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Effect of Ridge Shape on the Fit of Denture Bases

Permanent Link: http://ufdc.ufl.edu/UFE0021448/00001

Material Information

Title: Effect of Ridge Shape on the Fit of Denture Bases
Physical Description: 1 online resource (39 p.)
Language: english
Creator: Al-Tarakemah, Yacoub
Publisher: University of Florida
Place of Publication: Gainesville, Fla.
Publication Date: 2007

Subjects

Subjects / Keywords: acrylic, bases, denture, edentulous, fit
Dentistry -- Dissertations, Academic -- UF
Genre: Dental Sciences thesis, M.S.
bibliography   ( marcgt )
theses   ( marcgt )
government publication (state, provincial, terriorial, dependent)   ( marcgt )
born-digital   ( sobekcm )
Electronic Thesis or Dissertation

Notes

Abstract: The objective of this study was to determine the accuracy of heat cured acrylic base plates on simulated edentulous ridges with different configurations. Edentulous ridges of the maxillae were simulated by attaching parallel trapetsoidal rods simulating ridges to a flat plate simulating the palate. The slope of the palatal ridges was always 45 degrees, while the outside slopes were either 85 degrees, 75 degrees or 60 degrees. The sagital ridge convergencies were 5 degrees, 10 degrees or 15 degrees for each ridge shape. No ridges were simulated in the anterior regions. Two micrometers were attached to the aluminum base that mounts the simulated ridges. One measured the space between the metal palate surface and the base plate, and the other displaced the base plates in sagital anterior direction. PVS impressions of the simulated ridges were made. They were poured in type IV stone. A total of 54 acrylic base plates with 1 mm thickness were fabricated (n=6 per experimental condition). The acrylic base plates were placed on matching ridge models and the palatal-base plate distances were measured at each 1.000mm as the base plates were displaced in an anterior direction. The x and y values were plotted showing the vertical palate-base plate distance (y) as a function of anterior displacement (x). All results followed third degree polynomials. In conclusion, the best fit at zero displacement was for ridges with an anterior convergency of 15 degrees and an outside slope 60 degrees. Furthermore, it can be concluded from this study that the steeper the outer angles of the ridges, the worse the fit of the acrylic base at zero displacement. Also, the anterior displacement of a relatively well fitting acrylic base plate causes the fit to become poor because of the influence of the inner slopes of the simulated ridges.
General Note: In the series University of Florida Digital Collections.
General Note: Includes vita.
Bibliography: Includes bibliographical references.
Source of Description: Description based on online resource; title from PDF title page.
Source of Description: This bibliographic record is available under the Creative Commons CC0 public domain dedication. The University of Florida Libraries, as creator of this bibliographic record, has waived all rights to it worldwide under copyright law, including all related and neighboring rights, to the extent allowed by law.
Statement of Responsibility: by Yacoub Al-Tarakemah.
Thesis: Thesis (M.S.)--University of Florida, 2007.
Local: Adviser: Soderholm, Karl J.
Local: Co-adviser: Clark, Arthur E.

Record Information

Source Institution: UFRGP
Rights Management: Applicable rights reserved.
Classification: lcc - LD1780 2007
System ID: UFE0021448:00001

Permanent Link: http://ufdc.ufl.edu/UFE0021448/00001

Material Information

Title: Effect of Ridge Shape on the Fit of Denture Bases
Physical Description: 1 online resource (39 p.)
Language: english
Creator: Al-Tarakemah, Yacoub
Publisher: University of Florida
Place of Publication: Gainesville, Fla.
Publication Date: 2007

Subjects

Subjects / Keywords: acrylic, bases, denture, edentulous, fit
Dentistry -- Dissertations, Academic -- UF
Genre: Dental Sciences thesis, M.S.
bibliography   ( marcgt )
theses   ( marcgt )
government publication (state, provincial, terriorial, dependent)   ( marcgt )
born-digital   ( sobekcm )
Electronic Thesis or Dissertation

Notes

Abstract: The objective of this study was to determine the accuracy of heat cured acrylic base plates on simulated edentulous ridges with different configurations. Edentulous ridges of the maxillae were simulated by attaching parallel trapetsoidal rods simulating ridges to a flat plate simulating the palate. The slope of the palatal ridges was always 45 degrees, while the outside slopes were either 85 degrees, 75 degrees or 60 degrees. The sagital ridge convergencies were 5 degrees, 10 degrees or 15 degrees for each ridge shape. No ridges were simulated in the anterior regions. Two micrometers were attached to the aluminum base that mounts the simulated ridges. One measured the space between the metal palate surface and the base plate, and the other displaced the base plates in sagital anterior direction. PVS impressions of the simulated ridges were made. They were poured in type IV stone. A total of 54 acrylic base plates with 1 mm thickness were fabricated (n=6 per experimental condition). The acrylic base plates were placed on matching ridge models and the palatal-base plate distances were measured at each 1.000mm as the base plates were displaced in an anterior direction. The x and y values were plotted showing the vertical palate-base plate distance (y) as a function of anterior displacement (x). All results followed third degree polynomials. In conclusion, the best fit at zero displacement was for ridges with an anterior convergency of 15 degrees and an outside slope 60 degrees. Furthermore, it can be concluded from this study that the steeper the outer angles of the ridges, the worse the fit of the acrylic base at zero displacement. Also, the anterior displacement of a relatively well fitting acrylic base plate causes the fit to become poor because of the influence of the inner slopes of the simulated ridges.
General Note: In the series University of Florida Digital Collections.
General Note: Includes vita.
Bibliography: Includes bibliographical references.
Source of Description: Description based on online resource; title from PDF title page.
Source of Description: This bibliographic record is available under the Creative Commons CC0 public domain dedication. The University of Florida Libraries, as creator of this bibliographic record, has waived all rights to it worldwide under copyright law, including all related and neighboring rights, to the extent allowed by law.
Statement of Responsibility: by Yacoub Al-Tarakemah.
Thesis: Thesis (M.S.)--University of Florida, 2007.
Local: Adviser: Soderholm, Karl J.
Local: Co-adviser: Clark, Arthur E.

Record Information

Source Institution: UFRGP
Rights Management: Applicable rights reserved.
Classification: lcc - LD1780 2007
System ID: UFE0021448:00001


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EFFECT OF RIDGE SHAPE ON THE FIT OF DENTURE BASES


By

YACOUB AL-TARAKEMAH














A THESIS PRESENTED TO THE GRADUATE SCHOOL
OF THE UNIVERSITY OF FLORIDA IN PARTIAL FULFILLMENT
OF THE REQUIREMENTS FOR THE DEGREE OF
MASTER OF SCIENCE

UNIVERSITY OF FLORIDA

2007





































O 2007 Yacoub Al-Tarakemah



































To all who nurtured my intellectual curiosity, academic interests, and sense of scholarship,
making this milestone possible










ACKNOWLEDGMENTS

I would like to express my appreciation to Dr. Karl-Johan Soderholm, my supervisory

committee chair, for all his support and guidance. I would also like to thank Dr. Buddy Clark, my

supervisory committee cochair, for his time and effort. Special thanks go to Dr. Edgar O'Neill and

Dr. Lucius Battle for their insight and support. Thanks also go to Mr. Pete Michel and the

Bioengineering Department for all their help in constructing the equipment used in this study. To my

parents I express much gratitude and love for all the support and love they have provided me. Lastly,

I would like to thank my better half Rana, my wife, for her love and encouragement throughout my

studies.












TABLE OF CONTENTS


page

ACKNOWLEDGMENTS .............. ...............4.....


LIST OF FIGURES .............. ...............6.....


AB S TRAC T ......_ ................. ............_........7


CHAPTER


1 INTRODUCTION AND LITERATURE REVIEW .............. ...............9.....


Historical Overview of Materials Used to Replace Teeth ................. .......... ................9
Polymerization Shrinkage of Poly Methyl Methacrylate ........._.._.. ......._ ................1 1
Techniques Used for Processing of Poly Methyl Methacrylate .............. ....................1
Processing Errors of Poly Methyl Methacrylate ................ ... ........ ._._.. .... .... .... ..........1
Occlusal Disharmonies after Processing Heat Cured Poly Methyl Methacrylates.................15
Obj ective of Study ................. ...............15........ .....

2 MATERIALS AND METHODS .............. ...............16....


Simulated Ridges ...._.._ ................ .. ......__. ..........1
Acrylic Base Manufacturing Process ................. ...............17........... ...
M easuring Approach .............. ...............18....

3 RE SULT S AND DI SCU SSION ............... ...............2


Re sults ................ .......... ...............23.......
Zero Di spl acement. ........._._ ...... .__ ...............23..
Horizontal Displacement ........._._ ...... .... ...............23...
Discussion ........._..... ...... ...............24....
Zero Di spl acement. ........._._ ...... .__ ...............24..
Horizontal Displacement ........._._ ...... .... ...............25...

4 SUMMARY AND CONCLUSIONS ........._._.. ...... ...............34..


LIST OF REFERENCES ........._._ ...... .... ...............35...


BIOGRAPHICAL SKETCH .............. ...............39....











LIST OF FIGURES


Figure page

2-1 Aluminum ridge pairs. ............. ...............21.....

2-2 Ridge pair secured to aluminum plate .............. ...............21....

2-3 Ridge pair mounted to plastic stand ..........._ .....___ ...............22.

3-1 Ridge pair 1, 50 convergence. .............. ...............28....

3-2 Ridge pair 1, 100 convergence ...........__......___ ...............28.

3-3 Ridge pair 1, 150 convergence ...........__......___ ...............29.

3-4 Ridge pair 2, 50 convergence. .............. ...............29....

3-5 Ridge pair 2, 100 convergence. .............. ...............30....

3-6 Ridge pair 2, 150 convergence ...........__......___ ...............30.

3-7 Ridge pair 3, 50 convergence. ..........._ ..... ..__ ...............31.

3-8 Ridge pair 3, 100 convergence ...........__......___ ...............31.

3-9 Ridge pair 3, 150 convergence. .............. ...............32....

3-10 Distance between the acrylic base plates and the metal palatal plate ................ .. .............33









Abstract of Dissertation Presented to the Graduate School
of the University of Florida in Partial Fulfillment of the
Requirements for the Degree of Master of Science

EFFECT OF RIDGE SHAPE ON THE FIT OF DENTURE BASES

By

Yacoub Al-Tarakemah

August 2007

Chair: Karl-Johan Soiderholm
Cochair: Buddy Clark
Major: Dental Sciences

The obj ective of this study was to determine the accuracy of heat cured acrylic base

plates on simulated edentulous ridges with different configurations. Edentulous ridges of the

maxillae were simulated by attaching parallel trapetsoidal rods simulating ridges to a flat plate

simulating the palate. The slope of the palatal "ridges" was always 450, while the outside slopes

were either 850, 750 or 600. The sagital ridge convergencies were 50, 100 or 150 for each ridge

shape. No ridges were simulated in the anterior regions. Two micrometers were attached to the

aluminum base that mounts the simulated ridges. One measured the space between the metal

palate surface and the base plate, and the other displaced the base plates in sagital anterior

direction. PVS impressions of the simulated ridges were made. They were poured in type IV

stone. A total of 54 acrylic base plates with 1 mm thickness were fabricated (n=6 per

experimental condition). The acrylic base plates were placed on matching ridge models and the

palatal-base plate distances were measured at each 1.000mm as the base plates were displaced in

an anterior direction. The x and y values were plotted showing the vertical palate-base plate

distance (y) as a function of anterior displacement (x). All results followed third degree

polynomials. In conclusion, the best fit at zero displacement was for ridges with an anterior









convergency of 150 and an outside slope 600. Furthermore, it can be concluded from this study

that the steeper the outer angles of the ridges, the worse the fit of the acrylic base at zero

displacement. Also, the anterior displacement of a relatively well fitting acrylic base plate

causes the fit to become poor because of the influence of the inner slopes of the simulated ridges.









