Location via proxy:   [ UP ]  
[Report a bug]   [Manage cookies]                

Effect of Repair Gap Width On The Strength of Denture Repair: An in Vitro Comparative Study

Download as pdf or txt
Download as pdf or txt
You are on page 1of 8

Effect of Repair Gap Width on the Strength of Denture

Repair: An In Vitro Comparative Study


Mohammed M. Gad, MSc ,1 Ahmed Rahoma, PhD ,2 Reem Abualsaud, DScD ,1
Ahmad M. Al-Thobity, FRCD(C) ,1 & Shaimaa M. Fouda, MSc 1
1
Department of Substitutive Dental Sciences, College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
2
Department of Restorative Dental Sciences, College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia

Keywords Abstract
Acrylic denture base; denture repair; flexural
strength; impact strength; repair gap.
Purpose: To evaluate the effect of repair gap width on the flexural strength and impact
strength of a repaired acrylic denture with and without thermal cycling.
Correspondence
Materials and Methods: A total of 240 heat-polymerized acrylic resin specimens
Mohammed Moustafa Ahmed Gad, College were fabricated in dimensions of 65 × 10 × 2.5 ± 0.2 mm and 55 × 10 × 10 ±
of Dentistry, Imam Abdulrahman Bin Faisal 0.2 mm for flexural strength and impact strength testing, respectively. All specimens
University, P.O. Box 1982, Dammam 31411, were sectioned into halves then divided into 6 groups according to repair gap width
Saudi Arabia. E-mail: mmjad@iau.edu.sa (n = 10). The repair gap of the control group was 2.5 mm at the base, while the
repair gaps of the test groups were prepared as 2.0, 1.5, 1.0, 0.5, and 0 mm at the
The authors deny any conflicts of interest in base. All specimens were prepared with a 45° bevel joint. Each specimen was placed
regards to the current study. into the mold that retained the original length of the specimen and modified only the
repair gap, which was packed with repair resin. After polymerization, specimens were
Accepted May 17, 2019
finished and polished, and half of the specimens were thermal cycled for 5000 cycles.
Three-point bending test and Charpy impact test were used to determine the flexural
doi: 10.1111/jopr.13091
strength and impact strength, respectively. ANOVA and Tukey’s HSD test were used
for statistical analysis, where α was set at 0.05.
Results: Decreasing repair gap significantly increased the flexural strength in com-
parison to control group (p < 0.05); 0.5-mm repair gap showed the highest flexural
strength values. Changing the repair gap significantly increased the impact strength of
groups 2.0- and 1.5-mm (p < 0.05). Thermal cycling significantly decreased the flex-
ural strength of all tested groups as well as impact strength for groups with wide repair
gaps (2.5-, 2.0-, and 1.5-mm) (p < 0.05), while other tested groups had nonsignificant
effect on impact strength (p > 0.05).
Conclusion: Decreasing repair gap increased the flexural and impact strengths of
repaired acrylic resin. A repair gap of 0-, 0.5-, or 1.0-mm with beveled repair surface
is recommended to improve repair strength and overcome the drawbacks of increased
amounts of autopolymerized repair resin.

Dentures are susceptible to fracture. Thus, repair of broken gap,17,18 but few studies tested smaller repair gaps of 2 mm,19-22
dentures is a common clinical practice.1,2 Several repair mate- 1.5 mm,1,23 and 1 mm.24 Despite the wide range of repair gaps
rials, surface designs, and treatments are suggested to improve in different studies, the effect of gap width on strength was not
repair strength.3 The repair material should match the color of tested extensively, and the main focus was on repair surface
the denture, and the technique used for repair should be sim- design, material reinforcement, and/or surface treatment.4,6-24
ple and neither time consuming nor expensive.3 The repair of Few studies5,21,25 have investigated the effect of repair gap
a fractured denture begins with the creation of a gap at the size along with the other factors. Beyli and von Fraunhofer5 sug-
fracture site that is then filled with repair material.4 The size gested that small gap sizes (3 mm or less) would use less repair
of the gap created determines the amount of repair material material, reduce polymerization shrinkage, and minimize color
added and, consequently, the strength of the repaired denture.5 difference between original resin and repair material. Leong and
Several studies of repairs have used different gap widths.2 Nu- Grant25 found that deflection was reduced by 20% in specimens
merous studies tested a 10-mm gap;4,6-10 others used 5-mm11 with 1.5 mm gaps compared with 3 mm gaps. Shanoj et al21
and 3-mm gaps.3,12-16 Some other studies used a 2.5-mm repair evaluated the transverse strength of repaired heat-polymerized

