Dental Journal
Mahidol Dental Journal
Original Article
The effect of denture cleansing solutions on the retention of
Pink Locator® attachment: 1 year simulation
Pijitra Watcharapichat1, Chatchai Kunavisarut2, Piyapanna Pittayachawan3, Tassanee Tengrangsan4
1
2
3
4
M.Sc. (Implant Dentistry), Implant Center, Faculty of Dentistry, Mahidol University.
M.Sc. (Prosthodontics), Advanced General Dentistry Department, Faculty of Dentistry, Mahidol University.
Ph.D. (Dental Ceramics), Advanced General Dentistry Department, Faculty of Dentistry, Mahidol University.
M.Sc. (Endodontics), Advanced General Dentistry Department, Faculty of Dentistry, Mahidol University.
Abstract
Objective: To evaluate the effect of various denture cleansing solutions on
retention of pink Locator® attachments after 1 year
Materials and methods: Thirty-five pink Locator® attachments (3.0 lbs. Light
Retention) were divided into five groups (seven specimens in each group) and
soaked in different denture cleansers for 1 year. They were Polident® 5
minutes, Fittydent®, 0.12% Chlorhexidine gluconate, 1% sodium hypochlorite
and tap water as control. The pink Locator® attachment was tested for
load-to-dislodgement (retentive force; Newton) on a Universal Testing
Machine (Model 5566, Instron Corp, Norwood, MA) in separate soaking time
(before soaking, after simulated soaking for 1 month, 6 months and 1 year).
The percentage of retention loss after soaking in the denture cleansers for 1
month, 6 months and 1 year were compared by groups using the
Kruskal-Wallis Test and then followed by the Mann-Whitney U Test to indicate
which pairs of denture cleansers were different. A p-value ≤ 0.05 was
considered significant.
Results: After 1 month soaking time, there was no significant difference
among the cleansers (p-value > 0.05). After 6-month soaking time, the
retention for attachments soaked in Fittydent® (median of % retention loss:
-33.49%) and Chlorhexidine gluconate (-27.05%) were significantly higher than
that soaked in tap water (3.81%). There was no significant difference among
tap water, Polident® 5 minutes (-8%) and Sodium hypochlorite (-9.57%). After
1-year soaking time, the retention for attachments soaked in Sodium
hypochlorite (42.58%) was significantly lower than that soaked in other
solutions. The retention for attachments soaked in Fittydent® (-36.04% ) and
Chlorhexidine gluconate (-29.03%) were significantly higher than that soaked
in tap water (-10.15%). There was no significant difference between tap water
and Polident® 5 minutes (-12.41%).
Conclusion: Polident® 5 minutes had no significant effect on the retention of
pink Locator®. Fittydent® and Chlorhexidine gluconate significantly increased
the retention of the attachments. Sodium hypochlorite significantly decreased
the retention, thus it should not be recommended as a routine denture
cleanser.
Key words: dental implants, denture cleansing solutions, Locator® attachment,
overdenture, Retention.
How to cite: Watcharapichat P, Kunavisarut C, Pittayachawan P, Tengrangsan T.
The effect of denture cleansing solutions on the retention of pink Locator®
attachment: 1 year simulation. M Dent J 2014; 34: 204-14.
204
The effect of denture cleansing solutions on the retention of Pink Locator® attachment: 1 year simulation
Pijitra Watcharapichat, Chatchai Kunavisarut, Piyapanna Pittayachawan, Tassanee Tengrangsan
Corresponding Author:
Chatchai Kunavisarut
Advanced General Dentistry Department,
Faculty of Dentistry, Mahidol University.
6 Yothi Rd., Rajathevi Bangkok 10400.
Phone: 02-200-7853
Email: [email protected]
Received: 30 April 2014
Accepted: 26 June 2014
M Dent J Volume 34 Number 3 September-December 2014
Introduction
Implant retained overdenture is an
effective treatment option for edentulous
patients.1,2,3 It can improve the retention and
stability of the dentures, oral function and
significantly increase patients’ satisfaction with
their prostheses.4,5 There are various types of
attachment systems that can be applied for
implant retained overdentures and the most
commonly used attachment system is Locator®
attachment.
