Complete dentures

Physical
Zora Bkhov6,

factors
M.U.Dr.,

in retention
and Milan

of complete
Neuman, M.U.Dr.

dentures

Charles University, Plzen, Czechoslovakia

ometimes complete dentures that appear to be correctly made have inadequate retention, even though the anatomic conditions of the basal seat are good, Because of this, we investigated the physical factors which influence denture retention to determine their part in providing retention. A number of theories about retention have been proposed. Denture retention is often confused or identified with denture adhesion, even in someprosthetic textbooks. Denture retention is defined as its resistance against dislodging from the basal seatl; Herland? considers denture retention to be the resistance against the influence of chewing forces, gravity, etc. Among the physical factors that influence denture retention are : (1) adhesion and cohesion, (2) negative atmospheric pressureunder the denture, (3) capillarity, and (4) the viscosity of saliva. All of these factors were subjected to a thorough physical and mathematical analysis, and their application to denture retention will be explained. In addition, a model of the mechanismsinvolved in denture retention was developed.
ADHESION AND COHESION

Adhesion and cohesion are important physical factors in denture retention. The limit of the effect of molecular forces is of the order of 10Vscm. per 0.000001 cm. Between the surface of the denture and the mucous membrane of basal seat, there is a layer of saliva which has the thickness of the order of lo-* em. per 0.01 cm. (Fig. 1) .3-6Evidently the existence of forces of adhesion between the mucous membrane and the denture is not a consideration. Adhesion in denture retention plays a part only in connection with the wetting of the capillary space, Even in it, however, there is no relationship of direct proportion. Therefore, including adhesion in the first place among the physical factors of retention is not correct. Since forces of cohesion with water, and approximately with saliva as well, are in the order of 1 Gm. on 1 cm.*, this force is sufficient for overcoming the weight of the denture. However, cohesion is a negligible force in denture retention and need not be considered (Fig. 2). 230

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MUCOSA

SALIVA

MATERIAL OF DENTURE u= &cm

Fig. than 1. The distance r demonstrates the distance a which is between the extent the mucous of molecular power and is essentially membrane and the denture. smaller

Fig. 2. A glass plate strates that cohesion and the plate remains

laid on the is a milder wet.

surface power

of the water is drawn than adhesion, because

up by power I. This demonthe water column is broken

ATMOSPHERIC

PRESSURE

The theory of atmospheric pressure in retention of dentures is supported by a number of authors.3-51 7p8 The authors assume that when the denture is dislodged from the basal seat, a lower atmospheric pressure is formed under the denture in comparison with the pressure of the surrounding atmosphere. The force created by <the difference in pressure pushes the denture against the basal seat. This mechanism ,would function well if a perfect border seal were possible and if the space between l;he denture base and the mucous membrane were filled with air. However, the ;assumption of a perfect border seal is abstract, and the mucous membrane is con,tinually covered by a small layer of saliva which wets the tissue and separates it .from the denture. Furthermore, the saliva moves under the denture, particularly (during shifting of the denture bases. A number of arguments exist that complicate the theory of denture retention.

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Blahova

and Neuman

J. Prosth. Dent. March, 1971

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...**

MUCOSA

--~--SA L I VA --=---=-\ MATERIAL OF DENTURE

Fig. 3. Capillary
whole column to each other. attraction of the liquid,

(F) does not act on the surface

even on the walls of the

of the liquid capillary fissures

only. which

It acts attracts

in the them

Salivary glands and even blood in capillaries create pressure the rapid pressure differences which arise under the denture. pressure in itself cannot be the cause of denture retention. may be only the difference of pressures under the denture ever, atmospheric pressure is effective during dislodging action a more complicated mechanism.

which tends to balance Therefore, atmospheric The cause for retention and outside it. Howof dentures and sets in

CAPILLARY ATTRACTION
Capillary attraction is sometimes mentioned as a factor in denture retention.6, +I3 When the denture is adjusted on the tissue surface, a space of about 0.1 mm. is created between the denture and the mucous membrane. In this way, the condition for the capillary attraction to come into action is developed. The quantity of capillary attraction has been mathematically calculated on a theoretical basis.g However, the important fact is that capillary attraction comes into action also between two bases. The capillary attraction does not act only on the surface of the liquid as it is usually explained by examples of capillary elevation and depression, but it works in the whole column of the liquid. The same force that draws the meniscus at the surface of the fluid, attracts two capillary walls to each other (Fig. 3). The magnitude of the capillary attraction created by the space between the denture base and the mucous membrane is one half in comparison with the example of the attraction in the tubes. The more narrow the space, the greater the attraction, When good wetting of the walls of the space occurs, the attraction inside the liquid is lowered because of capillary attraction. In the case of the mucous membrane, saliva, and the denture base, the denture is attracted to the mucous membrane by a force whose magnitude responds to the difference of the attraction of the exterior atmosphere and the saliva under the denture. Thus, capillary attraction may be the force which results in denture retention.