684 Journal of Prosthodontics 28 (2019) 684–691 


C 2019 by the American College of Prosthodontists
Gad et al Effect of Repair Gap Width on Denture Repair

acrylic resin using glass fiber reinforced autopolymerized resin and 0 mm (0.0RG) (Fig 1). All sectioned specimens were pre-
and varying repair gaps (1 to 4 mm). Although they recom- pared with a 45° bevel joint, and the measurements were made
mended minimum repair gaps to improve transverse strength, at the base of the specimens (representing intaglio surface). For
other factors may have contributed to this conclusion, such standardization of the bevel joint and the different repair gap
as repair material reinforcement, surface design, and retention widths, guidelines were drawn on the bottom and top of each
groove created.21 Clark and Hsu studied the effect of varying specimen, and customized jigs with the same internal dimen-
thickness of autopolymerized repair resin (0, 1, or 3 mm) on the sions and bevel were used for each group. Each half of the
bond strength of repaired acrylic denture teeth. They concluded specimen was placed in the jig, and a cutting disc was used to
that there is an inverse relation between the bond strength of bevel the specimens following the drawn marks. In the 0-mm
repaired teeth and the amount of repair resin.26 repair gap group, the 2 parts of each specimen came in intimate
Autopolymerized acrylic resin has 3% to 5% free monomer, contact at the base (intaglio side) when reassembled, which
which adversely affects the surface roughness and mechanical appeared as a crack line but without repair material showing.
properties of the resin, and compromises biocompatibility.27 However, at the opposite side (the cameo surface) and due to
In addition to autopolymerized repair resin’s drawbacks, such the beveled repair surfaces, a larger distance was created be-
as polymerization shrinkage, color mismatch, and poor sur- tween the 2 parts and was filled with repair material. This area
face properties (low hardness and high roughness), increased was triangular, with the apex pointing toward the intaglio sur-
Candida adhesion has been reported.12,28 Reducing Candida face. Similarly, for the rest of the test groups, the mentioned
adhesion is particularly important at the intaglio surface of the gap width was measured at the intaglio surface, making the gap
denture,28 which could be accomplished by decreasing repair larger at the cameo surface due to the beveled surface (Fig 1).
gaps and the amount of repair resin material. All repair surfaces were treated with methyl methacrylate
The questions raised now are: Why are wide repair gaps used? monomer (MMA) for 120 seconds.13 Then each specimen was
Should we use smaller gap sizes, or follow the traditional repair placed into the mold used for fabrication of intact specimens to
techniques without solid evidence? To reach a conclusion and preserve its original length and to modify only the repair gap.
answer these questions, this study was undertaken to evaluate Autopolymerizing acrylic resin (Major Repair; Major Prodotti
the effect of repair gap width while standardizing all other Dentari SPA, Moncalieri, Italy) was mixed according to man-
factors (repair material, surface design, and surface treatment). ufacturer’s recommendations and manually packed into the re-
This study aims to evaluate the effects of different repair gaps pair gap with slight overfill to compensate for polymerization
as small as 0.0 and 0.5 mm, in addition to thermal cycling shrinkage and allow for finishing and polishing. After bench-
treatment on flexural strength (FS) and impact strength (IS) of polymerization for 15 minutes at room temperature (23 ±
repaired acrylic resin. The first null hypothesis of this study 2°C),19 specimens were polymerized under 2-bar pressure at
was that repair gap modifications had no effect on the FS and 45°C for 15 minutes using a pressure vessel. After polymeriza-
IS of repaired acrylic resin. The second null hypothesis was tion, specimens were finished using tungsten carbide burs (HM
that thermal stress had no effect on the FS and IS of repaired 79GX-040 HP; Meisinger, Centennial, CO) at low speed and
acrylic resin. polished under running water with progressively finer grits of
silicon carbide papers (320, 400, 600). Specimens with proper
Materials and methods dimensions were stored in distilled water at 37°C for 48 hours
prior to testing. Half the specimens were subjected to ther-
Power analysis found that 60 specimens (a total of 6 groups, mal stress using a thermocycling machine (Thermocycler THE-
n = 10) per test were needed to detect differences among dif- 1100 – SD; Mechatronik GmbH, Feldkirchen-Westerham, Ger-
ferent repair gaps and their effect on repair strength of repaired many) where they were exposed to 5000 thermal cycles between
denture base resin. The World Health Organization sample size 5°C and 55°C with a 30-second dwell time. These cycles of
calculation formula was employed to calculate the sample size thermal stressing corresponded to 6 months of intraoral use.31
with power of 80% and 0.05 level of significance. A total of The 3-point bending test was conducted on a universal testing
240 acrylic resin specimens (120 per test; 60 before and 60 after machine (Model 2519-106; Instron, Norwood, MA). A custom-
thermal cycling) were fabricated according to each test spec- made stainless-steel device with a 50 mm span between the 2
ification. The specimens for the FS test (65 × 10 × 2.5 ± supports was used. The load was applied centrally to the re-
0.2 mm) were fabricated according to ADA specification paired area of the specimens at the intaglio surface using a
No.12.29 The molds used to fabricate specimens for the IS 5 KN load cell and blunt round end tip (2-mm diameter) at
test were (55 × 10 × 10 ± 0.2 mm) with a standard notch 5 mm/min crosshead speed. The maximum load at fracture was
(2-mm deep) at mid-span, according to the ASTM D-256 stan- recorded, and the FS of each specimen was calculated using
dard and British Standard Institute (B.S.I.) Specification (1984) the following formula:32 S = 3WL/2bd2 , where S is the FS
No. 771.30 All specimens were produced following the conven- (MPa), W is the maximum load at fracture (N), L is the dis-
tional water bath method used for denture fabrication.18,28 tance between the supports (50 mm), b is the specimen width
Acrylic resin specimens were cut into halves using a high (10 mm), and d is the specimen thickness (2.5 mm). The IS
precision saw (Isomet 5000; Buehler Ltd., Lake Bluff, IL). All test was performed using a pendulum Charpy-type impact test
sectioned specimens were divided into 6 groups according to machine (Digital Charpy Izod impact tester, XJU 5.5; Jinan
the width of repair gap. The repair gap of the control group Hensgrand Instrument Co., Ltd., Jinan, China). Each specimen
was 2.5 mm (C), while test groups had repair gaps of 2.0 mm was positioned horizontally with a distance of 40 mm between
(2.0RG), 1.5 mm (1.5RG), 1.0 mm (1.0RG), 0.5 mm (0.5RG), the 2 fixed supports. At room temperature, a drop weight of

