Changing trends and clinical recommendations of denture adhesive in complete denture: A review

E Nagaraj; Rony Tomy Kondody; Aravind Kalambettu; Dileep Nag Vinnakota; Jangala Hari

doi:10.4103/jdrr.jdrr_97_21

REVIEW ARTICLE

Year : 2021 | Volume : 8 | Issue : 3 | Page : 228-232

Changing trends and clinical recommendations of denture adhesive in complete denture: A review

E Nagaraj¹, Rony Tomy Kondody², Aravind Kalambettu³, Dileep Nag Vinnakota⁴, Jangala Hari⁵
¹ Department of Prosthodontics, PMNM Dental College and Hospitals, Bagalkot, Karnataka, India
² Department of Orthodontics and Dentofacial Orthopaedics, ESIC Dental College, Gulbarga, Karnataka, India
³ Department of Prosthodontics, SRM Dental College and Hospital, Chennai, Tamil Nadu, India
⁴ Department of Prosthodontics, Narayana Dental College and Hospital, Nellore, Andhra Pradesh, India
⁵ H Dental Clinic, Hyderabad, Telangana, India

Date of Submission	02-Jun-2021
Date of Acceptance	10-Jul-2021
Date of Web Publication	23-Aug-2021

Correspondence Address:
E Nagaraj
Department of Prosthodontics, PMNM Dental College and Hospitals, Navanagar, Bagalkot - 587 103, Karnataka
India

Source of Support: None, Conflict of Interest: None

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DOI: 10.4103/jdrr.jdrr_97_21

Abstract

Over the past decade, the specialty of prosthodontics has witnessed a great deal of advancement in its treatment mechanics to improve the quality of complete dentures. Along with proper fabrication, various approaches such as retention by overdentures and the use of implants were widely used. Along with these, many patients use adhesive materials to increase the perceived sense of satisfaction. Whereas for patient well-being, long-term use of adhesives materials is not advocated or recommended in clinical practice. This review discusses various features, trends, and the need for clinical consideration for the application of denture adhesives in prosthodontic practice.

Keywords: Complete deanture, denture adhesive, prosthodontic practice

How to cite this article:
Nagaraj E, Kondody RT, Kalambettu A, Vinnakota DN, Hari J. Changing trends and clinical recommendations of denture adhesive in complete denture: A review. J Dent Res Rev 2021;8:228-32

How to cite this URL:
Nagaraj E, Kondody RT, Kalambettu A, Vinnakota DN, Hari J. Changing trends and clinical recommendations of denture adhesive in complete denture: A review. J Dent Res Rev [serial online] 2021 [cited 2023 Apr 1];8:228-32. Available from: https://www.jdrr.org/text.asp?2021/8/3/228/324424

Introduction

Accuracy in denture fabrication and efficient psychological counseling of the patient is critical for the success of any complete denture treatment. In addition, even the most successful clinician has difficulty in meeting the patient's complete expectations for denture stability and retention, and it is in that case, it is considered to be appropriate to prescribe a denture adhesive.^[1]

Over the years, there was always a negative approach or controversies toward the application of adhesives.^[2] The basic components include a polymer salt blend that improves hydration sensitivity, rapid onset, longer duration of action, resistance, and ease of maintenance.^[3]

Denture adhesives also may be advantageous to provide psychological benefits since they can provide stability during public interactions.^[4] However, it must not be a method to increase the retention of improperly fabricated dentures. Along with the availability of adhesive, there must be standardized protocol when to use and how to use denture adhesives.^[5]

According to the study of Zarb et al., the “denture adhesive” defines as a nontoxic, commercially available, soluble material that improves retention, stability, and function.^[6] The first case of adhesive use and its importance was described in 1913. It was classified as nonmedical products by the American Dental Association Council until 1935.^[2],[7]

Although many denture wearers use denture adhesive, dental practitioners have been slow to appreciate its effectiveness for denture retention.^[8] The primary factors influencing a patient's choice of adhesive product are patient comfort and ease of use.^[9]

Over the last decade, there have been extraordinary achievements and changes in the field of prosthodontics along with advancements in treatment mechanics that improve quality of life. The main focus of this narrative review is to provide a detailed as well as a comprehensive summary of trends and clinical aspects of denture adhesive in the field of prosthodontic practice.

Changing Concept from Past to Present

Even though denture adhesives have been used since the late 18^th century, the first published study dated from 1960. Initially, denture adhesives were created by combining vegetable oils. When they absorbed saliva, they formed a mucilaginous substratum that adhered to the tissues and the prosthesis. Calcium salts were added in the 1970s, and zinc was added to previous formulations in the 1980s to improve the effectiveness of denture adhesives. Nowadays, these materials are available in various forms. For soluble adhesives, they come in the form of powders, pastes, or creams, whereas for insoluble materials, they come in the form of strips or cushions.^{[10],[11],[12]}

In the presence of water or saliva, synthetic agents in the soluble group rely on the chemical properties of the active ingredients to increase their volume from 50% to 150% and become viscous and sticky, filling the gap between the prosthesis base and the underlying surface.^[12] The active ingredients are polymer salts with varying degrees of water solubility that are intended to produce both short- and long-acting adhesives. These salts include carboxymethyl cellulose (CMC) and methylcellulose, as well as polymethyl vinyl ether-maleic anhydrade (PVM-MA).