Locator® attachment (Zest Anchors, Inc,
homepage, Escondido, CA, USA) is an individual
mechanical attachment roughly similar in size
and function to a ball attachment.6 Locator®
attachment consists of Locator ® abutment
screwed on the implant and metal housing with
Locator® nylon (Dupont Zytel 101L NC-10 Nylon,
Zest Anchors Inc.) inserted into the denture
base. These nylon components are provided in
different colors with different retentive values
including blue, pink, clear, red, orange and
green color.
Implant retained overdenture needs
rigorous hygienic care. 7 Adequate denture
hygiene can treat and prevent infection in
edentulous patients.8,9 Failure to properly clean
the accumulated biofilm from the dentures is
related with an increased incidence of localized
denture stomatitis.10-12 Most patients clean their
denture by brushing; however elderly patients
tend to have compromised ability to manually
clean their dentures effectively. Moreover,
American college of Prosthodontists (ACP) has
recommended cleaning the dentures daily by
soaking and brushing with an effective,
nonabrasive denture cleanser. 8 There are
several denture cleansers available in Thailand
market such as Polident ®, Steradent ® and
Fittydent ®. Nevertheless, denture cleansing
solutions may cause negative effect on
prosthetic materials including Locator® nylon
component. Additionally, various types of
denture cleansing solutions may have different
effects on retention of Locator ® nylon
component. 13,14 Previous studies 13,14 showed
that only 6.15% Sodium hypochlorite
significantly reduced the retention of Locator®
nylon significantly, but other denture cleansing
solutions had no effect on retention. However,
the simulated soaking time of those studies
were only 6 months and also the soaking time
of Sodium hypochlorite was more than the ACP
recommendation.8
Therefore, this study evaluated the effect
of several denture cleansers including Polident®
, Fittydent®, 0.12% Chlorhexidine gluconate and
1% Sodium hypochlorite on the retention of
pink Locator® after 1 year.
Materials and methods
Acrylic resin blocks were fabricated and
divided into five groups according to types of
denture cleansers. One acrylic resin block was
used to house the implant analog attached
with Locator abutment (block A), while the
other 35 blocks (block B) were used to house
the metal housings with pink Locator® nylons
(7 block B for each group) (Figure 1).
Block A
The rectangular plastic molds with
internal dimensions of 1.5 x 3.5 x 2 cm were
fabricated. Self-polymerized pink acrylic resin
(SPD, Mulazzano, Italy) was mixed and poured
into the plastic mold and left until polymerization
was completed to form acrylic resin block A.
Figure 1 The acrylic resin blocks
The effect of denture cleansing solutions on the retention of Pink Locator® attachment: 1 year simulation
Pijitra Watcharapichat, Chatchai Kunavisarut, Piyapanna Pittayachawan, Tassanee Tengrangsan
205
M Dent J Volume 34 Number 3 September-December 2014
After polishing block A, one round hole (6mm
in diameter×3 mm in depth) was fabricated into
the top part of the block A at a distance of 7
mm from the center of the hole to the edge of
the block in order to form the index for block B.
Another round hole (10 mm in diameter×13
mm in depth) was fabricated at the center of
the block in order to prepare the space for
implant analog. One implant analog (RN 4.1
mm, 10 mm in length, Institute Straumann AG,
Waldenburg, Switzerland) was attached to a
surveyor (Degussa,VG1) by using implant
mounting and mounting adaptor. Then, an
implant analog was positioned in the prepared
hole perpendicular to the horizontal plane. The
platform of the implant was placed 1 mm
above the surface of the acrylic resin block.
Self-polymerized acrylic resin was mixed again
and poured into the hole and left until
polymerization was completed. One Locator®
abutment (Zest Anchors, Escondido, CA) was
torqued to 20 Ncm on the implant analog.