CHAPTER 1
INTRODUCTION AND LITERATURE REVIEW

Historical Overview of Materials Used to Replace Teeth

History reveals evidence of human struggle to replace missing teeth as far back as 3000

BC. Evidence was found that proves the Egyptians bounded teeth together with gold wires.1,2 In

700-500 B.C., the Etruscans became experts in restorative dentistry using gold bonded bridge

work.3,4 It is speculated that the Mayas were the first to perform tooth transplantation 200-900

B.C.5 Pfaff proposed softened wax techniques to make impressions of teeth sometime between

1746 and 1755. This was a maj or breakthrough because it was the first time it became possible

to use the indirect technique to fabricate dentures.6 As time passed by, loss of teeth was both

expected and accepted by the poor and wealthy. GeOrge Washington had several dentures

throughout the years, some were made out of gold, lead alloy, hippopotamus tusk and human

teeth.' As time progressed, wealthy people had dentures made of silver, gold, mother of pearl or

agate.3 In the 1700's entire dentures were made of porcelain. The porcelain dentures were

appealing because unlike their predecessors, they would not rot. Porcelain teeth were then

developed and moved to the United States in the 1800's and were marketed on a large scale.8 In

the 19th century, vulcanized rubber was the next discovery that caused a breakthrough in

denture fabrication.9 Following vulcanized rubber, polymers such as polystyrene, vinyl acrylates,

nylon and polycarbonate were used for fabricating dentures.10

Today, the most commonly used material for denture bases is methyl methacrylate. It was

first discovered in 1927, when Bauer, working with Otto Rohm, of Darmstadt, Germany,

developed a synthesis making possible the production of small quantities of methyl ester of

acrylic acid. 11 Products of polymerization of acrylic acid and its derivatives are known as

acrylic resins. 11 It is worth mentioning that German researchers were the first leaders of the









Hield of acrylic discovery. The fundamental research of acrylic resins for use in dentistry was

performed by German researchers and confirmed by researchers in the USA.

A progress report on denture base materials of that time was published by Sweeney et al. 12

In 1936, The House of Delegates of the American Dental Association requested a study of

denture materials from the research committee of the National Bureau of Standards. The

research was started with the obj ective of developing a set of tests, and test methods, which

would satisfactorily establish the suitability of denture base materials. The report dealt with tests

of denture base materials prior to PMMA mentioned earlier.

In 1937 acrylic resin was introduced to the United States from Germany and has since then

remained the material of choice in fabricating dentures. 13,14, 15,16 In 1939, Sweeney et al.17

published an article that compared the widely used denture base rubber and other materials with

the relatively newly discovered PMMA resin. He performed physical and chemical tests on both

materials and found PMMA to be superior to the hard rubber, which was the most used and most

satisfactory of denture bases at that time. The ninth report on organic denture base materials

from the laboratories of the National Bureau of Standards was published in 1942. 18 It also

compared PMMA resins with the denture base materials of that time and found PMMA and

acrylic-vinyl resin to be the most satisfactory for denture bases. The significance of this article is

that any new plastic from that time forward should first be tested as described in this paper

before marketed to be used as a denture base material. Peyton et al. 16 recognized the potential

of using acrylics in denture bases and restorative procedures but warns of failures in the latter if

not properly processed or placed. In 1942, Tylman et al. 19 recognized the potential of PMMA

for use as denture bases but warned of their use as restorative materials due to water absorption









of the material, which causes expansion. Acrylic resin was gaining in popularity due to its

excellent esthetic properties, adequate strength, resiliency, ease of processing and finishing.20

Polymerization Shrinkage of Poly Methyl Methacrylate

Acrylic resin did show a high degree of accuracy compared with the previous materials but

did not come without some shortcomings. The combined effects of polymerization contraction of

the PMMA acrylic, its thermal contraction, and strain induced during deflasking result in poor

adaptation of the denture base to the edentulous arch.21 The magnitude of this problem is easily

understood when one realizes that the volumetric shrinkage of the monomer is as high as 21 vol-

%. The denture base is required to intimately contact the supporting tissue in order for it to be

successful. The shrinkage of the acrylic denture negatively affects the intimate contact between

the acrylic denture and the supporting tissue. If the denture contracts away from certain areas in

the edentulous arch, then it will tend to apply pressure in other areas and could cause a change in

occlusion. Several authors stated that the shrinkage of PMMA was a 3-dimensional process in

several planes and was not linear.22,23 Polychronakis et al.24 agreed that maxillary dentures

did exhibit dimensional changes but the dimensional changes were considered clinically

acceptable.

Several authors used different techniques in to measure the effect of polymerization

shrinkage on the adaptation of the denture base. 15,25 Anthony et al.26 observed that nearly all

maxillary dentures, after they are processed and then placed back on the master casts, will appear

to contact the model in the flange regions and be deficient at the buccal borders. He also

observed that the dentures showed the greatest discrepancies across the central portion of the

posterior border.26 Sykora et al.27 measured the opening distance at the posterior palatal seal at

5 mm intervals across the posterior palatal border. Takamata et al.28 flowed low viscosity

addition polymerizing PVS material between the processed denture and the master die and then










weighed the PVS on an accurate scale. Consani et al.29 placed processed resin bases on the

master casts with an adhesive resin and then sectioned them laterally to measure the distance

between the resin and the master cast at different anterior-posterior segments.

Kawara et al.30 and Kimoto et al.31 used strain gauges and thermo-couples that were

imbedded in the resin at time of resin packing to quantitatively determine the degree of distortion

of heat cured PMMA resins while being processed. Kawara et al.30 and Kimoto et al.3 1 studies

differed from other studies by studying the shrinkage in a dynamic manner compared to others

that studied the distortion after the denture base had been processed and remained stationary.

Techniques Used for Processing of Poly Methyl Methacrylate

Several techniques for processing PMMA dentures have been described in the

literature.28 The traditional and most common technique of processing dentures has been in a

brass denture flask for compression molding of the heat cure acrylic while in its doughy stage.28

Several authors studied different processing techniques on the outcome of denture adaptation.

Sykora et al.27 compared the traditional heat cured compression molding technique to the

injection molding technique. Their results showed that the injection molding technique showed

greater dimensional stability compared to the compression molding technique. Goodkind et

al.32 compared pour technique of processing dentures versus cold cure packing and found that

bases processed with pour technique shrunk more than those processed from the cold cure

technique. Peyton et al.33 compared self-curing and heat curing denture resins. He found that

the dimensional stability of the self-curing acrylic is generally equal or superior to heat-cured

acrylic. Dukes et al.34 compared compression molding to the pour technique and discovered

that compression molding resulted in a smaller increase in vertical dimension of occlusion

compared to the pour resin technique. Several other authors studied different variations in

denture processing techniques but keeping the shape of the master model constant. In contrast,









some other authors chose to vary the shape of the master model. Sykora et al.27 compared a

continuous-inj section technique to the trial pack technique but varied the palatal vault shape by

either being flat or high. They stated that the inj ection-technique showed better adaptability and

that the results were influenced by palatal shape. Pow et al.35 studied the effect of relining and

rebasing on 22 different maxillary and mandibular complete dentures. They found that relining

and rebasing procedures exhibited shrinkage of 0.3% despite different shapes of maxillary and

mandibular dentures.

Hedge et al.10 compared V-shaped, U-shaped and flat-shaped palatal vaults using the heat

cured press pack technique. They concluded that the V shaped palatal vault exhibited the highest

dimensional change in the frontal and vertical planes. Koirber studied the effect of ridge size and

ridge shape and found that as the ridge size increased and the outer surfaces became more

parallel, the larger the palatal discrepancy became.36 Mandibular denture dimensional changes

were measured by Lechner et al.37. They found that linear shrinkage occurred in all dimensions

with the greatest shrinkage in the anterior-posterior direction along the lingual flanges. Vast

amount of literature is available that compares the processing techniques of complete dentures

against each other. Some of the for-mentioned articles add limited geometrical analysis of the

edentulous arch to the comparison. The geometry usually includes the palatal vault shape and

does not focus on other areas of the edentulous arch such as the outer slope of the buccal plates

or the overall taper of the j aw when viewed occlusally.

Processing Errors of Poly Methyl Methacrylate

Fabricating heat cured PMMA dentures requires multiple steps with special attention to

details in each step. Several articles are available that address the different steps in fabricating

dentures and suggest methods to reduce polymerization shrinkage.38 Chen et al.39 found that

thicker dentures exhibited less molar to molar linear shrinkage but higher gaps in the posterior










palate compared with thinner dentures. Woelfel et al.40 agreed with Chen et al. in that thick

upper and lower dentures changed dimensionally less than thin ones. Sykora et al.41

investigated the type of stone used in flasking dentures. They found that the use of high

expansion stone yielded dentures with less gap at the posterior palate compared to dentures

fabricated with type III stone. Becker et al.42 found no difference between all gypsum

processing technique compared to silicone gypsum processing technique.

Skinner et al.43 studied the effect of varying the powder-liquid ratio of the resin on

shrinkage and water sorption. They found that it had little effect as far as dimensional changes

occurring during and after processing. Jerolimov et al.44 varied polymer/monomer mixing ratios

from 1.5:1 to 4.5:1 vol/vol to determine the effect on dimensional accuracy and impact

resistance of PlVMA resin. The wide variation in powder-liquid ratio used by Kawara et al.30

revealed that a long, low-temperature processing technique was needed for the heat-activated

PlVMVA to reduce polymerization shrinkage and prevent boiling of the monomer. Yeung et al.45

findings disagreed with those findings of Kawara et al.30 because their results concluded that

temperature differential had been excluded as a reason for the warpage of dentures. Kobayashi

et al.46 suggested a gradual cooling course for 12 h or more after processing the heat-activated

acrylic denture to effectively lessen the denture deformation. Kimoto et al.31 concur with these

findings. Komiyama et al.47 on the other hand suggested bench cooling the flask for a minimum

of 1 d before deflasking. After processing and retrieval of the denture, Sykora et al.27 and

Anderson et al.48 agreed that immersion of the denture in water results in no statistically

significant change in dimensions. Cal et al.45 and Cheng et al.50 recommend adding glass fibers

to the denture base polymer to reduce dimensional changes in dentures. Collard et al.51 found









that the addition of montmorillonite to denture base resins reduced the linear shrinkage and

impact strength, while increased the roughness of the denture resin.

Occlusal Disharmonies after Processing Heat Cured Poly Methyl Methacrylates

Occlusal disharmonies after processing complete dentures are very common. A laboratory

remounting procedure is performed and the distortion usually causes a rise in the incisal pin of an

articulator an average of 0. 127 mm.34 Wesley et al.52 found a definite shift of tooth contacts to

the most posterior teeth after processing. Villa et al.53 TepOrted that shrinkage of an acrylic resin

during processing was the cause of occlusal discrepancies.

Basso et al. 54 COmpared the increase in vertical dimension of occlusion between dentures

with teeth arranged in lingualized occlusion and conventional balanced occlusion after heat-

processing. They found that both teeth arrangements exhibited similar vertical dimension of

occlusion increase but the lingualized occlusion was easier to adjust. Lingualized occlusion was

advocated as an effective occlusal scheme for maintaining balanced occlusion easily on one hand

and is aesthetically pleasing on the other hand. Also, lingualized occlusion ease of adjustability

may counteract the harmful tendency for teeth to shift due to polymerization distortion of the

heat cured PMMA dentures.54

Obj ective of Study

The obj ective of this study was to determine the accuracy of heat cured acrylic base plates

on simulated edentulous ridges with different geometric configurations. The hypothesis to be

tested was that the more parallel the outer ridges are, the larger the palatal discrepancy would be,

and the more parallel the ridges are in sagital direction, the more the base needs to be displaced

in anterior direction until optimal palatal adaptation is reached.









CHAPTER 2
MATERIALS AND IVETHODS

Simulated Ridges

Simulated ridges and sections of maxillary edentulous arches were made in aluminum by

attaching machined ridge sections to aluminum plates. The palatal slope of the aluminum ridges

was constant at a 45 degree angle. The outer slope of the ridges varied. One pair had an outer

slope of 85 degrees (pair number 1), the second pair had a slope of 75 degrees (pair number two)

and the third pair had a slope of 60 degrees (pair number 3). The right height of the three

different shapes was kept constant at 10 mm (Figure 2-1).

