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Adverse Reactions to Denture Resin Materials

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Adverse Reactions to Denture Resin Materials European Review for Medical and Pharmacological Sciences 2017; 21: 5298-5305 Adverse reactions to denture resin materials M. KOSTIC1, A. PEJCIC2, M. IGIC1, N. GLIGORIJEVIC1 1Clinic of Stomatology, Department of Prosthodontics, Faculty of Medicine, University of Nis, Nis, Serbia 2Clinic of Stomatology, Department of Oral Medicine and Periodontology, Faculty of Medicine, University of Nis, Nis, Serbia Abstract. – Irrespective of the new generation holders, artificial teeth, veneers and temporary of dental materials, acrylates still have a wide crowns and bridges3,4. Soft acrylic materials are indication field. Although they are classified used in the preparation, conditioning, and treat- as biomaterials, acrylates can have both local ment of damaged and inflamed tissue. Special and systemic side effects. The individual com- types of acrylates are used as a part of the structu- ponents of the acrylic materials may leave the dental restorations and diffuse into saliva. The re of materials for the permanent binding of fixed aim of this study was to point out the potential- dentures (resin cement, glass ionomer resin mo- ly toxic components of acrylic dental materials, dified cement). As supporting materials acrylates as well as their possible adverse effects on oral have found the application in making individual tissues and the organism in general. The paper trays, certain dental restorations models, bite pla- was based on the assumption that the appropri- nes and occlusal templates1,2. ate selection of the type of acrylic material and the proper method of their preparation reduce Acrylics, depending on their indication field, their adverse effects to a minimum, which was may differ by type and method of preparation. proven using literature data. The classification of acrylic polymers in dentistry is shown in Table I. Key Words: Dental acrylates are most often composed of Denture resin, Adverse, Reactions. poly (methyl methacrylate) (PMMA) generated by addition polymerization of methyl methacrylate (MMA), although there are variations which are Introduction primarily related to the type of monomer (butyl methacrylate-butyl, ethyl methacrylate-EMA and The long-term use of acrylic materials in den- urethane dimethacrylate (UDMA)) and crosslin- tistry is the proof of their satisfactory biological, king agents (Table II). physical and mechanical properties. However, in The aim of this work was to point out potential- time it has been shown that the acrylic polymers ly toxic components of acrylic dental materials as announced in the first half of the twentieth century well as the possible adverse effects of acrylates are not the ideal building material. Although not on oral tissues and the organism in general, which perfect, they considerably meet the requirements was proven using available literature data. of everyday dental practice due to relatively good The study was based on the assumption that the biocompatibility, their chemical inertness, fair appropriate selection of the type and method of mechanical properties, dimensional stability, the preparation of acrylate materials can reduce their possibility of coloring and transparency, simple side effects to a minimum. processing, the possibility of repairing as well as their low price1,2. Acrylates as Biomaterials As construction materials in dental medicine, Acrylates are classified as biomaterials due to acrylate polymers have various fields of appli- their morphological and functional role as substi- cation. They are used for making bases of full tuents in the oral cavity5. Acrylate biomaterials and partial dentures, their relining and repairs as are used to replace and compensate for the lost well as preparation for obturator prosthesis and or damaged tissues, and perform a particular fun- maxillofacial defects, faces prosthesis, splints, re- ction in the oral cavity6. While being in contact movable orthodontic appliances and dental space with oral structures, acrylates lead to a number 5298 Corresponding Author: Milena Kostic, DDS, Ms.D, Ph.D; e-mail: [email protected] Adverse reactions to denture resin materials Table I. Classification of dental base polymers. Denture base polymers type Description 1 Heat cured polymers (powder and liquid form) 1a Heat cured polymers (plastic cake form) 2 Self-cured-auto-polymerized polymers 3 Thermoplastic type resins 4 Light activated type resins 5 Microwave cured type resins Table II. Composition of acrylic denture base materials. cinogenic properties. A negative reaction to its Component Constituents presence may be a result of other harmful fac- tors, such as the accumulation of the infectious Powder substrate on the material9. Therefore, the material