Block B
The separating media was applied on the
top surface of block A. A block-out spacer and
a metal housing containing the processing cap
were placed over the abutment. Another
plastic mold was placed on top of the block A.
Self-polymerized acrylic resin was mixed and
poured into the upper plastic mold to form
acrylic resin block B in the same method as
block A. Then, a screw hook was embedded
into the top part of block B. Eventually, block B
contained metal housing and a key to match
the hole in the block A. This index aided in
anti-rotation and verification of complete
seating during testing procedures. The axial
walls of the hole in block A were slightly
relieved to reduce any friction produced
between these walls during the testing
procedure.
206
The black processing cap was replaced by
pink Locator® nylon by using Locator® core tool.
If there was excess acrylic resin at the margin of
the black processing cap, it would be removed
before taking the processing cap out of the
metal housing.
The pink Locator® attachment was tested
for load-to-dislodgement (retentive force;
Newton) on a Universal Testing Machine (Model
5566, Instron Corp, Norwood, MA). The testing
machine was calibrated before testing each
specimen. The acrylic block A was clamped
down and stabilized on the lower member. A
screw hook of block B was gripped to the upper
member of the machine. A tensile force at a 2
in/min crosshead speed15 was applied to the
specimen until the Locator® attachment was
separated from the abutment.
The retention of each specimen was
measured as followed: before soaking in
denture cleanser, after simulated 1-month
soaking time, after simulated 6-month soaking
time, and after simulated 1-year soaking time.
Each specimen was pulled 10 times and mean
retentive value (Newton) was calculated (Figure
2). To allow proper recovery of the nylon
components and to prevent potential heating
between the attachment parts, a period of 10
seconds between each pull was employed.16,17
The denture cleansing solutions used in
this study were Polident ® 5 minutes
(Glaxo Smith Kline, Philadelphia, PA) , Fittydent®
(Fittydent International GMBL, A-7423 Pinkafeld,
Austria), 0.12% Chlorhexidine gluconate (M
Dent, Faculty of Dentistry, Mahidol university,
Thailand) and 1% Sodium hypochlorite (M Dent,
Faculty of Dentistry, Mahidol university,
Thailand). Tap water was used as the control.
Five block B with pink Locator® attachments (3
lbs. or 13.35 N) were immersed in each of the
cleansing solution according to manufacturer’s
instructions for the time equivalent of 1 year.
(Table 1)
The effect of denture cleansing solutions on the retention of Pink Locator® attachment: 1 year simulation
Pijitra Watcharapichat, Chatchai Kunavisarut, Piyapanna Pittayachawan, Tassanee Tengrangsan
M Dent J Volume 34 Number 3 September-December 2014
Figure 2 Example of Polident® group at before soaking in denture cleanser period
Table 1 Denture cleansers
Solution
Water
Polident®
Fittydent®
0.12%Chlorhexidine
1% Sodium hypochlorite
Solution change
interval
(per day)
8 hours
5 minutes
30 minutes
20 minutes9
10 minutes8
The solutions were changed on a
simulated method. For example, Polident ®
required 5 minutes of soaking per day, hence,
the solution was changed every 5 minutes.
Between each immersion, the pink Locator ®
attachments within the block B were rinsed
with tap water for 60 seconds.
The pink Locator® attachment was tested
for retentive force at the period of before
soaking, after soaking for 1 month, 6 months
and 1 year. The percentage of retention loss
after soaking in the denture cleansers for 1
month, 6 months and 1 year were calculated
by using the mean retentive value before
soaking minus the mean retentive value after
soaking for 1 month, 6 months or 1 year,
divided by the mean retentive value before
soaking.
- After soaking for X months × 100
% retention loss = Before soakingBefore
soaking
Total soaking time
(1 year)
2880 hours
30 hours
180 hours
120 hours
60 hours
Negative values meant increased retention
while positive values meant decrease retention.