The CMC salts have good initial retention, but due to their high solubility, they dissolve rapidly and lose their effectiveness. The PVM-MA salts, on the other hand, have low solubility, which requires more time to get activated and have a longer period of action. Following that, calcium and zinc salts were added to denture adhesive formulations to improve their effectiveness.^[13]

Over the years, various studies have been conducted in the field of prosthodontics related to the use of adhesive. Kapur^[14] studied 26 denture wearers and devised a method for assessing denture retention and stability. He concluded that adhesives improved retention, which will improve denture wearers' incisive ability.

Stafford and Russell^[15] conducted a study using radio telemetry to measure pressure changes at the denture base–mucosa interface with and without adhesives. The study concluded that denture adhesive allowed for greater occlusal pressure.

Tarbet et al.^[16] investigated the role of adhesives in denture retention and stability and discovered that patients perceived improved chewing ability, confidence, and comfort, as well as reduced wobble and food particle collection under the denture.

In their studies, Panagiotouni et al.^[17] discovered that denture adhesive materials had a higher retentive ability than saliva and that when the adhesives were combined with artificial saliva, their retentive ability was significantly increased. According to their research, Abdelmelak and Michael found that the cushioning effect of denture adhesives reduced the pressure and friction transmitted to the underlying mucosa.^[18]

Denture adhesive must be used in cases of severely atrophied ridges, ridges with hypertrophied tissue, in case of reduced neuromuscular control, xerostomia, and maxillofacial defects that provide inadequate tissue support, according to Jagger and Harrison.^[19]

Chowdhry et al.,^[20] about various forms of adhesive material, concluded that the paste form is considered to be more resistant to dislodgement than the powder form. Psillakis et al.,^[21] found that denture adhesive improved patients' self-confidence. Whereas there was no difference in self-confidence levels in patients with various ridge conditions.

According to Figueiral et al.,^[22]intraoral transducers examined the retentive support of various adhesives on maxillary complete dentures and found that adhesives improved retention and stability, thereby increasing confidence and comfort among patients.

A study by Shamsolketabi S et al.^[23] found no significant differences in retention and improvement in chewing in patients with different ridge conditions whereas about 24.4% of cases faced difficulty in cleaning the adhesive material.

Composition and Mechanism of Action

Denture adhesive augments the retentive mechanism when a denture is worn. This is achieved by optimizing interfacial forces by increasing the adhesive and cohesive properties as well as the viscosity of the medium between the denture and soft tissue and also by preventing the formation of air columns between the surfaces of the denture and basal seat.^[23]

Furthermore, the presence of free carboxyl groups produced by adhesive hydration results in more cohesive adhesion than saliva.^[24]

Constituents of denture adhesive can be classified into three groups.^[25]

Group 1: Synthetic polymers, karaya gum, tragacanth, acacia, pectin, gelatin, hydroxyl-methyl cellulose and sodium CMC are examples of adhesive agents
Group 2: Hexachlorophene, sodium borate, sodium tetraborate, and ethanol are antimicrobial agents
Group 3: (Additional agents) Additives, plasticizers, and wetting agents come in a variety of forms.

Method of Application of Denture Adhesives

It is the sole responsibility of the prosthodontist to educate patients about denture adhesive, including its use, abuse, benefits, drawbacks, and available options. The decision between cream and powder is largely subjective, but certain facts may influence a patient's choice.

Various steps in the application of denture adhesive^[2] were as follows:

The tissue-bearing surface is thoroughly cleaned without any injury with the help of wipes, cotton applicators, and orange solvent
The entire mucosal surface must be devoid of food debris, saliva, and previously used adhesive materials
The adhesive is applied to the underside of the denture, and it is important to keep the surface moist before applying it [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]

Figure 1: Adhesive application to the maxillary denture base

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Figure 2: Adhesive application to the mandibular denture base

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Figure 3: Adhesive dispersed over the tissue surface of the denture

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Figure 4: Denture submerged in cool water to hydrate

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Figure 5: Place denture in the patient mouth

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Figure 6: Remove denture adhesive using a brush after each use

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When applying adhesive to maxillary dentures, consider areas of the alveolus, superior surface of the palate, and posterior palatal seal
For mandibular dentures, it is applied on anterior and posterior regions of the tissue-bearing area.