Journal of Prosthodontics 28 (2019) 684–691 


C 2019 by the American College of Prosthodontists 685
Effect of Repair Gap Width on Denture Repair Gad et al

Figure 1 Schematic of prepared specimens for repair according to repair gap. A; intact: (B-G) repair gap, ranging from 2.5 (control) to zero (0.0RG);
(H) repaired specimen from the 0.0RG group. Black represents heat-polymerized acrylic resin and orange represents repair resin (autopolymerized
acrylic resin). Left column of specimens is for FS testing and right column of specimens is for IS testing.

0.5 J was applied at the mid-span of the specimen on the op- SPSS-20.0 software (IBM Corp., Armonk, NY) was used for
posite side of the notch, and the value of the IS (kJ/m2 ) was statistical analysis. Means and standard deviations of FS and
recorded digitally.18 IS were used to present descriptive statistics. For inferential
After the fracture load of the test specimens had been mea- statistics, one-way ANOVA was used to test the variation be-
sured, surfaces were examined visually with naked eyes by 3 tween groups and within each group, and pairwise comparison
evaluators, then using scanning electron microscopy (SEM), was done using Tukey’s HSD test with p ࣘ 0.05 considered
(INSPECT S50; FEI, Brno, Czech Republic). The nature of statistically significant. For the nature of failure analysis, a
fracture was analyzed to classify it into adhesive, cohesive, or Mann-Whitney test was employed to analyze any significant
mixed. Then, 10 specimen sections were selected from each differences in FS and IS before and after thermal cycling.
group for SEM analysis, totaling 10 images per group. The na-
ture of failure was determined depending on the percentage of
Results
retained repair resin on the surface of acrylic denture base ma-
terial. It was classified as adhesive when up to 25% repair resin ANOVA was used to test the overall significance of FS between
was retained at the interface, cohesive when fracture of the base all groups (Table 1). The test was run twice, once for the data
material or repair resin happened in over 75%, or mixed when before thermal cycling and another after thermal cycling. After
25 to 75% of repair resin was found at the interface.18 Gold having significant p-value in both, pairwise comparisons were
coating was applied using a sputter coating machine (Q150R done using Tukey’s HSD post hoc test. In comparison to the
ES; Quorum, East Sussex, UK) to overcome the nonconduc- control group, the FS increased significantly (Table 2) in groups
tive nature of the material. SEM images were taken at different 1.0RG (p = 0.042), 0.5RG (p = 0.001), and 0.0RG (p = 0.012),
magnifications to determine the failure nature. while no significant differences were seen in groups 2.0RG

686 Journal of Prosthodontics 28 (2019) 684–691 


C 2019 by the American College of Prosthodontists
Gad et al Effect of Repair Gap Width on Denture Repair

Table 1 One-way ANOVA to evaluate significant differences among groups for FS test before and after thermal cycling

Flexural strength Sum of squares df Mean square F Sig.