The percentage of retention loss after soaking
in the denture cleansers for 1 month, 6 months
and 1 year were compared among the groups
by the Kruskal-Wallis Test followed by the
Mann-Whitney U Test to indicate which pairs of
denture cleansers were different. A p-value
≤ 0.05 was considered significant.
The surface texture of pink Locator ®
attachments were assessed under Scanning
Electron Microscope (SEM) after simulated 1year soaking time in order to identify the effects
caused by denture cleansers. The surface
texture was blindly evaluated by one operator.
Results
The results of this study accepted the
alternative hypothesis that denture cleansing
The effect of denture cleansing solutions on the retention of Pink Locator® attachment: 1 year simulation
Pijitra Watcharapichat, Chatchai Kunavisarut, Piyapanna Pittayachawan, Tassanee Tengrangsan
207
M Dent J Volume 34 Number 3 September-December 2014
solutions had significant effects on the
retention of pink Locator® nylons after 1-year
simulated immersion time.
After 1 month of simulated soaking time,
there was no significant difference among the
cleansers (p-value > 0.05). The median of
percentage of retention loss after soaking in tap
water for 1 month was -4.64% (negative values
meant increased retention while positive values
meant decrease retention), in Polident ® 5
minutes was 3.25%, in Fittydent® was 0.27%, in
Sodium hypochlorite was -6.81% and in
Chlorhexidine gluconate was -11.81%. Denture
cleansing solutions had no significant effects on
retention of attachments after soaking for 1
month (Figure 3).
After simulated 6-month soaking time, the
results showed that some denture cleansers
had significant effects on retentive values of the
attachments. The median of percentage of
retention loss in tap water was 3.81%, in
Polident® 5 minutes was -8%, in Fittydent® was
-33.49%, in Sodium hypochlorite was
-9.57% and in Chlorhexidine gluconate was
-27.05%. The retention for attachments soaked
in Fittydent® and Chlorhexidine gluconate were
significantly higher than that soaked in tap
water (p-value = 0.001 and 0.026 respectively).
There was no significant difference between tap
water, Polident ® 5 minutes and Sodium
hypochlorite (p-value > 0.05) (Figure 4).
After 1-year soaking time, some denture
cleansers had significant effects on retentive
values of the attachments. The median of
percentage of retention loss in tap water was
-10.15%, in Polident® 5 minutes was -12.41%, in
Fittydent® was -36.04%, in Sodium hypochlorite
was 42.58% and in Chlorhexidine gluconate was
-29.03%. The retention for attachments soaked
in Fittydent® and Chlorhexidine gluconate were
significantly higher than that soaked in tap
water (p-value = 0.011 and 0.026 respectively).
Additionally, the retention for attachments
soaked in Fittydent® was significantly higher
than that soaked in Polident ® 5 minutes
(p-value = 0.026). The retention for attachments
soaked in Sodium hypochlorite was significantly
lower than that soaked in other solutions
(p-value < 0.05). There was no significant
difference between tap water and Polident® 5
Figure 3 Percentage of retention loss of each sample in 5 cleansers after
1-month soaking.
208
The effect of denture cleansing solutions on the retention of Pink Locator® attachment: 1 year simulation
Pijitra Watcharapichat, Chatchai Kunavisarut, Piyapanna Pittayachawan, Tassanee Tengrangsan
M Dent J Volume 34 Number 3 September-December 2014
minutes (p-value = 0.805) (Figure 5).
Table 2 showed mean and standard
deviation (Newton) of retentive values in
different cleansers at each period of time.
Some denture cleansers caused
discoloration of the pink nylons and the pink
acrylic resin. Sodium hypochlorite eventually
softened the pink nylons, whitened the pink
nylons and acrylic resin. Fittydent ® also
whitened the pink nylon and acrylic resin. The
Figure 4 Percentage of retention loss of each sample in 5 cleansers after 6-month
soaking. Groups with the same letter are not significantly different.
Figure 5 Percentage of retention loss of each sample in 5 cleansers after 12-month
soaking. Groups with the same letter are not significantly different.