Hand pressure is used to seat the denture properly (10 s)

Excessive material should carefully be removed immediately with the help of cotton
Care must be taken to close the jaws in centric occlusion to evenly distribute adhesive in the form of a thin layer.

Application of Denture Adhesives in Modern Prosthodontic Care

The complex interplay of different forces related to soft- and hard-tissue anatomy, patient-dependent variables, prosthesis fabrication, and surface properties is recognized as the cause of denture retention in the oral cavity.^[26],[27] Previous studies have confirmed the benefits observed with denture adhesive use.^{[28],[29],[30]}

Because of the increased retention and stability, the forces during chewing increase, resulting in fewer strokes during swallowing. It also helps in the distribution of forces on the appliance, a reduction in food debris accumulation, and a reduction in fungal growth.^[31],[16]

Denture adhesive is indicated in conditions where well-fabricated denture does not satisfy a patient expectation of stability and retention. Therefore, various indications include the following:^[3],[32]

Denture adhesives help to stabilize trial bases that show reduced retention and stability, as well as to reduce patient anxiety about the final prosthesis fit
In cases of compromised denture-bearing areas, adhesive helps to add confidence thereby it helps in patient adaptation
Aid in soft-tissue healing, reducing compression or irritation of the oral mucosa
In cases of maxillofacial defects that require prosthesis, adhesives act like a cushion^[33]
Denture adhesives are an important tool for retaining radiation protection prostheses
Denture adhesives can be used to treat xerostomia caused by drugs or radiation. Patients with xerostomia must be educated on the importance of moisturizing surfaces before seating
In various neurological conditions, the adhesive will help to overcome the impediment imposed.

Contraindications

Long-term use of denture adhesive without proper follow-up was never an option in the clinical scenario. Multiple factors and conditions should be taken into account while advising the use of denture adhesive. Various systemical and medical factors complicate the daily use of adhesive material even in creams and powdered forms.

Various contraindications include the following:

Allergy to adhesive materials is one of the most common contraindications, so it is always advised to evaluate patients for any hypersensitive reactions^[34]
Severe mandibular or maxillary atrophy along with ill-fitting dentures is not a good scenario for the application of adhesive^[32]
For patients with severe soft-tissue defects or loss of vertical dimension, it is advised for new dentures rather than the usage of denture adhesive
A broken or poorly fabricated denture should not be retained by using an adhesive.^[32]

Advantages

Improved complete denture retention and stability^[5]
Increases patient satisfaction, confidence, and security in chewing^[22]
Incisal bite force exerted by well-fitting dentures during chewing is significantly improved^[32]
The frequency of dislodgement of the denture during chewing is markedly decreased^[35]
Mucosal tissue underlying adhesive shows reduced inflammation in a patient who maintains good oral hygiene.^[5]

Disadvantages^[36]

Some patients object to the grainy texture of the powder
Some patients are unable to tolerate the taste or odor of semi-dissolved adhesive material that escapes from the posterior region's peripheries^[37]
Difficulties removing adhesive from dentures and oral surfaces
The more viscous the adhesive pastes produce a greater error in vertical dimension and denture positioning because of their reduced flow characteristics^[36]
Because an ill-fitting denture is frequently retained by a large amount of adhesive material, a patient may be misled into ignoring the need for professional assistance.^[32]

Changing Trends in Denture Adhesive

Over the years, various materials have been evolved in the field of prosthodontics. Early materials of denture adhesives contain zinc that was removed from the market because of the development of copper deficiency, which was causing various neurologic diseases.^[37],[38] Nations et al.^[39] discovered a possible link between overuse of denture cream and hyperzincemia, hypocupremia, and various neurological signs and symptoms. Excessive zinc ingestion is caused by ill-fitting dentures. To reduce various complications created by this compound, the current trend is the development of zinc-free products (for example, GlaxoSmithKline's Super Poligrip “Free”) which is considered to be more effective and minimal side effects.^[39]

The use of additives that contain various antimicrobial and antifungal agents has become more popular and being advocated in edentulous patients who are subjected to various diseases like candidiasis.^[12] These materials could be used as part of a drug delivery system in future by incorporating various agents that could potentially benefit in reducing irritation and inflammation of the tissue.

Furthermore, one current challenge is the development of denture adhesives that do not allow food or even bacterial plaque to adhere to them, allowing them to be used for longer periods without the need for daily exchanges. Moreover, it was discovered that current material manufacturers have not yet found a way to deal with the challenge of maintaining their properties for longer periods.

Conclusion

Clinical use of denture adhesive is always a controversial topic in the field of prosthodontic society. Scientific evidence favoring the support of routine and safe use is lacking, yet clinical experience indicates that judicious use of denture adhesive is always welcomed since it could always provide comfort, retention, and stability to the denture in many clinical scenarios. In future, further development in denture adhesive material is very much necessary to provide better quality material, patients' satisfaction, and minimal complications.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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