Without thermal cycling Between groups 270.709 5 54.142 9.541 <0.0001


Within groups 306.442 54 5.675
Total 577.151 59
With thermal cycling Between groups 81.367 5 16.273 4.450 0.002
Within groups 197.465 54 3.657
Total 278.831 59

Table 2 Mean values and standard deviations (SD) of FS (MPa) for (p = 0.288); 1.0RG and 0.5RG (p = 0.076) or 0.0RG (p = 0.12);
tested specimens as well as between 0.5RG and 0.0RG (p = 1.00). Comparing
the effect of thermal cycling on the FS of each respective group,
Without thermal cycling With thermal cycling
significant reductions in FS values were found for all groups;
Groups Mean (±SD) Mean (±SD)
control (p = 0.001), 2.0RG (p = 0.006), 1.5RG (p < 0.001),
Control 66.59 (±3.9)a,b 61.18 (±1.70)a 1.0RG (p < 0.001), 0.5RG (p < 0.001), and 0.0RG (p = 0.004),
2.0RG 65.17 (±2.7)a 62.15 (±1.47)a,b before and after thermal cycling.
1.5RG 69.78 (±1.2)b,c 63.47 (±1.10)b,c For nature of failure (Table 3), statistical significance was
1.0RG 69.90 (±1.7)c,d 65.35 (±1.11)c,d not found in the control group and 2.0RG, while significant
0.5RG 71.34 (±2.0)c,d 67.17 (±1.66)d differences were found in groups 1.5RG, 1.0RG, 0.5RG, and
0.0RG 69.48 (±1.7)c,d 67.04 (±1.62)d 0.0RG. The classification of the nature of failure was aided by
Vertically, identical superscript small letters denote no significant differences the SEM examination. For FS testing before thermal cycling,
among groups (p > 0.05). All groups showed significant reductions in FS after adhesive fractures were found in control, 2.0RG, and 1.5RG
thermal cycling. groups (Fig 2A). Adhesive fracture was not seen in groups
1.0RG, 0.5RG, and 0.0RG, with group 0.0RG showing 100%
(p = 0.83) and 1.5RG (p = 0.056). Within the tested groups, mixed fracture. After thermal cycling (Fig 2B), the nature of
results showed that group 2.0RG had significant differences failure was altered, with a higher percentage of adhesive failure
from groups 1.5RG (p = 0.001), 1.0RG (p = 0.001), 0.5RG with control, 2.0RG, and 1.5RG groups. Groups 1.0RG, 0.5RG,
(p < 0.0001), and 0.0RG (p = 0.003), while no significant and 0.0RG showed a range of adhesive, cohesive, and mixed
differences were found between groups 1.5RG and 1.0RG type fractures.
(p = 1.00), 0.5RG (p = 0.767), and 0.0RG (p = 1.00). Also, no ANOVA was used to test the overall significance of IS
significant differences were found between 1.0RG and 0.5RG between all groups (Table 4). The test was run twice, once
(p = 0.826) and 0.0RG (p = 1.00). As a result, no significant for the data before thermal cycling and again after thermal
difference was found between 0.5RG and 0.0RG (p = 0.59). cycling. After having significant p-values in both, pairwise
The maximum FS value was found for group 0.5RG (71.34 ± comparisons were done using Tukey’s HSD post-hoc test. In
2.02 MPa), and the lowest was found for group 2.0RG comparison to the control group, significant differences in IS
(65.17 ± 2.7 MPa). values (Table 5) were found with groups 2.0RG (p = 0.03) and
Considering the thermal cycling effect (Table 2), and in com- 1.5RG (p = 0.027). No significant differences were apparent
parison to the control group, there was a significant increase in between the control and 1.0RG (p = 0.329), 0.5RG (p =
FS for groups 1.5RG (p = 0.009), 1.0RG, 0.5RG, and 0.0RG 0.093), and 0.0RG (p = 0.057) groups. The highest IS value
(p < 0.0001), but not for group 2.0RG (p = 0.682). The results was recorded with 2.0RG (3.87 ± 0.20 kJ/m2 ) while the lowest
showed significant differences in FS between group 2.0RG IS value was recorded with 1.0RG (3.62 ± 0.39 kJ/m2 )
and groups 1.0RG, 0.5RG, and 0.0RG (p < 0.0001), while no Considering thermal cycling effects, the results of IS testing
significant differences were found between 2.0RG and 1.5RG showed significant differences between control and groups

Table 3 Mann-Whitney test analysis for the nature of failure of FS test before and after thermal cycling

Test statisticsa

Control 2.0RG 1.5RG 1.0RG 0.5RG 0.0RG

Mann-Whitney U 43.500 40.000 23.500 25.000 23.000 30.000


Wilcoxon W 98.500 95.000 78.500 80.000 78.000 85.000
Z −0.548 −0.822 −2.232 −2.285 −2.412 −2.169
Asymp. Sig. (2-tailed) 0.584 0.411 0.026∗ 0.022∗ 0.016∗ 0.030∗
a
Grouping Variable: group.
*
Statistically significant differences between respective groups (p < 0.05).