Polymer Poly (methylmethacrylate) (PMMA) toxicity should be seen as just one aspect of their biocompatibility. Initiator Benzoyl peroxide To safely use a material in the professional Pigments Salts of cadmium or iron or organic field, it must have a standard label mark regula- dyes ting its quality-standards of the European Union’s target, International Organization for Standardi- Liquid zation (ISO). Dental materials and instruments Monomer Methyl methacrylate (MMA) Cross-linking Ethylene glycol dimethacrylate are certified by the ISO-TR 7405. agent (EGDM) Inhibitor Hydroquinone Potentially Toxic Substances in Acrylates Acrylics are not completely safe materials be- Activator N,N′-dimethyl-p-toluidine cause their polymerization chain reaction is never absolute. Potential causes of their harmfulness are unpolymerized components and by-products of complex interactions, which are collectively re- of the polymerization reaction10. The individual ferred to as biological tissue response7. Therefore, components of acrylic materials have the ability biocompatibility is considered to be an essential of leaching dentures and diffusing into saliva, feature of dental materials; so it is very important thus influencing oral tissues and the organism in for the success of dental therapy and also the pa- general5,11-13. The components which are released tient’s health. from the acrylic resin material by electrolysis or Biocompatibility is a material characteristic of hydrolysis processes are absorbed into the oral being accepted in a specific living environment mucosa, gastrointestinal tract, skin, and respira- without adverse or unwanted side effects. The tory system. The absorption mechanism depends absence of harmful effects of materials implies a on the nature and chemical properties of the rele- harmony with the biological functions of living ased elements. Adverse effects of acrylate com- tissues. Since there is no dental material that is ponents on tissues are less often caused by their fully biologically inert, we cannot talk about ab- toxicity but, more frequently, by their immunolo- solute, but a certain degree of biocompatibility. gical functioning15,16. As applied material and host tissue change over Residual monomers represent a certain amount time, biocompatibility should be seen as a dyna- of monomer which was not bound during the mic process. Any change in tissues (inflamma- polymerization process. Incomplete polymeriza- tion, thermal, chemical and mechanical damage) tion of acrylates reduces the physical-mechanical, reduces the degree of biocompatibility of the ap- and biological qualities of dental restorations. It plied material8. has been proven that the unbound MMA is an Biocompatibility of dental materials is most allergen and tissue irritant18-22. A certain amount commonly observed through their potential local of residual MMA was found in dentures that had or systemic toxicity. The material is considered been worn for seventeen23 to even thirty years24. biocompatible if it does not cause irritation or By hydrolyzing MMA, methacrylic acid is for- allergy, nor does it have any mutagenic or car- med with its proven cytotoxicity25,26. Gawkrod- 5299 M. Kostic, A. Pejcic, M. Igic, N. Gligorijevic ger et al27 stated EGDM as the strongest allergen aqueous solution reduces the amount of residual in the acrylic material. The potentially toxic ef- monomer for up to 25%37-39. fect is associated with the BuMA, the EMA and Formaldehyde in acrylic polymer appears as UDMA, and also with the co-monomer crosslin- a side effect of the oxidation of the methacrylic ker (ethylene glycol dimethacrylate – EGDM)28,29. group or the degradation of the oxido-methacrylic To overcome problems with allergies related copolymer. The amount of the generated formal- to conventional acrylates, new hypoallergenic dehyde depends on the MMA concentration and acrylic materials were introduced, where MMA polymerization completeness. The reduction can was replaced with diurethane dimethacrylate, be achieved by removing from the surface, less polyurethane, polyethylene terephthalate, and polymerized acrylic material. According to Oy- polybutylene terephthalate, but they did not pro- saed et al40, the largest amount of formaldehyde is ve to be definitely safe25. Also, the hypoallergenic left in the structure of cold polymerized acrylates. features of light-polymerized acrylates were di- The free residual monomer and formaldehyde sproven by the sensitivity of individual patients molecules can be associated with proteins in the to UDMA and bisphenol-glycidyl methacrylate patient’s mouth forming large molecules respon- (Bis-GMA)30. sible for oral tissue allergic reactions41. They are Over time, the residual monomer leaves the most commonly manifested as type I hypersensi- acrylic compensation and diffuses into saliva
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