In addition to the ridge shape variable, a second variable was the angle of convergence

between each of the paired simulated edentulous ridges when viewed from the anterior-sagital

direction. These angles were 5 degrees, 10 degrees and 15 degrees. For each ridge shape pair,

three aluminum plates were fabricated so the anterior-sagital conditions for each ridge shape

criteria could be met. The aluminum ridges were mounted on the plates by means of threaded

screws that precisely fit the aluminum ridges from the bottom. Thus, a total of nine simulated

ridge conditions were made (Figure 2-2).

After mounting the ridge pair on the respective aluminum plate, the partly simulated

aluminum maxilla was fitted to a four-legged plastic table that would suspend the aluminum

plate and ridges approximately 254 mm high (Figure 2-3). As seen from Figure 2-3, the

aluminum ridges lacked anterior segments representing the premaxillae. This segment was left

out intentionally. The reason the premaxillae was omitted from the design was due to the

method used to collect fitness data as the base was displaced in anterior direction.










Acrylic Base Manufacturing Process

A polyvinylsiloxane (PVS) duplicating material (PolyPour, batch #060321, GC Lab

Technologies, Alsip, IL, USA) was used to replicate each aluminum ridge pair. The area of

impression making was standardized by boxing the area of the ridges by using an aluminum

cylinder (inner diameter of 120 mm and 80 mm high) that fit all the plates accurately. After

boxing the aluminum ridges, the PVS catalyst and base were mixed. Equal quantity of the PVS

duplicating material was mixed (60 mL of each component) for 15 s until a homogenous color

was achieved then the mixture was slowly poured over the aluminum ridges. With this approach

one PVS mold per ridge condition was made. The impressions were poured in dental stone

(Microstone, batch# 027040705, Whip Mix, Louisville, KY, USA). The stone came in

individualized packages of 140 g. Each package was mixed with 40 mL water and hand mixed

for 15 s, whereupon the stone was mixed under vacuum (Vac-u-vestor, Serial # 0179003, Whip

Mix, Louisville, KY, USA) for another 25 s. The stone was then poured in each of the PVS

impressions and retrieved one hour after pouring. Each PVS mold was poured six times to yield

a total of 9 x 6 (54 stone models).

On each of the made gypsum casts, one layer of base plate wax (Henry Schien, Pink

Medium Wax, batch# 062542, Melville, NY, USA) was heated uniformly and fitted over each

model. The edges of the base plate wax were cut to fit the outer slopes of the model, the inner

slopes and the palate.

Flasking was done by placing the wax covered stone model in the base of the flask (Hanau

Varsity, Hanau Eng. Co. Inc., Model# 66039, Buffalo, NY, USA) and pouring stone

(Microstone, batch# 027040705, Whip Mix, Louisville, KY, USA) into the flask. The stone

around the master model was smoothed even and any undercuts were removed. A plaster

separator (Swan petroleum jelly, Cuberland Swan, Smyrna, TN, USA) was painted on the master









model and base stone. The upper half of the flask was then placed on the base securely and a

second mix of stone (Microstone) was flowed in place while the flask was resting on a vibrator

(Buffalo, No.2, Buffalo Dental Mfg Co., Inc., Syosset, NY, USA) at medium vibration. A

plaster separating material (Swan petroleum jelly) was then painted over the second stage pour.

A new mix of stone (Microstone) was then placed on the top half of the flask that was slightly

overfilled. The lid of the flask was then gently tapped to allow excess stone to exit the holes in

the flask edges and lid. The excess stone was cleaned off after it had set.

The acrylic base plates were processed in a similar manner described by Becker.42 After

boil-out of the base plate wax and a brief cooling of 15 minutes, the monomer and polymer of

the heat cured resin (Lucitone, batch# 061113, Dentsply Int., York, PA) were mixed according to

the instructions supplied by the manufacturers liquid-powder ratio and allowed to gel in an air

tight mixing j ar for about three minutes. The room temperature was kept at 23.50C. One trial

pack of the resin was needed due to the small amount needed to fill the lost wax. Eleven

hundred twenty N of pressure was used for the trial pack with two sheets of cellophane. Final

closure was done at 20016 N of pressure. The flask was then transferred to a hand press. The

long cure method was used for polymerization by immersing the flask in 710 C for 9 h. After 9 h

in the water bath, the flask was bench-cooled for 12 h in compliance with Kobayashi.46 After

separation from the flask; the acrylic base plates were recovered from the stone models and

placed in an air tight plastic bag with water. Measurements were made approximately 24 h after

recovery of the base plates.

Measuring Approach

To measure the fit of the acrylic bases to the original aluminum models, two micrometers

(Fowler 0-6" 0.00005", Fred V. Fowler Co., Inc, Newton, Massachusetts, USA) were attached to

the aluminum plates to which the aluminum ridges had been mounted. The micrometers were









attached by means of screws that were machined in each of the aluminum plates in the exact

same position (Figure 2-3). One micrometer was attached to the bottom of the aluminum plate in

the center of the simulated j aw segment. At that location, a hole was drilled so the micrometer

could read the distance between the aluminum plate and the palate of the acrylic base. This hole

was located in the exact same position in relation to the pair of aluminum ridges regardless

which plate they were mounted to. The other micrometer was attached at the edge of the

aluminum plate touching the widest part of the acrylic base representing the posterior edge of the

denture. This micrometer was used to displace the acrylic base anteriorly. Thus, by use of these

two micrometers, it was possible to record the vertical distance between the palate part of the

aluminum plate and the acrylic base plate as it was displaced in the horizontal direction. The

reason the aluminum ridges lacked the anterior segment representing the premaxillae was to

allow the recording of the acrylic base as it was displaced anteriorly without interfering with an

anterior ridge segment

Before a measurement procedure started, all sharp and uneven edges around the periphery

of the acrylic denture base were smoothed to allow the seating of the acrylic base plate on the

aluminum ridges more accurately. The edge of the denture base was aligned with a straight line

connecting the posterior edges of the aluminum ridges. This position represented the horizontal

location of the denture base before it had been displaced and was assigned the horizontal 0.000

mm position. The vertical micrometer was set in its zero position representing a position when

its measuring rod was flush with the simulated palate of the aluminum plate. The vertical

micrometers wheel was then turned until the rod touched the intaglio surface of the denture base.

The reading of that distance was recorded as the vertical discrepancy at the horizontal "O"

position. The denture base was then displaced horizontally in 1.000 mm steps by using the









horizontal micrometers rod and at each such step the distance between the palate and the intaglio

of the denture base was read with the vertical micrometer at that position until no further

displacement could be read because of interference between the two micrometers (Figure 2-3).

The interference between the two micrometers would coincide with a horizontal displacement of

14.000 mm in all 54 cases.

The measured distances between the acrylic base plates and the aluminum plates at all

intervals were entered into Microsoft Excel (Microsoft, Redmond, WA, USA) and plotted using

the XY scatter chart type. After the graphs were completed, Microsoft Excel was used to

formulate a trend-line of the plotted data. The trend-line chosen was a polynomial of the third

degree. In addition, the software was used to calculate the equation of the third degree

polynomial and show it on the graph. By deriving the third degree polynomial, it was also

possible to determine max and mean values that were found for some cases within the 0.000 to

14.000 mm displacement.

























Figure 2-1. Aluminum ridge pairs. Pair number 1 is far left with outer wall slope of 850. Pair
number 2 in the middle with outer wall slope of 750 and pair number 3 with outer
wall slope of 600 in the far right.




















Figure 2-2. Ridge pair secured to aluminum plate. The sagital ridge convergences were either
50, 100 or 150 for each ridge pair. This was achieved by mounting the machined
ridge pairs on aluminum plates by means of precisely placed screws. No ridges were
simulated in the anterior region.




































Figure 2-3. Ridge pair mounted to plastic stand. To measure the fit of the processed acrylic
bases, two micrometers were attached to the aluminum plates. One measured any
space between the intaglio surface of the base plate, and the other measured the
displacement of the base plate in sagital/anterior direction.









CHAPTER 3
RESULTS AND DISCUSSION

Results

Zero Displacement

The results for the different ridges are presented in Figures 3-1 to 3-9. Figure 3-1 shows

the graph for the ridge pair 1 with the 5 degrees convergence angle. At the zero mm

displacement position, the average of the six samples yielded a spacing between the palatal part

of the acrylic base and the metal plate of 2.290 mm. Figure 3-2 shows the value for the same

ridge pair but with a sagital convergence angle of 10 degrees, while Figure 3-3 shows the

displacement for the same ridge pair but with a convergence angle of 15 degrees. As seen from

Figure 3-2, the zero mm displacement position was an average of 1.313 mm, while in Figure 3-3,

the zero mm displacement position was an average of 0.564 mm. From these figures it is clear

that at the zero mm position distance, the acrylic plate to metal plate distance decreased,

suggesting that as the convergence angle between the aluminum ridge increased, the better the fit

between the acrylic base plate and the aluminum ridges. A similar pattern was observed in the

10 and 15 degree convergence of the aluminum ridges with 75 and 85 degree outer slopes at zero

displacement.

Horizontal Displacement

After performing the measurements at zero displacement, the acrylic plates were displaced

anteriorly by 1.000 mm increments. For the ridges with anterior convergency, the gap between

the aluminum plate and the acrylic base plates decreased as the base plates were displaced

anteriorly. However, after the gap between the acrylic base plates and the aluminum plates

reached a certain distance, the acrylic plates started rising again and the measurements become

larger. An exception was the 15 degree convergence ridges which had a tendency to raise the










acrylic plate early in the displacement if not as soon as the displacement had begun. The inner

slope of the aluminum ridges, which formed a 45 degree angle with the metal plates, was found

to be the contributing factors to the rise of the acrylic plates. Even though all inner slopes were

constant at 45 degrees, they influence the fit by interfering with the intaglio surface of the more

converging ridges as the base plate was anteriorly displaced (Figure 3-10).

The x and y values of each ridge condition (Figures 3-1 to 3-9) followed third degree

polynomials quite well (see the R-values for the different curves). The y-values at x=0 were

analyzed using a two-way ANOVA to determine significant effects (p<0.05) of ridge slope and

ridge convergency. The same analysis was conducted for the y-values determined at the 14.000

mm displacement location in sagital direction.

The results revealed strong significant correlations between ridge slope and ridge

convergency (p<0.001) and a weaker but still strongly significant (p<0.001) interaction between

these two variables. The polynomials made it also possible to determine the location within the

measured range where the shortest y-value existed. The results recorded at x=0.000 and

x=14.000 as well as where the shortest y-value were detected between these two end points.

Discussion

Zero Displacement

As seen from Figure 3-10, the y-values at zero displacement (blue bars) revealed that the

fit of the processed record base on ridge pair 1 (850 outer walls) with 50, 100 or 150 convergence

(1,50), (1,100) and (1,150) is clearly worse than ridge pair 2 (750 outer wall) and ridge pair 3 (600

outer wall) both with 50, 100 and 150 convergence. In other words, as the outer walls of the ridge

pairs became steeper, the worse the initial fit of the acrylic plates became apparent at zero mm

displacement. This can be attributed to the polymerization shrinkage of the acrylic base plates

resulting in a tighter contact on the outer wall of the steeper ridges (ridge pair 1 with 850 outer









walls) in comparison to the less steep outer walls of ridges 2 and 3 (with the 750 and 600

respectively).

Further along at zero mm displacement, ridge pair 1 with 50 convergence (1,50) exhibits a

poorer fit than the (1,100) and (1,150) convergency. When comparing all three ridge pairs (1, 2

and 3) with 50 convergence to same ridge pair with 100 and 150 convergence, it is clear that the

fit of the acrylic base plates improves respectively as the sagital convergency increases.

Consequently, all ridge pairs with 50 convergency (smallest anterior convergency angle),

adapts poorly in comparison to ridge pairs which converged more. On the other hand, it was

noticed that the poor fit of the record base at (1,50) was improved when the same convergence

angle (50) was tested on ridge pair 2 and 3 (750 and 600 respectively) at zero displacement

(Figure 3-10). The same applies to all ridge pairs with 100 and 150 convergency at zero

displacement (Figure 3-10). Thus, ridges with more sagital/anterior convergence had better

adapting record bases at x=0. This allows us to postulate that edentulous maxillas that are

tapered when viewed occlusaly would have a better denture fit compared to an edentulous

maxillae that is squared when viewed occlusaly. This result is in line with Koirber' s36 clinical

study. In addition, dentures fabricated for edentulous maxillary ridges with more resorption on

the buccal plate would fit better than dentures made for parallel ridges.

