: (55)16-222-4823
E-MAIL: nogueira@foar.unesp.br
results and conditions of this study, the following con-
clusions were drawn: Copyright © 1999 by The Editorial Council of The Journal of Prosthetic
1. The injection molding method produced a signif- Dentistry.
0022-3913/99/$8.00 + 0. 10/1/99814
icantly smaller incisal pin opening over the standard
compression molding technique when PMMA resin
was used.