FACTORS AFFECTING RETENTION

OF COMPLETE DENTURES
LUBWAMA RICHARD 17/U/20003/PS
 Retention

Retention: It is defined as ‘that quality inherent in the dental prosthesis

acting to resist the forces of dislodgement along the path of placement’.
Retention can also be defined as the ability of the prosthesis to withstand
displacement against its path of opening.
Factors Affecting Retention
(i) Biological factors; • Anatomical factors • Physiological factors • Muscular
factors
(ii) (ii) Mechanical factors
(iii) (iii) Physical factors
(iv) (iv) Psychological factors
(v) (v) Surgical factors
 Biological factors
• Anatomical factors
 Size of denture-bearing area: Retention increases with an increase of denture-
bearing area. Size of the maxillary denture-bearing area is 22.96 cm2 , whereas the
size of mandibular denture area is 12.25 cm2 ; therefore, maxillary dentures have
more retention than the mandibular dentures.
 Quality of denture-bearing area: Firm, keratinized tissues provide best support and
do not move easily and, therefore, provide maximum retention in comparison to
tissues that get easily displaced during function.
• Physiological factors
 Quantity and quality of saliva: Quality of the saliva determines retention.
Thick and ropy saliva gets accumulated between the tissue surfaces of the
denture and the mucosa leading to loss of retention. Likewise, thin and
watery saliva also leads to reduced retention.
 Condition of mucosa and sub mucosa: Maximum coverage without undue
displacement of the tissues during impression making determines retention
in the complete denture.
 Cont…
 Neuromuscular control: It refers to the functional forces exerted by the
musculature of the patient that can affect retention
 Ridge characteristics: An ideal ridge is parallel or nearly parallel with
adequate vertical height and flat crest. This type of ridge provides
maximum amount of support and stability and retention.
 Ridge relationship: There should be an adequate inter-ridge distance
between the upper and the lower ridges. Excessive inter-ridge distance
results in poor stability and retention because of the increased leverage. A
small inter-ridge distance will lead to difficulty in arranging the teeth and
maintaining a proper freeway space.
 Muscular factors Orofacial muscles provide supplementary retentive force,
if the following are noticed: • Teeth are arranged in neutral zone between
the cheeks and the tongue. • Polished surfaces of the dentures are
properly shaped. • Base of the tongue serves as an emergency retentive
force
 Cont...
• Occlusal plane should be at the correct level. • Denture bases should be
extended over the maximum area possible. • Muscle control and patient
tolerance often play a vital role in retention of the complete denture
prosthesis. It is the muscle control that enables the patient to function
with dentures which rest on the basal tissues that have undergone the
resorptive changes.
 Mechanical factors
• Undercuts: Mild undercuts help in providing retention. Also, unilateral
undercuts may aid in retention but severe bilateral undercuts will mostly
require surgical intervention before denture fabrication.
• Retentive springs: Mode of retention which is not in use currently.
• Denture adhesives: These are nontoxic soluble materials, which are
supplied as powder, cream or liquid and are applied to the tissue side of
the denture to improve denture retention and stability.
• Contour of denture base: The polished surface of the denture base should
be properly placed. Proper contour and design of the polished surface
should harmonize with the function of the tongue, lips and cheeks to
effect seating of the denture.
• Parallel buccal and lingual walls: These provide significant retention by
increasing the surface area between the denture base and mucosa. This
enhances the retention by increasing the interfacial surface tension and
atmospheric forces.
 Physical factors
•Adhesion: It is defined as ‘the physical attraction of unlike molecules to one
another’. Adhesion of saliva to the mucous membrane and the denture base is
achieved through ionic forces between charged salivary glycoproteins and
surface epithelium or acrylic resin. A thin film of saliva formed between the
denture and the tissue surface helps to hold the denture to the mucosa.
Retention by adhesion is proportional to the amount of denture-bearing area.
•Cohesion: It is the physical attraction of like molecules to each other. .
•Interfacial surface tension: It is the resistance to separation of two parallel
surfaces that is imparted by a film of saliva between them. The thin film of saliva
tends to resist the displacing force which tends to separate the denture from
the tissues.
• Atmospheric pressure: It acts to resist the dislodging forces applied to the
dentures, provided they have effective peripheral seal. This peripheral seal
prevents the entry of air between the denture surface and the soft tissue. When
displacing forces act on the denture, a partial vacuum is produced between the
denture and the soft tissues, which aids in retention..
•Gravity:
 Psychological and surgical factors