Horizontal Displacement

At maximum displacement (x=14.00 mm, yellow bars in Figure 3-10), the fit of the

processed base plate had an inversely related relationship with the fit of the acrylic base plate at

zero displacement. This is especially evident if the initial fit is poor or good. It was noticed

while performing the measurements that the inner slopes of the ridge pairs had a large influence

on this phenomenon. When the initial fit of the record base was mediocre, it seemed to be a

competition between the outside ridge slope and the palatal ridge slope as the base plate was










displaced in an anterior direction. That interaction explains why a minimum (red bar in Figure

3-10) in y-values existed between the extreme displacement locations x = 0.000 mm and x =

14.000 mm. The reason behind the observations stated above is the degree of convergence of the

ridge pairs. The more the ridge pairs converged anteriorly, the better the initial fit at zero

displacement. However, the inner slope of the ridge pair influenced the base plate sooner in the

displacement and worsens the fit of the base plate.

The results of this study can be applied to the edentulous arch when viewed transversely.

The buccal plate of the edentulous maxillary arch resorbs medially as time passes. As suggested

by the results of this investigation, the higher the degree of buccal resorption, the better the

palatal adaptation will be. In cases where the edentulous arches are more parallel in sagital

direction, a clinician should expect more denture adjustments to be done on the buccal plate.

Conversely, if the buccal plates of an edentulous arch seem highly resorbed, the clinician might

predict an intimate adaptation of the denture.

The shapes of the edentulous arches when viewed occlusaly is another factor that can help

a clinician predict the fit of a denture. If the shape of the edentulous arch is tapered, one might

argue that the patient will experience more sore spots around the inner slopes of the pre-maxillae

area. This is extrapolated from the study because the higher the convergence seen between the

edentulous arches, the sooner the interference exhibited by the inner slope of those edentulous

arches. If the shape of the edentulous arches is square on the other hand, the clinician might find

less sore spots around the inner slopes of the premaxillae because the inner slopes wouldn't

interfere with the seating of the denture as soon as a tapered shaped maxillary arch. In contrast,

the sore spots might show more on the distal slope of the maxillary ridges close to the hamulus.









If a clinician could predict areas of soreness by studying the shape of an edentulous

maxillary arch, he or she could relief those areas on the master cast before the denture is

processed or delivered. Possible ways to achieve such relief could be to use tin foils in order to

relief the critical areas. For example, if a patient presented with a tapered maxillary arch, the

dentist could use tin foil and burnish it on the premaxillae and the inner slopes of the edentulous

arches close to the premaxillae to alleviate future soreness in this area resulting from the

tendency of these areas to lift the acrylic base. However, the relief of the compressed regions

could also have negative effects on denture retention. It is well-known that upper dentures are

very well retained initially, but after a few weeks in service their retention decrease. That

decrease is most likely a result of tissue adaptation to an initially poorly fit denture. Thus, by

using tin foils to relief pressure sites. The relief could result in a denture that the patient would

perceive as a poorly retained denture, which could have negative effects as well. Therefore, to

determine whether predicted pressure sites should be relieved or not, it is important to perform

systematic clinical studies in an attempt to find the best way to optimize the performance of a

complete denture.

Further analysis could be performed to describe the fit of the acrylic base plate by use of a

third degree polynomial (y= Dx3 + Cx2+ Bx + A). From our study we know that A in that

polynomial describes the starting gap between the base plate and the palate. More analysis

should be performed to study the variables B, C and D which could be linked to the shrinkage of

the acrylic base plate and the two angle variables (outer slopes and sagital convergency).




















-*-eries1
- Poly. (Series1)


0 1 2 3 4 5 6 7 8 9 101112131415
Anterior Displacement (mm)

Figure 3-1. Ridge pair 1, 50 convergence. Changes in base plate/palatal displacement as base
plate is displaced in an anterior direction. Diamond shapes represent mean values
(n=6) and adjacent vertical lines their standard deviations. The polynomial for this
curve was y= 0.0006x3 0.0094x2 0.081x + 2.3074 and the R2 = 0.9861


-*-Series 1
- Poly. (Series1)


0 1 2 3 4 5 6 7 8 9 101112131415
Anterior Displacement (mm)

Figure 3-2. Ridge pair 1, 100 convergence. Changes in base plate/palatal displacement as base
plate is displaced in an anterior direction. Diamond shapes represent mean values
(n=6) and adjacent vertical lines their standard deviations. The polynomial for this
curve was y= 0.0003x3 + 0.0049x2 0.1489x + 1.3415 and the R2 = 0.9665



















-*- Series 1
-Poly. (Series 1)


0 5 10

Anterior Displacement (mm)


Figure 3-3. Ridge pair 1, 150 convergence. Changes in base plate/palatal displacement as base
plate is displaced in an anterior direction. Diamond shapes represent mean values
(n=6) and adjacent vertical lines their standard deviations. The polynomial for this
curve was y= -0.0004x3 + 0.0111x2 + 0.0183x + 0.535 and the R2 = 0.999


1.4


1.


S0.8

S0.6

10.4

10.2


-o- Series 1
-Poly. (Series 1)


0 1 2 3 4 5 6 7 8 9 101112131415
Ante rior Dis place ment (m m)


Figure 3-4. Ridge pair 2, 50 convergence. Changes in base plate/palatal displacement as base
plate is displaced in an anterior direction. Diamond shapes represent mean values
(n=6) and adjacent vertical lines their standard deviations. The polynomial for this
curve was y= -0.0005x3 + 0.0158x2 0. 1314x + 0.8272 and the R2 = 0.9088














S1.4
1.2


S0.8

g 0.6
-- 0.4

a 0.2


-o- Series 1
-Poly. (Series 1)


0 1 2 3 4 5 6 7 8 9 101112131415

Anterior Displacement (mm)


Figure 3-5. Ridge pair 2, 100 convergence. Changes in base plate/palatal displacement as base
plate is displaced in an anterior direction. Diamond shapes represent mean values
(n=6) and adjacent vertical lines their standard deviations. The polynomial for this
curve was y= -0.0006x3 + 0.0179x2 0.087x + 0.5298 and the R2 = 0.9586


-o-Series 1
- Poly. (Series1)


0 1 2 3 4 5 6 7 8 9 101112131415

Anterior Displacement


Figure 3-6. Ridge pair 2, 150 convergence. Changes in base plate/palatal displacement as base
plate is displaced in an anterior direction. Diamond shapes represent mean values
(n=6) and adjacent vertical lines their standard deviations. The polynomial for this
curve was y= -0.0012x3 + 0.027x2 0.0527x + 0.2574 and the R2 = 0.9773




















-o-Series 1
- Poly. (Series1)


0 2 4 6 8 10 12 14 16
Anterior Displacement (mm)


Figure 3-7. Ridge pair 3, 50 convergence. Changes in base plate/palatal displacement as base
plate is displaced in an anterior direction. Diamond shapes represent mean values
(n=6) and adjacent vertical lines their standard deviations. The polynomial for this
curve was y= -2E-05x3 + 0.0034x2 0.044x + 0.5539 and the R2 = 0.9429


1.4

S1.2



S0.8

S0.6

S0.4



0


-*-eries1
- Poly. (Series1)


0 1 2 3 4 5 6 7 8 9 101112131415
Ante rior Dis place m ent (m m)


Figure 3-8. Ridge pair 3, 100 convergence. Changes in base plate/palatal displacement as base
plate is displaced in an anterior direction. Diamond shapes represent mean values
(n=6) and adjacent vertical lines their standard deviations. The polynomial for this
curve was y= -0.0005x3 + 0.0148x2 0.0501x + 0.3924 and the R2 = 0.9991


















-o-eries1
- Poly. (Series1)


0 5 10 15 20
Anterior Displacement (mm)


Figure 3-9.


Ridge pair 3, 150 convergence. Changes in base plate/palatal displacement as
base plate is displaced in an anterior direction. Diamond shapes represent mean
values (n=6) and adj acent vertical lines their standard deviations. The polynomial for
this curve was y= 0.0001x3 0.003 1x2 + 0. 13 62x + 0.2738 and the R2 = 0.9981






















L II I n Distance at zero
displacement
E Minimum Distance
E1.5

o Distance at Maximum
1 CCC- Displacement


0.5






Ridge, Convergence Angle

Fig. 3-10. Distance between the acrylic base plates and the metal palatal plate. [At zero
displacement (blue bars) and after 14 mm anterior displacement (yellow bars)]. In
some cases a lower displacement was identified between the start and end positions.
These minimum distances are shown as the red bars in the graph.









CHAPTER 4
SUMMARY AND CONCLUSIONS

Three configurations of edentulous arches with three options of anterior-sagital

convergences (per pair) were tested. Heat cured acrylic base plates were fabricated to measure

degree of adaptability of these base plates to the original simulated edentulous arches. The

adaptability was measured by means of micrometers attached to the bottom and side of the base

plates to be measured. The distance between the intaglio of the base plates and the palate was

measured by the vertical micrometer while the horizontal displacement was performed by the

horizontal micrometer in 1.000 mm increments. The measurements were plotted and equations

of the graphs were determined.

It can be concluded from this study that the steeper the outer angles of the ridges, the worse

the fit of the acrylic base at zero displacement. If the initial fit of the record base is poor (parallel

outer slopes or parallel convergence), anterior displacement causes it to improve. On the other

hand, if the initial fit of the record base is good (converged outer slopes or converged ridges), the

anterior displacement causes the fit to become poor because of the influence of the inner slopes

of the simulated ridges. These findings support our formulated hypothesis.









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BIOGRAPHICAL SKETCH

I was born in 1976 and grew up in Kuwait City, Kuwait. I graduated from Sabah Elsalim

High School in Kuwait City in 1994. In 1994, I enrolled at the University of Missouri Kansas

City as a dental student where I j oined the six year combined program of Bachelors of Arts and

Science and Dentistry. At the University of Missouri Kansas City I met my wife Rana, whom I

married to in 2002. Together we worked for the public health system of Kuwait from 2002 to

2004 before we decided to go back to the USA to specialize. I enrolled in the Graduate

Prosthodontics program at The University of Florida and she enrolled at the Graduate

Periodontic program at the University of Florida also. In 2004, Rana and I were blessed with our

first born Jawan and in 2005 we were blessed with our son Yousef. After graduation as a

specialist in Prosthodontics from the University of Florida in August of 2007, I will continue

teaching there until 2008 when my wife graduates. After both of us have graduated, we plan to

go back to Kuwait and work for the public health system for the betterment of the dental service

of our beloved country. This is the beginning of the rest of our lives.





PAGE 1

1 EFFECT OF RIDGE SHAPE ON THE FIT OF DENTURE BASES By YACOUB AL-TARAKEMAH A THESIS PRESENTED TO THE GRADUATE SCHOOL OF THE UNIVERSITY OF FLOR IDA IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF SCIENCE UNIVERSITY OF FLORIDA 2007

PAGE 2

2 2007 Yacoub Al-Tarakemah

PAGE 3

3 To all who nurtured my intellectual curiosity, academic interests, and sense of scholarship, making this milestone possible

PAGE 4

4 ACKNOWLEDGMENTS I would like to express my appreciation to Dr. Karl-Johan Sderholm, my supervisory committee chair, for all his support and guidance. I would also like to thank Dr. Buddy Clark, my supervisory committee cochair, for his time and effort. Special thanks go to Dr. Edgar ONeill and Dr. Lucius Battle for their insight and support. Thanks also go to Mr. Pete Michel and the Bioengineering Department for all their help in constructing the equipment used in this study. To my parents I express much gratitude and love for all the support and love they have provided me. Lastly, I would like to thank my better half Rana, my wife, for her love and encouragement throughout my studies.