Journal of Prosthodontics 28 (2019) 684–691 


C 2019 by the American College of Prosthodontists 687
Effect of Repair Gap Width on Denture Repair Gad et al

Figure 2 Nature of failure of FS tested specimens (A) before thermal cycling, (B) after thermal cycling.

Table 4 One-way ANOVA to evaluate significant differences among groups for IS test before and after thermal cycling

Impact strength Sum of squares df Mean square F Sig.

Without thermal cycling Between groups 1.719 5 0.344 3.727 0.006


Within groups 4.982 54 0.092
Total 6.701 59
With thermal cycling Between groups 3.404 5 0.681 8.533 <0.0001
Within groups 4.308 54 0.080
Total 7.712 59

Table 5 Mean values and standard deviations of IS (kJ/m2 ) for tested groups 1.0RG (p = 0.229), 0.5RG (p = 0.435), and 0.0RG
specimens (p = 0.607).
Regarding the nature of failure for IS before and after thermal
Without thermal cycling With thermal cycling
cycling, statistical significance was not found in any group
Groups Mean (±SD) Mean (±SD)
(Table 6). Figure 3A represents the nature of failure for IS-
Control 3.33 (±0.16)a,A 2.99 (±0.22)a,B tested specimens before thermal cycling. Adhesive fracture was
2.0RG 3.87 (±0.20)b,A 3.14 (±0.24)a,c,B seen in a small percentage, with cohesive-type fracture being
1.5RG 3.77 (±0.32)b,A 3.30 (±0.37)a,b,B the most common failure in control and 2.0RG. After thermal
1.0RG 3.62 (±0.39)a,b,A 3.45 (±0.28)b,c,A cycling (Fig 3B), the nature of failure changed to show more
0.5RG 3.71 (±0.32)a,b,A 3.62 (±0.26)b,A adhesive failure, especially for wider gaps. Groups 0.5RG and
0.0RG 3.73 (±0.40)a,b,A 3.65 (±0.29)b,A 0.0RG showed more cohesive and mixed fractures.
Vertically, identical superscripted small letters denote no significant differences
among groups (p > 0.05). Horizontally, identical superscripted capital letters Discussion
denote no significant differences of thermal cycling effect (p > 0.05).
Repair edge profile and surface treatment were considered to
be important factors influencing denture repair strength,2,5 in
1.0RG (p = 0.009), 0.5RG (p = 0.001), and 0.0RG (p = addition to another neglected factor, repair gap width. During
0.001), with no differences between control and groups 2.0RG the repair procedure, borders of a fractured denture are pre-
(p = 0.876) and 1.5RG (p = 0.114). In addition, group 2.0RG pared to create a gap.21 The width of this gap determines the
showed significant difference when compared to groups 0.5RG amount of repair material needed, which affects the strength
(p = 0.005) and 0.0RG (p = 0.002), while no significant of repaired denture. The conventional method of denture repair
difference was detected with 1.5RG (p = 0.668) and 1.0RG involves the use of autopolymerized acrylic resin,22 the most
(p = 0.154). Results showed no significant differences between popular repair material; however, insufficient FS of this resin
groups 1.0RG, 0.5RG, and 0.0RG (p > 0.05), with the maxi- can cause a refracture at the repair site.21,22 Aiming to decrease
mum IS value reported for group 0.0RG (3.65 ± 0.29 kJ/m2 ). the amount of repair resin and its negative effects, the current
Regarding the effect of thermal cycling on IS for each respective study was performed to evaluate the FS and IS of repaired
test group, significant differences were found for the control acrylic resin with different repair gaps. The results of this study
group (p = 0.001) and groups 2.0RG (p < 0.001) and 1.5RG showed that smaller gaps improved the FS, while the IS was
(p = 0.010), while no effect of thermal cycling was seen for significantly increased with 2.0- and 1.5-mm gaps but did not

688 Journal of Prosthodontics 28 (2019) 684–691 


C 2019 by the American College of Prosthodontists
Gad et al Effect of Repair Gap Width on Denture Repair

Table 6 Mann-Whitney test analysis for the nature of failure of IS test before and after thermal cycling

Test statisticsa

Control 2.0RG 1.5RG 1.0RG 0.5RG 0.0RG

Mann-Whitney U 34.500 36.500 34.000 39.500 41.000 40.000


Wilcoxon W 89.500 91.500 89.000 94.500 96.000 95.000
Z −1.400 −1.137 −1.378 −0.885 −0.755 −0.835
Asymp. Sig. (2-tailed) 0.161 0.255 0.168 0.376 0.450 0.403
a
Grouping Variable: group.
*
Statistical significant differences between respective groups (p < 0.05).