• Psychological factors
 Intelligence
 Expectation
 Apprehension or fear of embarrassment
 Gagging
• Surgical factors
• Implant dentures: Retention is definitely enhanced in implant-retained prosthesis.
• Ridge extension: It increases retention by increasing the surface area. E.W. Fish
(1948) gave three principal factors that affect the retention of complete dentures
i.e. (i) Denture-bearing surface(ii) A balanced harmonious occlusion (iii) Properly
formed polished surface. S. Friedman (1957) advocated three basic goals for
achieving retention, i.e. (i) Maximal coverage without undue displacement of
tissues (ii) Development of good border seal (iii) Adequate provision for resistance
areas
 Denture adhesives
•Denture adhesives are pastes, powders or adhesive pads that
may be placed in/on dentures to help them stay in place.
Sometimes denture adhesives contain zinc to enhance
adhesion.
Note: In most cases, properly fitted and
maintained dentures should not require the use of denture
adhesives.
Requirements of an adhesive material
Easy application and removal from the tissue surface of the
denture
Adhesiveness should be retained for 12-16hrs
Dimensional stability
Adequate mechanical properties to resist forces of mastication
Hydro resistance
Biological compatibility; non toxic and non irritant
Neutral odor and taste
 Composition and classification

• Main ingredients of denture adhesives are classified into

three groups
i. Group 1 (Adhesive agents); gelatin, methylcellulose, acacia,
hydroxyl methylcellulose, sodium carboxyl methyl cellulose,
pectin, synthetic polymers like acrylamides, acetic etc.
ii. Group 2 (Anti microbial agents); Sodium tetra borate,
ethanol, hexachlorophene and sodium borate
iii. Group 3 (Other agents); Plasticizing agents, flavoring agents
like oil of peppermint, oil of wintergreen and wetting agents
 Indications and contraindications for denture
adhesives
Indications
 Need to stabilize the trial denture bases which show inadequate retention and stability due
to various reasons
 When well made complete dentures do not satisfy a patient’s perceived retention and
stability expectations
 Patients who suffer from xerostomia due to medication side effects, a history of head and
neck irradiation, systemic diseases or diseases of the salivary glands have retention issues
and an increased tendency for ulceration of the bearing tissues
 Use of denture adhesives can compensate for the retention that is lacking in the absence of
healthy saliva, and can mitigate the onset of oral ulcerations that result from frequent
dislodgements
 Prove psychologically beneficial when the patient requires supplemental retention stability
 Patients with compromised denture bearing areas
 Immediate dentures get loosened soon due to tissue healing and resorption requiring
relining, rebasing or anew denture fabrication. Adhesives can therefore be used in this
interim period to provide comfort
 Cont…
 Reduced clinical findings of ulcers, tissue irritation, inflammation and
compression of the oral mucosa
 Need to stabilize dentures in patients with hormonal changes and
neuromuscular disorders like myasthenia gravis, Parkinson's and Alzheimer’s
disease
 Prosthesis to rehabilitate gross maxillofacial defects requires denture adhesives
for retention
Contraindications
 Allergies to denture adhesives or any of its components
 Gross inadequacies in retention and function
 Excessive bone resorption and soft tissue shrinking leading to loss of vertical
dimension
 Adhesives should not be used to retain fractured dentures or dentures with lost
flanges
 Patients with inability to maintain proper hygiene of the denture should avoid
the use of denture adhesives
 Adverse reactions to denture adhesives

• Problems with zinc such as neurological damage and blood

abnormalities.
• Tumor growth
• Pain
• Weakness
• Paralysis
• Tingling and numbness
• Difficulties in balance and walking
• Masking an underlying condition
 References

• Prosthetic treatment for edentulous patients, complete and

implant supported prostheses by Zab Bolender
• Concise Prosthodontics, 2nd edition by Vijay Prakash and Ruchi
Gupta
• www.ncbi.nlm.nih.gov > PMC4516076 – Denture adhesives in
prosthodontics