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5 TABLE OF CONTENTS page ACKNOWLEDGMENTS...............................................................................................................4 LIST OF FIGURES................................................................................................................ .........6 ABSTRACT....................................................................................................................... ..............7 CHAPTER 1 INTRODUCTION AND LITERATURE REVIEW................................................................9 Historical Overview of Materi als Used to Replace Teeth........................................................9 Polymerization Shrinkage of Poly Methyl Methacrylate.......................................................11 Techniques Used for Processing of Poly Methyl Methacrylate.............................................12 Processing Errors of Poly Methyl Methacrylate.....................................................................13 Occlusal Disharmonies after Processing H eat Cured Poly Methyl Methacrylates.................15 Objective of Study............................................................................................................. .....15 2 MATERIALS AND METHODS...........................................................................................16 Simulated Ridges............................................................................................................... .....16 Acrylic Base Manufacturing Process......................................................................................17 Measuring Approach............................................................................................................. .18 3 RESULTS AND DISCUSSION.............................................................................................23 Results........................................................................................................................ .............23 Zero Displacement...........................................................................................................23 Horizontal Displacement.................................................................................................23 Discussion..................................................................................................................... ..........24 Zero Displacement...........................................................................................................24 Horizontal Displacement.................................................................................................25 4 SUMMARY AND CONCLUSIONS.....................................................................................34 LIST OF REFERENCES............................................................................................................. ..35 BIOGRAPHICAL SKETCH.........................................................................................................39

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6 LIST OF FIGURES Figure page 2-1 Aluminum ridge pairs....................................................................................................... .21 2-2 Ridge pair secured to aluminum plate...............................................................................21 2-3 Ridge pair mounted to plastic stand...................................................................................22 3-1 Ridge pair 1, 5 convergence.............................................................................................28 3-2 Ridge pair 1, 10 convergence...........................................................................................28 3-3 Ridge pair 1, 15 convergence...........................................................................................29 3-4 Ridge pair 2, 5 convergence.............................................................................................29 3-5 Ridge pair 2, 10 convergence...........................................................................................30 3-6 Ridge pair 2, 15 convergence...........................................................................................30 3-7 Ridge pair 3, 5 convergence.............................................................................................31 3-8 Ridge pair 3, 10 convergence...........................................................................................31 3-9 Ridge pair 3, 15 convergence...........................................................................................32 3-10 Distance between the acrylic base pl ates and the metal palatal plate................................33

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7 Abstract of Dissertation Pres ented to the Graduate School of the University of Florida in Partial Fulfillment of the Requirements for the Degree of Master of Science EFFECT OF RIDGE SHAPE ON THE FIT OF DENTURE BASES By Yacoub Al-Tarakemah August 2007 Chair: Karl-Johan Sderholm Cochair: Buddy Clark Major: Dental Sciences The objective of this study was to determin e the accuracy of heat cured acrylic base plates on simulated edentulous ridges with differe nt configurations. Edentulous ridges of the maxillae were simulated by attaching parallel trapetsoidal rods simulating ridges to a flat plate simulating the palate. The slope of the palatal ridges was always 45, while the outside slopes were either 85, 75 or 60. The sagital ridge convergencies were 5, 10 or 15 for each ridge shape. No ridges were simulated in the anterior regions. Two micrometers were attached to the aluminum base that mounts the simulated ridge s. One measured the space between the metal palate surface and the base plate, and the other displaced the base plates in sagital anterior direction. PVS impressions of the simulated ridg es were made. They were poured in type IV stone. A total of 54 acrylic base plates w ith 1 mm thickness were fabricated (n=6 per experimental condition). The acryl ic base plates were placed on matching ridge models and the palatal-base plate distances were measured at each 1.000mm as the base plates were displaced in an anterior direction. The x and y values were plotted showing the ver tical palate-base plate distance (y) as a function of anterior displa cement (x). All results followed third degree polynomials. In conclusion, the best fit at zero displacement was for ridges with an anterior

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8 convergency of 15 and an outside slope 60. Fu rthermore, it can be concluded from this study that the steeper the outer angles of the ridges, the worse the fi t of the acrylic base at zero displacement. Also, the anterior displacement of a relatively well fitting acrylic base plate causes the fit to become poor because of the influence of the inner slopes of the simulated ridges.

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9 CHAPTER 1 INTRODUCTION AND LITERATURE REVIEW Historical Overview of Materi als Used to Replace Teeth History reveals evidence of human struggle to replace missing teeth as far back as 3000 BC. Evidence was found that proves the Egyptia ns bounded teeth together with gold wires.1,2 In 700-500 B.C., the Etruscans became experts in re storative dentistry using gold bonded bridge work.3,4 It is speculated that the Mayas were th e first to perform toot h transplantation 200-900 B.C.5 Pfaff proposed softened wax techniques to make impressions of teeth sometime between 1746 and 1755. This was a major breakthrough becau se it was the first time it became possible to use the indirect techni que to fabricate dentures.6 As time passed by, loss of teeth was both expected and accepted by the poor and wealthy. George Washington had several dentures throughout the years, some were made out of gold, lead alloy, hippopotamus tusk and human teeth.7 As time progressed, wealthy people had dentures made of silver, gold, mother of pearl or agate.3 In the 1700s entire dentures were made of porcelain. The porcelain dentures were appealing because unlike their predecessors, they would not rot. Porcelain teeth were then developed and moved to the United States in the 1800s and were marketed on a large scale.8 In the 19th century, vulcanized rubber was the ne xt discovery that cau sed a breakthrough in denture fabrication.9 Following vulcanized rubb er, polymers such as polystyrene, vinyl acrylates, nylon and polycarbonate were used for fabricating dentures.10 Today, the most commonly used material for de nture bases is methyl methacrylate. It was first discovered in 1927, when Bauer, working with Otto Rohm, of Darmstadt, Germany, developed a synthesis making possi ble the production of small qua ntities of met hyl ester of acrylic acid.11 Products of pol ymerization of acrylic acid an d its derivatives are known as acrylic resins.11 It is worth mentioning that Ge rman researchers were th e first leaders of the

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10 field of acrylic discovery. The fundamental research of acrylic resins for use in dentistry was performed by German researchers and confirmed by researchers in the USA. A progress report on denture base materials of that time was published by Sweeney et al.12 In 1936, The House of Delegates of the Ameri can Dental Association requested a study of denture materials from the research committee of the National Bureau of Standards. The research was started with the objective of deve loping a set of tests, and test methods, which would satisfactorily establish the su itability of denture base material s. The report dealt with tests of denture base materials prio r to PMMA men tioned earlier. In 1937 acrylic resin was introduced to the Unite d States from Germany and has since then remained the material of choice in fabric ating dentures.13,14,15,16 In 1939, Sweeney et al.17 published an article that compared the widely used denture base rubber and other materials with the relatively newly discovered PMMA resin. He performed physic al and chemical tests on both materials and found PMMA to be su perior to the hard rubber, whic h was the most used and most satisfactory of denture bases at that time. The ninth report on organic denture base materials from the laboratories of the National Bureau of Standards was published in 1942.18 It also compared PMMA resins with the denture base materials of that time and found PMMA and acrylic-vinyl resin to be the most satisfactory for denture bases. Th e significance of this article is that any new plastic from that time forward should first be tested as described in this paper before marketed to be used as a denture base material. Peyton et al .16 recognized the potential of using acrylics in denture bases and restorative procedures but warn s of failures in the latter if not properly processed or plac ed. In 1942, Tylman et al.19 rec ognized the potential of PMMA for use as denture bases but warned of their use as restorative materials due to water absorption

PAGE 11

11 of the material, which causes expansion. Acry lic resin was gaining in popularity due to its excellent esthetic properties, adequate strengt h, resiliency, ease of processing and finishing.20 Polymerization Shrinkage of Poly Methyl Methacrylate Acrylic resin did show a high degree of accuracy compared with the previous materials but did not come without some shortcomings. The comb ined effects of polymerization contraction of the PMMA acrylic, its thermal contraction, and st rain induced during deflasking result in poor adaptation of the denture base to the edentulous arch.21 The magnitude of this problem is easily understood when one realizes that the volumetric shrinkage of the monomer is as high as 21 vol%. The denture base is required to intimately co ntact the supporting tissue in order for it to be successful. The shrinkage of the acrylic denture negatively affects the intimate contact between the acrylic denture and the supporting tissue. If the denture contracts away from certain areas in the edentulous arch, then it will tend to apply pressure in other ar eas and could cause a change in occlusion. Several authors stated that the shrinkage of PMMA was a 3-dimensional process in several planes and was not linear.22,23 Polychronakis et al.24 agreed that maxillary dentures did exhibit dimensional changes but the dimens ional changes were c onsidered clinically acceptable. Several authors used different techniques in to measure the effect of polymerization shrinkage on the adaptation of the denture base .15,25 Anthony et al.26 observ ed that nearly all maxillary dentures, after they are processed and then placed back on the master casts, will appear to contact the model in the flange regions and be deficient at the buccal borders. He also observed that the dentures showed the greatest discrepancies across the central portion of the posterior border.26 Sykora et al.27 measured the opening distance at the posterior palatal seal at 5 mm intervals across the posterior palatal borde r. Takamata et al.28 flowed low viscosity addition polymerizing PVS material between the pr ocessed denture and the master die and then

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12 weighed the PVS on an accurate scale. Consan i et al.29 placed processed resin bases on the master casts with an adhesive resin and then sectioned them laterally to measure the distance between the resin and the mast er cast at different anteri or-posterior segments. Kawara et al.30 and Kimoto et al.31 used strain gauges and thermo-couples that were imbedded in the resin at time of resin packing to quantitatively determine the degree of distortion of heat cured PMMA resins while being proces sed. Kawara et al.30 and Kimoto et al.31 studies differed from other studies by studying the shrink age in a dynamic manner compared to others that studied the distortion after the denture base had been proce ssed and remained stationary. Techniques Used for Processing of Poly Methyl Methacrylate Several techniques for processing PMMA dentures have been described in the literature.28 The traditional and most common tec hnique of processing dentures has been in a brass denture flask for compression molding of the heat cure acryl ic while in its doughy stage.28 Several authors studied different processing techniques on the out come of denture adaptation. Sykora et al.27 compared the traditional heat cured compression molding technique to the injection molding technique. Thei r results showed that the inj ection molding technique showed greater dimensional stability compared to the compression molding technique. Goodkind et al.32 compared pour technique of processing dentur es versus cold cure packing and found that bases processed with pour technique shrunk more than those processed from the cold cure technique. Peyton et al.33 comp ared self-curing and heat curing denture resins. He found that the dimensional stability of the self-curing acrylic is generally equal or superior to heat-cured acrylic. Dukes et al.34 compared compression molding to the pour technique and discovered that compression molding resulted in a smaller increase in vertical dimension of occlusion compared to the pour resin technique. Several other authors studied di fferent variations in denture processing techniques but ke eping the shape of the master model constant. In contrast,

PAGE 13

13 some other authors chose to vary the shape of the master model. Sykora et al.27 compared a continuous-injection technique to the trial pack techni que but varied the palatal vault shape by either being flat or high. They stated that the injec tion-technique showed better adaptability and that the results were influenced by palatal shape. Pow et al.35 studied th e effect of relining and rebasing on 22 different maxillary and mandibular complete dentures. They found that relining and rebasing procedures exhibited shrinkage of 0.3% despite different shapes of maxillary and mandibular dentures. Hedge et al.10 compared V-shaped, U-shaped an d flat-shaped palatal vaults using the heat cured press pack technique. They concluded that the V shaped palatal vault exhibited the highest dimensional change in the frontal and vertical planes. Krber studied the effect of ridge size and ridge shape and found that as the ridge size in creased and the outer surfaces became more parallel, the larger the palatal discrepancy became.36 Mandibular denture dimensional changes were measured by Lechner et al.37. They found that linear shrinkage occurred in all dimensions with the greatest shrinkage in the anterior-poste rior direction along the lin gual flanges. Vast amount of literature is available that compares the processing t echniques of complete dentures against each other. Some of the for-mentioned ar ticles add limited geomet rical analysis of the edentulous arch to the comparison. The geomet ry usually includes the palatal vault shape and does not focus on other areas of the edentulous arch such as the outer slope of the buccal plates or the overall taper of the jaw when viewed occlusally. Processing Errors of Poly Methyl Methacrylate Fabricating heat cured PMMA dentures requir es multiple steps with special attention to details in each step. Several ar ticles are available that address the different steps in fabricating dentures and suggest methods to reduce polymer ization shrinkage.38 Chen et al.39 found that thicker dentures exhibited less molar to molar li near shrinkage but higher gaps in the posterior