Figure 3 Nature of failure of IS tested specimens (A) before thermal cycling, (B) after thermal cycling.

change in smaller gap groups; hence, the first null hypothesis therefore, comparing the results with previous studies was
was rejected. In this study, moving from wide repair gaps (2.5 difficult.18,20
and 2.0 mm) to smaller gaps (1.5 to 0 mm) caused the FS to in- A comparison of the tested properties with and without
crease significantly. This increase may be due to lower amount thermal cycling for each group revealed that FS decreased
of repair material, which overcame its drawbacks. When repair significantly for all groups, while IS decreased significantly
material amount decreases, stresses resulting from polymeriza- for groups with larger repair gaps (1.5, 2.0 mm). Therefore, the
tion shrinkage are lowered.5,23 second null hypothesis was partially accepted. In the oral cav-
A previous report21 suggested that achieving optimum repair ity, moisture contamination and thermal fluctuation facilitate
strength values would occur with repair gaps not greater than absorption of water. Water absorption, along with the changes
1.0 mm. Although the findings agreed with the results of this in temperature, may cause degradation of denture polymer.16,31
study, the technique of preparing repair gap and repair ma- When water molecules penetrate the PMMA mass, they
terial used were different. The addition of glass fibers to the occupy spaces between polymer chains, forcing them apart
repair material in that study could be the main reason for im- and affecting the mechanical properties of acrylic resin.16 The
proved transverse strength, compared to the pure autopolymer- absorption of water into resin is influenced by the polarity of
ized resin used in the current study. Beyli and von Fraunhofer5 PMMA molecules and the diffusion of water molecules into
assessed the FS of repaired polymethyl methacrylate (PMMA) interstitial spaces between polymer chains. Heat stress may
denture base using unreinforced repair acrylic resin at varying increase water absorption because of the widely separated
gap widths (1.0 to 5.0 mm) and different edge profiles. They polymer chains, where it allows the chains to slide easily under
found no significant difference in FS with gap width variation. load, decreasing the polymer’s mechanical properties.33
This is inconsistent with the results obtained in this study. The The bond between repair resin and denture base resin
differences in the results could be attributed to discrepancies in is achieved by an interpenetrating polymer network at the
the methodology. interface. This interface may influence the magnitude of effects
Regarding IS, as repair gap decreased from 2.5 mm, the caused by changing temperatures.34 A previous study observed
IS increased significantly; however, this increase was not significant decreases in FS and IS of high-impact acrylic
significant when the repair gap was 1.0 mm or less. This denture base after thermal cycling for 5000 cycles.35 These
positive change in IS may be associated with the reduc- results were in partial agreement with the current study, which
tion in repair resin amount. The IS of repaired dentures has showed a significant decrease in FS after thermal stressing.
been investigated in few studies with standard repair gap; For the majority of experimental conditions evaluated, thermal

Journal of Prosthodontics 28 (2019) 684–691 


C 2019 by the American College of Prosthodontists 689
Effect of Repair Gap Width on Denture Repair Gad et al