VISCOSITY OF SALIVA
Saliva, a relatively viscous liquid, is present in the space between

base and the mucous membrane. The tion of the serous and mucous glands.

viscosity depends

on the proportion

the denture of secre-

Physical

f ac t OIF., in retention

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233

The movement of a viscous liquid can be imagined as a successive shifting of infinitesimal layers. During this shifting, friction develops which tends to impede the shifting. At a sufficiently small distance between the denture and the mucous membrane, the layer of saliva is parallel to both walls and the resistance of this layer is indirectly proportional to the distance. Dislodgment of denture is rendered possible in the initial phase only by the fact that the quantity of saliva between the mucous membrane and the denture base increases by a certain volume from the surroundings and from palatal glands. lo, I23 I4 Viscosity of saliva, then, is not a direct source of the force which retains the denture. However, viscosity of saliva helps prevent the dislodgment of denture, especially in the initial phase, and so it becomes an important factor in retention. The effect of the viscosity of saliva, in contradiction to other physical phenomena, is also related to mobility. This problem deals mainly with the displacement of a :substance in relation to time. This fact explains the problem of expressing capillary attraction and viscosity mathematically as the application of equations of motion becomes necessary.lOJ 1*-14

MODEL FOR DENTURE RETENTION

When the denture is pressed to place on the mucous membrane, only a thin layer of saliva of about 0.1 mm. thickness remains under the denture. At the same time, the mucous membrane is elastically deformed to the outline of the denture. In this way, a suitable condition for capillary attraction comes into action which is sufficiently powerful to hold the denture on the basal seat in static conditions. However, a positive relationship has been found between the degree of the load on the denture and the time after which retention fails.l* Viscosity is the only factor in retention of complete dentures that is dependent upon time. A difference in pressure arises in the layer of saliva which brings the saliva into motion. The speed of this motion is dependent on many factors such as the viscosity of the saliva, and the width of the space between the denture base and the mucosa. As this space gradually increases and is filled with saliva, the capillary at traction, whose magnitude was at first sufficient for denture retention, is reduced to such an extent that the retention fails (Fig. 4) . A question still unexplained involves the failure of capillary attraction to mainta.in retention after a certain time. The deformed mucous membrane returns slowly to the original condition and at the same time releases energy which was accumula.ted by the force of the denture. The released energy manifests itself by motion in the layer of saliva under the denture. The saliva increases and the capillary attraction decreases as the space under the denture becomes larger, thus reducing retention (Fig. 5). For the denture to maintain retention during resting conditions, it is necessary from time to time to deform the mucous membrane to conform with the denture base. This is performed easily by the patient when he sucks and swallows saliva which has increased under the denture and, at the same time, pushes the denture back into place on the mucosa. Capillary attraction in a capillary tube or space ceases to be effective if the tube is submerged under the surface of the same liquid. A similar situation occurs

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and Neuman

J. Prosth. Dent. March. 1971

.\,MUCOUS

MEMBRANE

Fig. 4. A cross section of the upper jaw and denture. If a downward force (P) is exerted on the denture, the thickness of the layer of saliva increases, the capillary attraction decreases, and retention is reduced.

Fig. 5. A cross section of the upper jaw and denture. The mucous membrane is deformed by pressure on the denture PI. However, in time the mucosa is dislodged from the denture,
saliva flows under the denture, the capillary space enlarges, and the denture falls off.

in lower complete dentures. The basal seat tissues of the lower jaw are wetted by saliva far more intensively than the basal seat tissues of the upper jaw. Therefore, the capillary attraction in lower complete dentures functions only very little and for a short period of time in many instances as saliva accumulates.

SUMMARY
None of the physical factors involved in complete denture retention can be totally explained. However, some of them participate commonly in the intricate mechanism which is set in action at the moment of dislodgment of the denture. A most important factor in retention seems to be capillary attraction. Another factor is the viscosity of saliva which affects the motion of saliva under the denture. Denture

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retention is enhanced by the elasticity of the mucous membrane of the basal seat area and by a good border seal which keeps the space between the denture and the mucosa as small as possible.
ReFerences
1. Boucher, C. O., Frechette, A. A., and Gehl, D. H.: Glossary of Prosthodontic Terms, Ed. 2, J. PROSTH. DENT. 1: 39,196O. 2. Herlands, R. E.: Removable Partial Denture Terminology, J. PROSTH. DENT. 8: 964791, 1958. 3. Kantorovicz, A.: Innen-und ausen-Wentil, Adhlsion und Luftdruck, D. Z. Z. 5: 784791, 1956. 4. Kubali, H. N.: The Theoretic Basis of the Functional Vacuum Method for Complete Denture Construction, J, PROSTH. DENT. 10: 673-681, 1960. 5. Kuck, M.: Adhlsion und Luftdruck, D. Z. Z. 5: 792-797, 1956. 6. Lammie, G. A.: The Retention of Complete Dentures, J. Amer. Dent. Ass. 55: 502-508, 1957. 7. Campbell, R. L.: Relief Chambers in Complete Dentures, J. PROSTH. DENT. 11: 230236, 1961. 8. Stamoulis, S.: Physical Factors Affecting the Retention of Complete Dentures, J. PROSTH. DENT. 12: 857-869, 1962. 9. Betzler, H., and Riedel, H.: Die Ursachen und Gesetze beim Halt der Prothese, Stoma 14: 117-134,, 182-209, 1961. 10. Graig, R. G., Berry, G. C., and Peyton, F. A.: Physical Factors Related to Denture Retention, J. PROSTH. DENT. 10: 459-467, 1960. 11. Lawson, W. A.: Die Haftfahigkeit der Vollprothese, Linformation dent. 48-24: 26252635, 1966. 12. Ostlund, S. G.: Saliva and Denture Retention of Complete Dentures, J. PROSTH. DENT. 10: 658-663, 1960. 13. Stanitz, J. D.: An Analysis of the Part Played by the Fluid Film in Denture Retention J. Amer. Dent. Ass. 37: 168-172, 1948. 14. Campbell, R. L.: Effects of Water Sorption on Retention of Acrylic Resin Denture Bases, J. Amer. Dent. Ass. 52: 448-454, 1956.
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