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14 palate compared with thinner dentures. Woelfel et al.40 agreed with Chen et al. in that thick upper and lower dentures changed dimensionally less than thin ones. Sykora et al.41 investigated the type of stone used in flasking dentures. Th ey found that the use of high expansion stone yielded dentures with less gap at the posterior palate compared to dentures fabricated with type III stone. Becker et al.42 found no difference between all gypsum processing technique compared to silic one gypsum processing technique. Skinner et al.43 studied the effect of vary ing the powder-liquid ra tio of the resin on shrinkage and water sorption. They found that it had little effect as far as dimensional changes occurring during and after proces sing. Jerolimov et al.44 vari ed polymer/monomer mixing ratios from 1.5:1 to 4.5:1 vol/vol to determine th e effect on dimensional accuracy and impact resistance of PMMA resin. The wide variati on in powder-liquid ratio used by Kawara et al.30 revealed that a long, low-temper ature processing technique was n eeded for the heat-activated PMMA to reduce polymerization shrinkage and prevent boiling of the monomer. Yeung et al.45 findings disagreed with those fi ndings of Kawara et al.30 because their results concluded that temperature differential had been excluded as a reason for the warpage of dentures. Kobayashi et al.46 suggested a gradual cooli ng course for 12 h or more afte r processing the heat-activated acrylic denture to effectively lessen the denture deformation. Kimoto et al.31 concur with these findings. Komiyama et al.47 on the other hand s uggested bench cooling the flask for a minimum of 1 d before deflasking. After processing and retrieval of the dentur e, Sykora et al.27 and Anderson et al.48 agreed that im mersion of the denture in wate r results in no statistically significant change in dimensions. Cal et al.45 and Cheng et al.50 recomme nd adding glass fibers to the denture base polymer to reduce dimensi onal changes in dentures. Collard et al.51 found

PAGE 15

15 that the addition of montmorillonite to dentur e base resins reduced the linear shrinkage and impact strength, while increased the roughness of the denture resin. Occlusal Disharmonies after Processing Heat Cured Poly Methyl Methacrylates Occlusal disharmonies after processing comple te dentures are very common. A laboratory remounting procedure is performed and the distortion usually causes a rise in the incisal pin of an articulator an average of 0.127 mm.34 Wesley et al.52 found a definite shift of tooth contacts to the most posterior teeth afte r processing. Villa et al.53 reported that shrinkag e of an acrylic resin during processing was the cause of occlusal discrepancies. Basso et al. 54 compared the increase in vertical di mension of occlusion between dentures with teeth arranged in lingualized occlusion a nd conventional balanced occlusion after heatprocessing. They found that both teeth arrangements exhibited si milar vertical dimension of occlusion increase but th e lingualized occlusion was easier to adjust. Lingualized occlusion was advocated as an effective occlusal scheme for maintaining balanced occlusion easily on one hand and is esthetically pleasing on the other hand. Al so, lingualized occlusion ease of adjustability may counteract the harmful tendency for teeth to shift due to polymerization distortion of the heat cured PMMA dentures.54 Objective of Study The objective of this study was to determine th e accuracy of heat cured acrylic base plates on simulated edentulous ridges with different geometric configurations. The hypothesis to be tested was that the more parallel the outer ridges are, the larger the palatal discrepancy would be, and the more parallel the ridges ar e in sagital direction, the more the base needs to be displaced in anterior direction until optimal palatal adaptation is reached.

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16 CHAPTER 2 MATERIALS AND METHODS Simulated Ridges Simulated ridges and sections of maxillary ed entulous arches were made in aluminum by attaching machined ridge sections to aluminum plates. The palatal slope of the aluminum ridges was constant at a 45 degree angle. The outer slop e of the ridges varied. One pair had an outer slope of 85 degrees (pair number 1), the second pair had a slope of 75 degr ees (pair number two) and the third pair had a slope of 60 degrees (p air number 3). The right height of the three different shapes was kept cons tant at 10 mm (Figure 2-1). In addition to the ridge shape variable, a s econd variable was the angle of convergence between each of the paired simulated edentulous ridges when viewed from the anterior-sagital direction. These angles were 5 degrees, 10 degr ees and 15 degrees. For each ridge shape pair, three aluminum plates were fabricated so the anterior-sagital conditions for each ridge shape criteria could be met. The aluminum ridges were mounted on the plates by means of threaded screws that precisely fit the al uminum ridges from the bottom. T hus, a total of nine simulated ridge conditions were made (Figure 2-2). After mounting the ridge pair on the respective aluminum plate, the partly simulated aluminum maxilla was fitted to a four-legged pl astic table that would suspend the aluminum plate and ridges approximately 254 mm high (Fi gure 2-3). As seen from Figure 2-3, the aluminum ridges lacked anterior segments repres enting the premaxillae. This segment was left out intentionally. The reason the premaxillae was omitted from the design was due to the method used to collect fitness data as the base was displaced in anterior direction.

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17 Acrylic Base Manufacturing Process A polyvinylsiloxane (PVS) duplicating ma terial (PolyPour, batch #060321, GC Lab Technologies, Alsip, IL, USA) was used to replicate each alumin um ridge pair. The area of impression making was standardized by boxing th e area of the ridges by using an aluminum cylinder (inner diameter of 120 mm and 80 mm high) that fit all the plates accurately. After boxing the aluminum ridges, the PVS catalyst and base were mixed. Equal quantity of the PVS duplicating material was mixed (60 mL of each component) for 15 s until a homogenous color was achieved then the mixture was slowly poured ove r the aluminum ridges. With this approach one PVS mold per ridge condition was made. Th e impressions were poured in dental stone (Microstone, batch# 027040705, Whip Mix, Louisville, KY, USA). The stone came in individualized packages of 140 g. Each pack age was mixed with 40 mL water and hand mixed for 15 s, whereupon the stone was mixed under v acuum (Vac-u-vestor, Serial # 0179003, Whip Mix, Louisville, KY, USA) for another 25 s. The stone was then poured in each of the PVS impressions and retrieved one hour after pouring. Each PVS mold was poured six times to yield a total of 9 x 6 (54 stone models). On each of the made gypsum casts, one laye r of base plate wax (Henry Schien, Pink Medium Wax, batch# 062542, Melville, NY, USA) was heated uniformly and fitted over each model. The edges of the base plate wax were cu t to fit the outer slopes of the model, the inner slopes and the palate. Flasking was done by placing the wax covered stone model in the base of the flask (Hanau Varsity, Hanau Eng. Co. Inc., Model# 66039, Buffalo, NY, USA) and pouring stone (Microstone, batch# 027040705, Whip Mix, Louisville, KY, USA) into the flask. The stone around the master model was smoothed even and any undercuts were removed. A plaster separator (Swan petroleum jelly, Cuberland Swan, Smyrna, TN, US A) was painted on the master

PAGE 18

18 model and base stone. The upper half of the fl ask was then placed on the base securely and a second mix of stone (Microstone) was flowed in place while the flask was resting on a vibrator (Buffalo, No.2, Buffalo Dental Mfg Co., Inc., S yosset, NY, USA) at medium vibration. A plaster separating material (Swan petroleum jelly ) was then painted over the second stage pour. A new mix of stone (Microstone) was then placed on the top half of the flask that was slightly overfilled. The lid of the flask wa s then gently tapped to allow excess stone to exit the holes in the flask edges and lid. The excess st one was cleaned off after it had set. The acrylic base plates we re processed in a similar manner described by Becker.42 After boil-out of the base plate wax and a brief cool ing of 15 minutes, the monomer and polymer of the heat cured resin (Lucitone, batch# 061113, Dent sply Int., York, PA) were mixed according to the instructions supplied by the manufacturers li quid-powder ratio and allowed to gel in an air tight mixing jar for about three minutes. The ro om temperature was kept at 23.5C. One trial pack of the resin was needed due to the sma ll amount needed to fill the lost wax. Eleven hundred twenty N of pressure was used for the tr ial pack with two sheets of cellophane. Final closure was done at 20016 N of pressure. The flas k was then transferred to a hand press. The long cure method was used for polymerization by im mersing the flask in 71 C for 9 h. After 9 h in the water bath, the flask was bench-cool ed for 12 h in compliance with Kobayashi.46 After separation from the flask; the ac rylic base plates were recove red from the stone models and placed in an air tight plastic bag with water. Measurements were made approximately 24 h after recovery of the base plates. Measuring Approach To measure the fit of the acrylic bases to th e original aluminum models, two micrometers (Fowler 0-6 0.00005, Fred V. Fowler Co., Inc, Newton, Massachusetts, USA) were attached to the aluminum plates to which the aluminum ri dges had been mounted. The micrometers were

PAGE 19

19 attached by means of screws that were machined in each of the aluminum plates in the exact same position (Figure 2-3). One micrometer was a ttached to the bottom of the aluminum plate in the center of the simulated jaw segment. At that location, a hole was drilled so the micrometer could read the distance between th e aluminum plate and the palate of the acrylic base. This hole was located in the exact same position in relati on to the pair of aluminum ridges regardless which plate they were mounted to. The other mi crometer was attached at the edge of the aluminum plate touching the widest part of the ac rylic base representing th e posterior edge of the denture. This micrometer was used to displace the acrylic base anteriorly. Thus, by use of these two micrometers, it was possible to record the vertical distance be tween the palate part of the aluminum plate and the acrylic base plate as it was displaced in the horizontal direction. The reason the aluminum ridges lacked the anterior segment representing the premaxillae was to allow the recording of the acrylic base as it was displaced anteriorly with out interfering with an anterior ridge segment Before a measurement procedure started, all sharp and uneven edges around the periphery of the acrylic denture base were smoothed to a llow the seating of the acr ylic base plate on the aluminum ridges more accurately. The edge of th e denture base was aligned with a straight line connecting the posterior edges of the aluminum ri dges. This position represented the horizontal location of the denture base before it had b een displaced and was assigned the horizontal 0.000 mm position. The vertical micrometer was set in its zero position representing a position when its measuring rod was flush with the simulated pa late of the aluminum plate. The vertical micrometers wheel was then turned until the rod touc hed the intaglio surface of the denture base. The reading of that distance was recorded as the vertical discrepanc y at the horizontal position. The denture base was then displaced horizontally in 1.000 mm steps by using the

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20 horizontal micrometers rod and at each such step the distance between the palate and the intaglio of the denture base was read with the vertical micrometer at that position until no further displacement could be read because of interference between the two micrometers (Figure 2-3). The interference between the two micrometers would coincide with a horizontal displacement of 14.000 mm in all 54 cases. The measured distances between the acrylic ba se plates and the aluminum plates at all intervals were entered into Mi crosoft Excel (Microsoft, Redm ond, WA, USA) and plotted using the XY scatter chart type. After the graphs were completed, Microsoft Excel was used to formulate a trend-line of the pl otted data. The trend-line chosen was a polynomial of the third degree. In addition, the software was used to calculate the equation of the third degree polynomial and show it on the graph. By derivi ng the third degree polynomial, it was also possible to determine max and mean values that were found for some cases within the 0.000 to 14.000 mm displacement.

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21 Figure 2-1. Aluminum ridge pairs. Pair number 1 is far left with outer wall slope of 85. Pair number 2 in the middle with outer wall slope of 75 and pair number 3 with outer wall slope of 60 in the far right. Figure 2-2. Ridge pair secured to aluminum plate. The sagital ridge convergences were either 5, 10 or 15 for each ridge pair. This was achieved by mounting the machined ridge pairs on aluminum plates by means of precisely placed screws. No ridges were simulated in the anterior region.

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22 Figure 2-3. Ridge pair mounted to plastic stand. To measure the fit of the processed acrylic bases, two micrometers were attached to the aluminum plates. One measured any space between the intaglio surface of the ba se plate, and the other measured the displacement of the base plate in sagital/anterior direction.