cycling did not affect IS of the material.36,37 In this study, References


repairs of wider gaps resulted in significantly lower IS values
after thermal cycling. This reduction may be linked to the 1. Polyzois GL, Handley RW, Stafford GD: Repair strength of
effects of water absorption, polymer structure, or dimensional denture base resins using various methods. Eur J Prosthodont
changes of bulky repair material after thermal stress. Restor Dent 1995;3:183-186
2. Seó RS, Neppelenbroek KH, Filho JN: Factors affecting the
In the nonthermocycled control and 2.0RG groups, most of
strength of denture repairs. J Prosthodont 2007;16:302-310
the FS fractures occurred at the denture base/repair material in-
3. Minami H, Suzuki S, Kurashige H, et al: Flexural strengths of
terface (adhesive). For the other groups (1.5RG, 1.0RG, 0.5RG, denture base resin repaired with auto polymerizing resin and
0.0RG), the failure was mainly mixed, with sporadic cohesive reinforcements after thermocycle stressing. J Prosthodont
failures, with the 0-mm-gap group showing 100% mixed type of 2005;14:12-18
fracture. The nature of failure differed greatly among the ther- 4. Rached RN, Powers JM, Del Bel Cury AA: Repair strength of
mal cycled groups, where the adhesive type was more prevalent auto polymerizing, microwave, and conventional heat
in wider gap groups, while mixed-type fractures were com- polymerized acrylic resins. J Prosthet Dent 2004;92:79-82
monly seen in groups 1.0RG, 0.5RG, and 0.0RG. This finding 5. Beyli MS, von Fraunhofer JA: Repair of fractured acrylic resin.
confirmed the effect of thermal stress on bond strength at the J Prosthet Dent 1980;44:497-503
resin/repair interface. 6. Rached RN, Del Bel Cury AA: Heat-cured acrylic resin repaired
Clinically, denture repair could be made with a 0-mm-gap with microwave-cured one: bond strength and surface texture.
J Oral Rehabil 2001;28:370-375
and bevel-edge profile as a possible method to avoid adding
7. Lewinstein I, Zeltser C, Mayer CM, et al: Transverse bond
repair resin bulk. Decreased gap width may result in better
strength of repaired acrylic resin strips and temperature rise of
esthetics, as it reduces the color mismatch between the repair dentures relined with VLC reline resin. J Prosthet Dent 1995;74:
material and original denture base.21 Additionally, the adverse 392-399
effects on surface properties may be reduced as the amount of 8. Vojdani M, Rezaei S, Zareeian L: Effect of chemical surface
repair material decreases. Subsequently, discoloration, micro- treatments and repair material on transverse strength of repaired
bial adhesion, and colonization may be decreased.28 Further acrylic denture resin. Indian J Dent Res 2008;19:2-5
investigations are required to evaluate the minimum repair gap 9. Agarwal M, Nayak A, Hallikerimath RB: A study to evaluate the
width with surface treatment and repair material reinforcement, transverse strength of repaired acrylic denture resins with
which collectively may enhance repair strength; however, there conventional heat-cured, autopolymerizing and microwave-cured
are certain limitations in this in vitro study. It was not pos- resins: an in vitro study. J Indian Prosthodont Soc 2008;8:36-41
sible to duplicate the different types of stresses generated in 10. Ellakwa AE, El-Sheikh AM: Effect of chemical disinfectants and
repair materials on the transverse strength of repaired
the oral cavity. In addition, the curvature of the denture al-
heat-polymerized acrylic resin. J Prosthodont 2006;15:300-305
lows for anatomic contours that follow the oral tissues, which 11. Sharma A, Batra P, Vasudeva K, et al: Influence of repair
was not simulated in this study. In clinical practice, the frac- material, surface design and chemical treatment on the transverse
ture of a denture does not necessarily occur in a linear pattern. strength of repaired denture base—an in-vitro study. Ind J Dent
For the purpose of standardization, this was not investigated in Sci 2012;4:23-26
this study. Mimicking one of the in vivo degradation factors, 12. Şahin C, Ergin A, Ayyıldız S, et al: Evaluation of flexural strength
thermal stressing was employed to disclose its effects on the and Candida albicans adhesion of an acrylic resin repaired with
general degradation process. Based on the findings, variations 4 different resin materials. Clin Dent Res 2012;36:10-14
in oral temperature may have an overall negative effect on repair 13. Alkurt M, Yeşil Duymuş Z, Gundogdu M: Effect of repair resin
strength; therefore, it should be noted that clinical conditions type and surface treatment on the repair strength of
heat-polymerized denture base resin. J Prosthet Dent
differ from an in vitro setting. For this reason, the findings of
2014;111:71-78
this study must be interpreted carefully. 14. Vasthare A, Shetty S, Kamalakanth Shenoy KK, et al: Effect of
different edge profile, surface treatment, and glass fiber
reinforcement on the transverse strength of denture base resin
Conclusions repaired with autopolymerizing acrylic resin: an In vitro study.
J Interdiscip Dent 2017;7:31-37
The FS of repaired acrylic denture base increased as the repair
15. Ward JE, Moon PC, Levine RA, et al: Effect of repair surface
gap decreased, both before and after thermal cycling, while design, repair material, and processing method on the transverse
the IS of repaired acrylic denture base increased with 2.0- and strength of repaired acrylic denture resin. J Prosthet Dent
1.5-mm repair gaps. Thermal cycling was found to affect the IS 1992;67:815-820
of larger repair gaps. Finally, repair gaps ranging between 0.0 16. Lin CT, Lee SY, Tsai TY, et al: Degradation of repaired denture
and 1.0 mm with beveled repair surface are recommended to base material in simulated oral fluid. J Oral Rehabil
improve repair strength and overcome the drawbacks of thermal 2000;27:190-198
stressing at the repair interface. 17. Gad M, ArRejaie AS, Abdel-Halim MS, et al: The reinforcement
effect of nano-zirconia on the transverse strength of repaired
acrylic denture base. Int J Dent 2016;2016.
Acknowledgments https://doi.org/10.1155/2016/7094056
18. Gad MM, Rahoma A, Al-Thobity AM, et al: Influence of
The authors would like to deeply thank Mr. Lindsey Mateo and incorporation of ZrO2 nanoparticles on the repair strength of
Mr. Soban Khan for their assistance with the mechanical testing polymethyl methacrylate denture bases. Int J Nanomed
and statistical analysis 2016:27;5633-5643