The effect of denture cleansing solutions on the retention of Pink Locator® attachment: 1 year simulation
Pijitra Watcharapichat, Chatchai Kunavisarut, Piyapanna Pittayachawan, Tassanee Tengrangsan
209
M Dent J Volume 34 Number 3 September-December 2014
others did not affect the colour visually (Figure
6).
According to microscopic visualization of
the nylon surfaces after 1 year soaking, Polident®
group had no surface change compared to
control group. Fittydent®, Sodium hypochlorite
and Chlorhexidine gluconate groups had
rougher surface. Sodium hypochlorite group
had much more surface change than other
groups (Figure 7).
Discussion
This study emphasized on testing the
Locator® attachment because it is one of the
most popular attachment systems. It provides
several advantages, which are low-profile height,
resiliency, self-aligning, durability, dual retention,
easy replacement and repair, angulation
correction and long-term stability. A tensile
force at a 2 in/min crosshead speed was
applied because it was the speed which
patients removed overdentures from their
Locator® abutments.15 The retention of each
specimen was measured for 4 periods (before
soaking in denture cleanser, after simulated 1month soaking time, after simulated 6-month
soaking time, and after simulated 1-year soaking
time) in order to investigate only the effects of
denture cleansers on retention at each period
of time. However, there were other factors that
can influence retentive value of nylon
component of Locator ® including denture
removal-insertion 16,18-20, occlusal function,
implant angulation and numbers of implants18
etc.
The solutions used in this study were
Polident® 5 minutes, Fittydent®, Chlorhexidine
gluconate and Sodium hypochlorite. Polident®
Table 2 Retention of each cleanser at different soaking time
Retention: Mean±SD (Newton)
Period
Water
Polident Fittydent
NaOCl
Before soaking 19.02±2.07 21.39±1.54 19.47±1.86 19.47±2.94
1-month soaking 19±1.95 21.46±3.69 19.5±2.66 20.89±2.01
6-month soaking 18.71±1.94 24.95±5.09 25.39±1.6 21.91±3.83
1-year soaking 20.79±2.07 23.62±3.51 29.04±6.73 11.25±2.65
CHX
17.27±2.29
18.34±2.62
20.93±2.73
22.46±3.29
Figure 6 Examples of pink Locator® attachments and a part of
pink acrylic resin after soaking for 1 year. (1) tap water.
(2) Polident® 5 minutes. (3) Fittydent ®. (4) Sodium
hypochlorite. (5) Chlorhexidine gluconate.
210
The effect of denture cleansing solutions on the retention of Pink Locator® attachment: 1 year simulation
Pijitra Watcharapichat, Chatchai Kunavisarut, Piyapanna Pittayachawan, Tassanee Tengrangsan
M Dent J Volume 34 Number 3 September-December 2014
Figure 7 Surface texture of the nylon surfaces after 1 year soaking under
SEM at 1000x. (1) tap water. (2) Polident ® 5 minutes. (3)
Fittydent®. (4) Sodium hypochlorite. (5) Chlorhexidine gluconate.
and Fittydent ® were able to reduce dental
biofilm including Candida species effectively.21-27
They have similar major components, which are
Sodium bicarbonate, Potassium monopersulphate
and detergent. Sodium hypochlorite is another
denture cleanser, which is superior to all other
types of commercially available denture
cleansers.28-31 Francine et al.32 reported that 1%
sodium hypochlorite is a valid alternative for
disinfection of acrylic resin. However, guideline
from the American college of Prosthodontists
(ACP) recommended that dentures should not
be soaked in Sodium hypochlorite longer than
10 minutes per day to avoid denture damage.8
Chlorhexidine gluconate is a broad spectrum
antiseptic agent. It can inhibit Candida albicans
and other common non-albican yeast species.33,34
Chlorhexidine is one of the most widely used
agents and has been used as an adjunctive
treatment of oral candidiasis since the 1970s.