PAGE 23

23 CHAPTER 3 RESULTS AND DISCUSSION Results Zero Displacement The results for the different ridges are presen ted in Figures 3-1 to 3-9. Figure 3-1 shows the graph for the ridge pair 1 with the 5 degrees convergence angle. At the zero mm displacement position, the average of the six samples yielded a spacing between the palatal part of the acrylic base and the metal plate of 2.290 mm. Figure 3-2 shows the value for the same ridge pair but with a sagita l convergence angle of 10 degrees, while Figure 3-3 shows the displacement for the same ridge pair but with a convergence angle of 15 degrees. As seen from Figure 3-2, the zero mm displacement position wa s an average of 1.313 mm, while in Figure 3-3, the zero mm displacement positi on was an average of 0.564 mm. Fr om these figures it is clear that at the zero mm position di stance, the acrylic plate to metal plate distance decreased, suggesting that as the convergen ce angle between the aluminum ri dge increased, the better the fit between the acrylic base plate and the aluminum ridges. A similar pattern was observed in the 10 and 15 degree convergence of th e aluminum ridges with 75 and 85 degree outer slopes at zero displacement. Horizontal Displacement After performing the measurements at zero disp lacement, the acrylic plates were displaced anteriorly by 1.000 mm increments. For the ridg es with anterior convergency, the gap between the aluminum plate and the acrylic base plates decreased as the base plates were displaced anteriorly. However, after the gap between the acrylic base plates and the aluminum plates reached a certain distance, the acrylic plates st arted rising again and the measurements become larger. An exception was the 15 degree converg ence ridges which had a tendency to raise the

PAGE 24

24 acrylic plate early in the disp lacement if not as soon as the displacement had begun. The inner slope of the aluminum ridges, which formed a 45 degree angle with the metal plates, was found to be the contributing fact ors to the rise of the acrylic plates. Even t hough all inner slopes were constant at 45 degrees, they influence the fit by interfering with the intaglio surface of the more converging ridges as the base plate was anteriorly displaced (Figure 3-10). The x and y values of each ridge condition (Figures 3-1 to 3-9) followed third degree polynomials quite well (see the R-values for the di fferent curves). The y-values at x=0 were analyzed using a two-way ANOVA to determine si gnificant effects (p<0.05) of ridge slope and ridge convergency. The same analysis was cond ucted for the y-values determined at the 14.000 mm displacement location in sagital direction. The results revealed strong significant co rrelations between ri dge slope and ridge convergency (p<0.001) and a weaker but still strongly significant (p<0.001) interaction between these two variables. The polynomials made it also possible to determine the location within the measured range where the shortest y-value existed. The results recorded at x=0.000 and x=14.000 as well as where the shortest y-value we re detected between these two end points. Discussion Zero Displacement As seen from Figure 3-10, the y-values at zero displacement (blue bars) revealed that the fit of the processed record base on ridge pair 1 (85 outer walls) with 5, 10 or 15 convergence (1,5), (1,10) and (1,15) is clea rly worse than ridge pair 2 (75 outer wall) and ridge pair 3 (60 outer wall) both with 5,10 and 15 convergence. In other words, as the outer walls of the ridge pairs became steeper, the worse the initial fit of the acrylic plates became apparent at zero mm displacement. This can be attributed to the po lymerization shrinkage of the acrylic base plates resulting in a tighter contact on the outer wall of the steeper ridges (ridge pair 1 with 85 outer

PAGE 25

25 walls) in comparison to the less steep outer wa lls of ridges 2 and 3 (with the 75 and 60 respectively). Further along at zero mm displacement, ridge pair 1 with 5 convergence (1,5) exhibits a poorer fit than the (1,10) and (1,15) convergency. When compar ing all three ridge pairs (1, 2 and 3) with 5 convergence to same ridge pair wi th 10 and 15 convergence, it is clear that the fit of the acrylic base plates improves resp ectively as the sagital convergency increases. Consequently, all ridge pairs with 5 converg ency (smallest anterior convergency angle), adapts poorly in comparison to ridge pairs whic h converged more. On the other hand, it was noticed that the poor fit of the record base at (1,5) was improved when the same convergence angle (5) was tested on ridge pa ir 2 and 3 (75 and 60 respec tively) at zero displacement (Figure 3-10). The same applies to all ridg e pairs with 10 and 15 convergency at zero displacement (Figure 3-10). Thus, ridges with more sagital/anterior convergence had better adapting record bases at x=0. This allows us to postulate that edentulous maxillas that are tapered when viewed occlusaly would have a be tter denture fit compared to an edentulous maxillae that is squared when viewed occlus aly. This result is in line with Krbers36 clinical study. In addition, dentures fabricated for edentu lous maxillary ridges with more resorption on the buccal plate would fit better than dentures made for parallel ridges. Horizontal Displacement At maximum displacement (x=14.00 mm, yello w bars in Figure 3-10), the fit of the processed base plate had an inversely related relati onship with the fit of the acrylic base plate at zero displacement. This is especially evident if the initial fit is poor or good. It was noticed while performing the measurements that the inner slopes of the ridge pair s had a large influence on this phenomenon. When the initial fit of the record base was mediocre, it seemed to be a competition between the outside ridge slope and th e palatal ridge slope as the base plate was

PAGE 26

26 displaced in an anterior direc tion. That interactio n explains why a minimum (red bar in Figure 3-10) in y-values existed between the extreme displacement locations x = 0.000 mm and x = 14.000 mm. The reason behind the obse rvations stated above is the degree of convergence of the ridge pairs. The more the ridge pairs converged anteriorly, the better th e initial fit at zero displacement. However, the inner slope of the ridg e pair influenced the base plate sooner in the displacement and worsens the fit of the base plate. The results of this study can be applied to th e edentulous arch when viewed transversely. The buccal plate of the edentulous maxillary arch resorbs medially as time passes. As suggested by the results of this investigation, the highe r the degree of buccal re sorption, the better the palatal adaptation will be. In cases where the eden tulous arches are more parallel in sagital direction, a clinician should expe ct more denture adjustments to be done on the buccal plate. Conversely, if the buccal plates of an edentulous arch seem highly resorb ed, the clinician might predict an intimate adaptation of the denture. The shapes of the edentulous arches when view ed occlusaly is another factor that can help a clinician predict the fit of a denture. If the shape of the edentulous arch is tapered, one might argue that the patient will experience more sore spots around the inner slopes of the pre-maxillae area. This is extrapolated from the study becau se the higher the convergence seen between the edentulous arches, the sooner the interference ex hibited by the inner slope of those edentulous arches. If the shape of the edentulous arches is square on the other ha nd, the clinician might find less sore spots around the inner slopes of the premaxillae because the inner slopes wouldnt interfere with the seating of the denture as soon as a tapered shaped maxillary arch. In contrast, the sore spots might show more on the distal slop e of the maxillary ridges close to the hamulus.

PAGE 27

27 If a clinician could predict areas of sore ness by studying the shape of an edentulous maxillary arch, he or she could relief those areas on the master cast before the denture is processed or delivered. Possible ways to achieve such relief could be to use tin foils in order to relief the critical areas. For example, if a patient presented with a tapered maxillary arch, the dentist could use tin foil and burnish it on the pr emaxillae and the inner slopes of the edentulous arches close to the premaxillae to alleviate fu ture soreness in this area resulting from the tendency of these areas to lift th e acrylic base. However, the re lief of the compressed regions could also have negative effect s on denture retention. It is we ll-known that upper dentures are very well retained initially, but after a few w eeks in service their re tention decrease. That decrease is most likely a result of tissue adapta tion to an initially poorly fit denture. Thus, by using tin foils to relief pressure sites. The reli ef could result in a dentur e that the patient would perceive as a poorly retained dent ure, which could have negative effects as well. Therefore, to determine whether predicted pressure sites should be relieved or not, it is important to perform systematic clinical studies in an attempt to fi nd the best way to optimize the performance of a complete denture. Further analysis could be performed to describe the fit of the acrylic base plate by use of a third degree polynomial (y= Dx3 + Cx2+ Bx + A) From our study we know that A in that polynomial describes the starting ga p between the base plate and the palate. More analysis should be performed to study the variables B, C a nd D which could be linked to the shrinkage of the acrylic base plate and the two angle variables (outer slope s and sagital convergency).

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28 0 0.2 0.4 0.6 0.8 1 1.2 1.4 1.6 1.8 2 2.2 2.4 2.6 2.8 0123456789101112131415 Anterior Displacement (mm)Base Plate/Palatal Gap (mm) Series1 Poly. (Series1) Figure 3-1. Ridge pair 1, 5 convergence. Chan ges in base plate/palatal displacement as base plate is displaced in an anterior direc tion. Diamond shapes represent mean values (n=6) and adjacent vertical lines their standard deviations. The polynomial for this curve was y= 0.0006x3 0.0094x2 0.081x + 2.3074 and the R2 = 0.9861 0 0.2 0.4 0.6 0.8 1 1.2 1.4 1.6 1.8 0123456789101112131415Anterior Displacement (mm)Base Plate/Palatal Gap (mm) Series1 Poly. (Series1) Figure 3-2. Ridge pair 1, 10 convergence. Cha nges in base plate/palatal displacement as base plate is displaced in an anterior direc tion. Diamond shapes represent mean values (n=6) and adjacent vertical lines their standard deviations. The polynomial for this curve was y= 0.0003x3 + 0.0049x2 0.1489x + 1.3415 and the R2 = 0.9665

PAGE 29

29 0 0.2 0.4 0.6 0.8 1 1.2 1.4 1.6 1.8 2 051015Anterior Displacement (mm)Base Plate/Palatal Gap (mm) Series1 Poly. (Series1) Figure 3-3. Ridge pair 1, 15 convergence. Cha nges in base plate/palatal displacement as base plate is displaced in an anterior direc tion. Diamond shapes represent mean values (n=6) and adjacent vertical lines their standard deviations. The polynomial for this curve was y= -0.0004x3 + 0.0111x2 + 0.0183x + 0.535 and the R2 = 0.999 0 0.2 0.4 0.6 0.8 1 1.2 1.4 0123456789101112131415Anterior Displacement (mm)Base Plate/Palatal Gap (mm) Series1 Poly. (Series1) Figure 3-4. Ridge pair 2, 5 convergence. Chan ges in base plate/palatal displacement as base plate is displaced in an anterior direc tion. Diamond shapes represent mean values (n=6) and adjacent vertical lines their standard deviations. The polynomial for this curve was y= -0.0005x3 + 0.0158x2 0.1314x + 0.8272 and the R2 = 0.9088

PAGE 30

30 0 0.2 0.4 0.6 0.8 1 1.2 1.4 1.6 0123456789101112131415Anterior Displacement (mm)Base Plate/Palatal Gap (mm) Series1 Poly. (Series1) Figure 3-5. Ridge pair 2, 10 convergence. Cha nges in base plate/palatal displacement as base plate is displaced in an anterior direc tion. Diamond shapes represent mean values (n=6) and adjacent vertical lines their standard deviations. The polynomial for this curve was y= -0.0006x3 + 0.0179x2 0.087x + 0.5298 and the R2 = 0.9586 0 0.2 0.4 0.6 0.8 1 1.2 1.4 1.6 1.8 0123456789101112131415 Anterior DisplacementBase Plate/Palatal Gap (mm) Series1 Poly. (Series1) Figure 3-6. Ridge pair 2, 15 convergence. Cha nges in base plate/palatal displacement as base plate is displaced in an anterior direc tion. Diamond shapes represent mean values (n=6) and adjacent vertical lines their standard deviations. The polynomial for this curve was y= -0.0012x3 + 0.027x2 0.0527x + 0.2574 and the R2 = 0.9773

PAGE 31

31 0 0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8 0.9 1 0246810121416 Anterior Displacement (mm)Base Plate/Palatal Gap (mm) Series1 Poly. (Series1) Figure 3-7. Ridge pair 3, 5 convergence. Chan ges in base plate/palatal displacement as base plate is displaced in an anterior direc tion. Diamond shapes represent mean values (n=6) and adjacent vertical lines their standard deviations. The polynomial for this curve was y= -2E-05x3 + 0.0034x2 0.044x + 0.5539 and the R2 = 0.9429 0 0.2 0.4 0.6 0.8 1 1.2 1.4 0123456789101112131415Anterior Displacement (mm)Base Plate/Palatal Gap (mm) Series1 Poly. (Series1) Figure 3-8. Ridge pair 3, 10 convergence. Cha nges in base plate/palatal displacement as base plate is displaced in an anterior direc tion. Diamond shapes represent mean values (n=6) and adjacent vertical lines their standard deviations. The polynomial for this curve was y= -0.0005x3 + 0.0148x2 0.0501x + 0.3924 and the R2 = 0.9991

PAGE 32

32 0 0.5 1 1.5 2 2.5 05101520 Anterior Displacement (mm)Base Plate/Palatal Gap (mm) Series1 Poly. (Series1) Figure 3-9. Ridge pair 3, 15 convergence. Ch anges in base plate/palatal displacement as base plate is displaced in an anterior direction. Diamond shapes represent mean values (n=6) and adjacent vertical lines th eir standard deviations. The polynomial for this curve was y= 0.0001x3 0.0031x2 + 0.1362x + 0.2738 and the R2 = 0.9981

PAGE 33

33 0 0.5 1 1.5 2 2.5 31,5 1,10 1,15 2,5 2,10 2,15 3,5 3,10 3,15Ridge, Convergence Anglemm Distance at zero displacement Minimum Distance Distance at Maximum Displacement Fig. 3-10. Distance between the acrylic base pl ates and the metal palatal plate. [At zero displacement (blue bars) and after 14 mm ante rior displacement (yellow bars)]. In some cases a lower displacement was identi fied between the start and end positions. These minimum distances are shown as the red bars in the graph.