690 Journal of Prosthodontics 28 (2019) 684–691 


C 2019 by the American College of Prosthodontists
Gad et al Effect of Repair Gap Width on Denture Repair

19. Anasane N, Ahirrao Y, Chitnis D, et al: The effect of joint repaired polymethyl methacrylate denture bases and interim
surface contours and glass fiber reinforcement on the transverse removable prostheses: a new approach for denture stomatitis
strength of repaired acrylic resin: an in vitro study. Dent Res J prevention. Int J Nanomed 2017:28:5409-5419
2013;10:214-219 29. Revised American Dental Association Specification No. 12 for
20. Hanna EA, Shah FK, Gebreel AA: Effect of joint surface denture base polymers. J Am Dent Assoc 1975;90:451-458
contours on the transverse and impact strength of denture base 30. International Standard Organization and British standards for the
resin repaired by various methods. An in-vitro study. J Am Sci testing of denture base Resins; ISO 1567, 1988; BS 2487, 1989
2010;6:115-125 31. Minami H, Suzuki S, Minesaki Y, et al: In vitro evaluation of the
21. Shanoj RP, Razak PA, Kumar KN, et al: Comparative evaluation influence of repairing condition of denture base resin on the
of the strength of denture base resin repaired with glass bonding of autopolymerizing resins. J Prosthet Dent
fiber-reinforced acrylic resin: an in vitro study. J Contemp Dent 2004;91:164-170
Pract 2018;19:792-798 32. Gad MM, Fouda SM, ArRejaie AS, et al: Comparative effect of
22. Stipho HD: Repair of acrylic resin denture base reinforced with different polymerization techniques on the flexural and surface
glass fiber. J Prosthet Dent 1998;80:546-550 properties of acrylic denture bases. J Prosthodont
23. Stipho HD, Stipho AS: Effectiveness and durability of repaired 2019;28:458-465
acrylic resin joints. J Prosthet Dent 1987;58:249-253 33. Braden M: Absorption of water by acrylic resins and other
24. Keyf F, Uzun G: The effect of glass fibre-reinforcement on the materials. J Prosthet Dent 1964;14:307-316
transverse strength, deflection and modulus of elasticity of 34. Vallittu PK, Ruyter IE: The swelling phenomenon of acrylic
repaired acrylic resins. Int Dent J 2000;50:93-97 resin polymer teeth at the interface with denture base polymers.
25. Leong A, Grant AA: The transverse strength of repairs in J Prosthet Dent 1997;78:194-199
polymethyl methacrylate. Aust Dent J 1971;16:232-234 35. Machado AL, Puckett AD, Breeding LC, et al: Effect of
26. Clark WA, Hsu YT: The effect of autopolymerizing acrylic resin thermocycling on the flexural and impact strength of
thickness on the bond strength of a repaired denture tooth. urethane-based and high-impact denture base resins.
J Prosthodont 2014;23:528-533 Gerodontology 2012;29:318-323
27. Bahrani F, Safari A, Vojdani M, et al: Comparison of hardness 36. Wady AF, Machado AL, Vergani CE, et al: Impact strength of
and surface roughness of two denture bases polymerized by denture base and reline acrylic resins subjected to long-term
different methods. World J Dent 2012;3:171-175 water immersion. Braz Dent J 2011;22:56-61
28. Gad MM, Al-Thobity AM, Shahin SY, et al: Inhibitory effect of 37. Machado AL, Bochio BC, Wady AF, et al: Impact strength of
zirconium oxide nanoparticles on Candida albicans adhesion to denture base and reline acrylic resins: an in vitro study. J Dent
Biomech 2012;3. https://doi.org/10.1177/1758736012459535.

Journal of Prosthodontics 28 (2019) 684–691 


C 2019 by the American College of Prosthodontists 691

You might also like