Andrade et al. 9 indicated that 0.12%
chlorhexidine solution had an ability to remove
denture biofilm and had no adverse effect or
stains on dentures and none of the participants
complained about the bad taste associated
with the Chlorhexidine.
After a simulated period of 1 year,
Polident® 5 minutes had no significant effect on
the retention of pink Locator ®, which is in
agreement with the studies of You et al.13 and
The effect of denture cleansing solutions on the retention of Pink Locator® attachment: 1 year simulation
Pijitra Watcharapichat, Chatchai Kunavisarut, Piyapanna Pittayachawan, Tassanee Tengrangsan
211
M Dent J Volume 34 Number 3 September-December 2014
Nguyen et al,14 and had no effect to the surface
texture. Thus, it can be an alternative routine
denture cleanser. Furthermore, it has short
soaking time which is easy for the patient to
use. Fittydent ® significantly increased the
retention of the attachments and also whitened
the pink nylon and acrylic resin despite their
major components are similar to Polident® 5
minutes. This might be due to the product
recommended soaking time of Fittydent ®,
which is longer than Polident ® 5 minutes.
Furthermore, microscopic visualization showed
the rougher surface compared to the control
and Polident® groups. Chlorhexidine gluconate
significantly increased the retention of the
attachments and did not affect the colour
visually, which is in agreement with the study of
Andrade et al. 9 Thus, it can be used as an
alternative routine denture cleanser including
the cleanser for oral candidiasis patient.
Moreover, the cost compared to other
commercial denture cleansers is lower. The
increased retention might be due to some
texture change on the nylon surfaces. However,
the effect of surface texture change in longer
soaking time should be evaluated in future
studies. Although the soaking time of Sodium
hypochlorite in this study was limited to 10
minutes per day which was less than previous
studies13,14 (8 hours); however, the retention of
nylon was still decreased after 1 year. After 1
and 6-month soaking, the increased retention
might be due to the abundant surface change
of the nylons. The texture change caused the
surface getting rougher and had more friction.
However, after continuing soaking for 1 year,
there might be material degradation that
caused the nylon to be softened. Finally, the
retention was dropped drastically even if the
soaking time did not exceed 10 minutes per
day. Thus, it should not be recommended as a
routine denture cleanser, which is in agreement
with the studies of You et al.13 and Nguyen et
212
al 14. Furthermore, Sodium hypochlorite had
several detrimental effects to denture materials,
which are metal corrosion, irritant effect on the
skin and other cells and unpleasant residual
odor and taste.9, 35,36
This in vitro study had some limitations.
The pink nylons were soaked continuously in
the denture cleansers for a simulated 1 year.
This is different from the clinical situation,
which periods of soaking and periods of use are
alternate. The attachments were not tested
under mimic normal oral environment and
occlusal function. These conditions may
conceal the effect from denture cleansers. Thus,
the solutions that increased the retention of
pink Locator ® should be interpreted with
caution because different results may be
obtained when normal oral environment and
occlusal function are combined. In addition, the
data were not normally distributed. This might
be due to the small sample size. However, the
results from the study were clear and the
surface textures under microscopic visualization
were consistent with the results.
Within the limitations of this study, the
authors concluded that
Polident® 5 minutes had no significant
effect on the retention of pink Locator®.
Fittydent® and Chlorhexidine gluconate
significantly increased the retention of the
attachments. However, Fittydent ® also
whitened the pink nylon and acrylic resin.
Sodium hypochlorite eventually
significantly decreased the retention and
softened and whitened the pink nylon and
acrylic resin, thus it should not be recommended
as a routine denture cleanser.
Acknowledgements
The authors would like to express sincere
gratitude to DKSH Company Limited as the
sponsor for the research materials.
The effect of denture cleansing solutions on the retention of Pink Locator® attachment: 1 year simulation
Pijitra Watcharapichat, Chatchai Kunavisarut, Piyapanna Pittayachawan, Tassanee Tengrangsan
M Dent J Volume 34 Number 3 September-December 2014
Funding: None
Competing Interests: None
Ethical Approval: None (Experimental Study)
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