PAGE 34

34 CHAPTER 4 SUMMARY AND CONCLUSIONS Three configurations of edentulous arches with three options of anterior-sagital convergences (per pair) were tested. Heat cured acrylic base plates were fabricated to measure degree of adaptability of these base plates to the original simulated edentulous arches. The adaptability was measured by mean s of micrometers attached to th e bottom and side of the base plates to be measured. The distance between the intaglio of the base plates and the palate was measured by the vertical micrometer while th e horizontal displacement was performed by the horizontal micrometer in 1.000 mm increments. The measurements were plotted and equations of the graphs were determined. It can be concluded from this study that the st eeper the outer angles of the ridges, the worse the fit of the acrylic base at zero displacement. If the initial fit of the record base is poor (parallel outer slopes or parallel convergence ), anterior displacement causes it to improve. On the other hand, if the initial fit of the r ecord base is good (converged outer slopes or converged ridges), the anterior displacement causes the fit to become po or because of the influence of the inner slopes of the simulated ridges. These findi ngs support our formulated hypothesis.

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35 LIST OF REFERENCES 1. Ring ME. Dentistry in ancient Egypt. Compendium 1987;8(5).386. 2. Smith GE. The most ancient splints. Brit Med J 1908;1:732-4. 3. Ambler HL. History of dental prosthesis. Op Cit 1947;1:246-9. 4. Walsh J. Dentistry among the Etrusc ans. The Apollonian 1930;4:113-119. 5. Weinberger BW. Ancient dentistry in th e old and new world. Annals Med Hist 1934;6:264-279. 6. Pfaff, Philipp. Abhandlung von den zaehnen des menschlichen koerpers undderen krankheiten. Berlin: Haude & Spener, 1756, port.16 1. 184 pp. 7 pl. 7. Weinberger BW. George Washingtons dentures. Dent Survey 1934;10:28-29. 8. Weinberger BW. The history of dentistr y. Volume 1. Birminghman, Alabama: L.B. Adams : Privately printed for the members of the Classics of Dentistry Library;1981. p.377. 9. Bremner MD. The story of dentistry. Brooklyn, NY: Dental Items of Interest Publishing Co; 1946. p.171. 10. Hegde V, Patil N. Comparative evaluation of th e effect of palatal vault configuration on dimensional changes in complete denture during processing as well as after water immersion. Indian J Dent Res 2004;15:62-5. 11. Wright WH. Denture base materials as related to prosthetic oral health service. J Am Dent Assoc 1939;26:1837-41. 12. Sweeney WT, Schoonover IRL. A progress report on denture base material (1935). J Am Dent Assoc 1936;23:1498-12. 13. Graser GN. Completed bases for removabl e dentures. J Prosth Dent 1978;39:232-6. 14. Peyton FA, Mann WR. Acrylic and acrylic-styrene resins: their properties in relation to their uses as restorative material s. J Am Dent Assoc 1942;29:1852-64. 15. Baydas S, Bayindir F, Akyil MS. Effect of processing variables (different compression packing processes and investment material ty pes) and time on the dimensional accuracy of polymethyl methacrylate denture ba ses. Dent Mater J 2003;22:206-13. 16. Peyton FA. History of resins in dent istry. Dent Clin North Am 1975;9:211-22. 17. Sweeney WT. Denture base material: Acrylic resins. J Am Dent Assoc 1939;26:1863-73.

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36 18. Sweeney WT, Paffenbarger GC, Beall J. Acrylic resins for dentures. J Am Dent Assoc 1942;29:7-33. 19. Tylman SD. Where and how may acrylics be us ed in restorative dentistry? J Am Dent Assoc 1942;29:640-47. 20. Winkler. Denture base resin. Dent Clin North Am 1984;28:287-98. 21. Antonopoulos AN. Dimensional and occlusal change s in fluid resin dentures. J Prosth Dent 1978;39:605-15. 22. Fairhurst CW, Ryge G. Tin foil substitute, warpage and crazing of acrylic resins. J Prosth Dent 1954;274-87. 23. Skinner EW, Jones PM. Dimensiona l stability of self-curing dent ure base acrylic resins. J Am Dent Assoc 1955;51:426-31. 24. Polychronakis N, Yannikakis S, Zissis A. A clinical 5-year longitudinal study on the dimensional changes of complete maxillar y dentures. Int J Pros thodont 2003;16:78-81. 25. Kraut RA, Fort OC. A comparison of de nture base accuracy. J Am Dent Assoc 1971;83:352-57. 26. Anthony D.H, Peyton F.A. Dimensional accuracy of various denture-base ma terials. J Prosthet Dent 1962;12:67-81. 27. Sykora O, Sutow EJ. Posterior palatal seal ad aptation: influence of processing technique, palate shape and immersion. J Oral Rehabil 1993;20:19-31. 28. Takamata T, Setcos J, Philips R, Boone M. Adaptation of acrylic resin dentures as influenced by the activation mode of polym erization. J Am Dent Assoc 1989;119:271-6. 29. Consani RL, Domitti SS, Rizzatti Barbosa CM, C onsani S. Effect of commercial acrylic resins on dimensional accuracy of the maxillary denture base. Braz Dent J 2002;13:57-60. 30. Kawara M, Komiyama O, Kimoto S, Kobaya shi N, Kobayashi K, Nemoto K. Distortion behavior of heat-activated acrylic denture-base resin in conventional and long, lowtemperature processing methods. J Dent Res 1998; 77(6):1446-53. 31. Kimoto S, Kobayashi N, Kobayashi K, Ka wara M. Effect of bench cooling on the dimensional accuracy of heat-cured acrylic denture base material. J Dent 2005;33:57-63. 32. Goodkind RJ, Schulte RC. Dimensional accuracy of pour acrylic resin and conventional processing of cold-curing acrylic resin bases. J Prosthet Dent 1970;24:662-8. 33. Peyton FA, Shiere HB, Delgado VP. Some co mparisons of self-curing and heat-curing denture resins. J Pros th Dent 1953;3:332-8.

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37 34. Dukes BS, Fields H, Olson JW, Scheetz JP. A laboratory study of changes in vertical dimension using a compression molding and a pour resin technique. J Prosthet Dent 1985;53:667-9. 35. Pow EH, Chow TW, Clark RK. Linear dimensional change of heat-cured acrylic resin complete dentures after reline and rebase. J Prosthet Dent 1998; 80:238-45. 36. Krber KH. Accuracy of fit of the dentur e base depending on va rious jaw geometries; Biotechnical analysis. Dtsch Zahnarztl Z 1991;46(2):112-8. 37. Lechner SK, Thomas GA. Changes caused by pr ocessing complete mandibular dentures. J prosth Dent 1994;72:606-13. 38. Peyton FA, Anthony DH. Evaluation of dentures pro cessed by different techni ques. J prosth Dent 1963;13:269-82. 39. Chen JC, Lacefield WR, Castleberry DJ. Eff ect of denture thickness and curing cycle on the dimensional stability of acrylic resi n denture bases. Dent Mater 1988;4:20-4. 40. Woelfel JB, Paffenbarger GC, Sweeney WT. Di mensional changes occurring in dentures during processing. J Am De nt Assoc 1960;61:413-30. 41. Sykora O, Sutow E. Improved fit of maxillary complete dentures processed on high expansion stone casts. J Pr osthet Dent 1997;77:205-8. 42. Becker CM, Smith DE, Nicholls JI. The comparison of denture-base processing techniques. Part II. Dimensiona l changes due to processing. J Prosthet Dent 1977; 37:4509. 43. Skinner EW, Cooper EN. Physical properties of denture resins: Part I. Curing shrinkage and water sorption. J Am Dent Assoc 1943;30:1845-52. 44. Jerolimov V, Brooks SC, Huggett R, Stafford GD. Some effects of varying denture base resin polymer/monomer ratios. Int J Prosthodont 1989;2:56-60. 45. Yeung KC, Chow TW. Temperature and dimensi onal changes in the two-stage processing technique for complete dent ures. J Dent 1995;23:245-53. 46. Kobayashi N, Komiyama O, Kimoto S, Ka wara M. Reduction of shrinkage on heatactivated acrylic denture base resin obtaining gradual cooling after processing. J Oral Rehabil 2004;31:710-6. 47. Komiyama O, Kawara M. Stress relaxation of h eat-activated acrylic denture base resin in the mold after processing. J Prosthet Dent 1998;79:175-81. 48. Anderson CG, Schulte JK, Arnold TG. Dimensiona l stability of inject ion and conventional processing of denture base acrylic resin. J Prosth De nt 1988; 60:394-8.

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38 49. Cal NE, Hersek N, Sahin E. Water sorption and dimensional changes of denture base polymer reinforced with glass fibers in c ontinuous unidirectional and woven form. Int J Prosthodont 2000;13:487-93. 50. Cheng YY, Hui OL, Ladizesky NH. Processing shrinkage of heat-curing acrylic resin reinforced with high-performance polyethyl ene fibre. Biomateria ls 1993; 14:775-80. 51. Collard SM, Karimzadeh A, Smith LT, Pari kh U. Polymerization shrinkage, impact strength and roughness of montmorillonite-modified denture base resins. Am J Dent 1991;4:285-90. 52. Westley RC, Henderson D, Frazier QZ, Rays on JH, Ellinger CW, Lutes MR. Processing changes in complete dentures : posterior tooth contacts a nd pin opening. J Prosth Dent 1973;29:46-54. 53. Villa H. Double-processing technique for comp lete dentures. J Prosth Dent 1969;22:500-5. 54. Basso MF, Noqueira SS, Arioli-Filho JN. Compar ison of the occlusal vertical dimension after processing complete dentures made with lingualized balanced occlusion and conventional balanced occlusi on. J Prosth Dent 2006;96:200-4.

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39 BIOGRAPHICAL SKETCH I was born in 1976 and grew up in Kuwait City, Kuwait. I graduated from Sabah Elsalim High School in Kuwait City in 1994. In 1994, I enro lled at the University of Missouri Kansas City as a dental student where I joined the six year combined pr ogram of Bachelors of Arts and Science and Dentistry. At the University of Mi ssouri Kansas City I met my wife Rana, whom I married to in 2002. Together we worked for th e public health system of Kuwait from 2002 to 2004 before we decided to go back to the USA to specialize. I enrolled in the Graduate Prosthodontics program at The University of Florida and she enrolled at the Graduate Periodontic program at the Univers ity of Florida also. In 2004, Rana and I were blessed with our first born Jawan and in 2005 we were blessed w ith our son Yousef. After graduation as a specialist in Prosthodontics from the University of Florida in August of 2007, I will continue teaching there until 2008 when my wife graduates. After both of us have graduated, we plan to go back to Kuwait and work for the public health sy stem for the betterment of the dental service of our beloved country. This is th e beginning of the rest of our lives.


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