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Denture adhesives are products used by wearers of removable dental prosthesis; however, systematic reviews on their influence on masticatory performance are lacking.
The purpose of this systematic review was to evaluate the efficiency of denture adhesives in improving the masticatory performance of users of complete dentures (CD).
Material and methods
This systematic review was organized from the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist, and the methods were registered on the international prospective register of systematic reviews (PROSPERO-CRD42020187385). The focus question was as follows: “Does the use of denture adhesives improve the masticatory performance of patients with removable dental prostheses?” The databases PubMed/MEDLINE, Scopus, Web of Science, and Cochrane Library were used to extract information.
The search yielded 1338 articles, of which 6 met the inclusion criteria and were selected. All included studies were crossover randomized controlled trials including bimaxillary edentulous individuals. Masticatory performance was evaluated by using a comminution and sieve method.
Denture adhesives significantly increased the masticatory performance of CD users.
Denture adhesives increase masticatory performance and are a good choice for patients for whom retention and stability have not been satisfactorily achieved.
Despite the success rate of dental implant-supported prostheses and bone grafting,
removable complete dentures are still commonly provided, including for patients with limited financial resources, severe bone resorption, as an interim treatment before dental implant loading, for patients with severe systemic diseases unable to undergo surgical procedures,
and for those who are satisfied with CDs and decline surgical treatment. Although the success of removable dental prostheses depends on different factors, the influence of adequate retention, stability, and support has been emphasized.
and are composed primarily of bonding agents. Most brands use a naturally occurring compound such as carboxymethylcellulose (CMC), which, when in contact with saliva, promotes adhesion between the intaglio surface of the denture and the oral mucosa.
However, masticatory performance (MP), which is defined by the Glossary of Prosthodontic Terms as “a measure of the comminution of food attainable under standardized testing conditions,” needs to be further investigated for DA usage.
The most commonly used method is the comminution and sieve, where the patient is instructed to perform a certain number of masticatory movements with the test food and the content is passed through sieves and evaluated.
and the methods were registered on the international prospective register of systematic reviews (PROSPERO-CRD42020187385).
The selection of studies was based on the population, intervention, comparison, and outcome (PICO) strategy as follows: Population, rehabilitated patients or users of a removable dental prosthesis; Intervention, use of DAs; Comparison, no application of DAs (negative control); and Outcome, MP measured with objective methodologies as the primary outcome. Additionally, the focus question was “Does the use of DAs improve the MP in individuals with removable dental prostheses?”
The inclusion criteria were randomized clinical trials, studies published in English, and studies comparing MP with objective methodologies in users of removable dental prostheses. The exclusion criteria were in vitro studies, case series or case reports, retrospective and prospective studies, and pilot studies.
The PubMed/MEDLINE, Scopus, Web of Science, and Cochrane Library databases were used, and the electronic search was performed by 2 authors (R.T.F.C., T.E.L.V.-N.) independently, with the following search strategy: #1 (complete denture OR denture OR removable prosthesis OR removable partial denture OR overdenture), #2 (denture cream OR denture adhesive OR denture fixative), #3 (mastication OR masticatory OR masticatory efficiency OR masticatory ability OR masticatory performance OR bite OR chew) and grouped #1 AND #2 and #3.
In each database, studies were selected based on the title and abstract. To determine inclusion, each article was read in its entirety. The choices made by the 2 evaluators were analyzed by a third author (S.L.D.M.), and a consensus was reached through discussion.
A manual search for the articles was also performed in specific prosthodontic journals, namely, The Journal of Prosthetic Dentistry, International Journal of Prosthodontics, Journal of Dental Research, Journal of Oral Rehabilitation, and Journal of Prosthodontics.
One author (R.T.F.C.) collected the information from the articles, and another author (T.E.L.V.-N.) reviewed the results. As before, the choices made by the 2 evaluators were analyzed by a third author (S.L.D.M.), and a consensus was reached through discussion. Information on the variables was collected from the articles: the author, year, type of study, characteristics of patients and prosthesis, number of participants, mean age of participants, information and characteristics of the DAs, test “food” used in the measurements, MP method, and study results.
The risk of bias was assessed using the Cochrane risk-of-bias tool
and was carried out by 2 researchers (R.T.F.C., T.E.L.V.N.). This instrument assessed aspects related to random sequence generation and allocation (selection bias), blinding of participants, personnel, and outcome assessment (performance bias and detection bias), incomplete outcome data (attrition bias), selective reporting (reporting bias), and other forms of bias that may have been detected in the study. To evaluate the concordance between the examiners, the Kappa Score was used to determine the included studies among those identified through the initial database search. Any disagreement between the authors was discussed, and a consensus was reached.
The electronic search in August 2020 provided 1337 articles: 889 from PubMed/Medline, 87 from Web of Science, 43 from the Cochrane Library, and 318 from Scopus. After duplicate articles were removed, 1191 articles remained. The title and abstract of the articles were read, and the eligibility criteria were applied, which led to an analysis of 46 articles. After the articles were read, 40 were excluded for the following reasons: retention and stability evaluation using DAs (n=15), subjective methodologies (n=14), food accumulation under CD analyses (n=2), mandibular movements using DAs (n=3), denture dislodgments using DAs (n=2), technique description of a test food (n=1), effect of DAs on oral moisture (n=1), and nonrandomized clinical trial (n=2). In total, 6
studies were included in this systematic review. A flowchart detailing the search strategy is presented in Figure 1.
The values of the Kappa score between the examiners for the selected articles were as follows: PubMed/MEDLINE (0.83), Scopus (1.0), Web of Science (0.83), and Cochrane Library (0.83). The range 0.80 to 1.00 suggests an “almost perfect agreement” between the reviewers.
Table 1 shows the data collected from the included studies. All studies were randomized controlled trials (RCTs) with a crossover design and included participants who were edentulous in both jaws. Four
of the 6 studies carried out the assessments of MP using CDs recently delivered to the participants and were carried out under similar conditions. Regarding the number of participants (N), half of the studies
performed sample calculation with N ranging from 16 to 52 individuals. Among the DAs chosen in the studies, Corega (Corega denture fixative cream; GlaxoSmithKline) was the most commonly tested. Only 2 studies
detailed the main ingredients contained in the products, and the 3 textures (cream, strip, and powder) of the material were analyzed in the studies. The comminution and sieve method used for assessing the MP was selected in the studies; however, the hole sizes of the sieves and the “foods” used in the tests varied. Five
blinded the operators, through the selection of 2 operators, one at the time of preparing the patients and the other for the masticatory evaluation. In the item blinding of outcome assessment (detection bias), 2 studies
The results of this study indicate a positive effect of the use of DAs on the MP of the studied participants. Therefore, the hypothesis of this study, that the use of a DA would significantly improve MP, was accepted.
The active ingredient of DA is a bonding agent, for example, polyvinyl ether methylcellulose (PVM-MA) and CMC.
They also reported that despite the number of bites in the consumption of an apple remaining constant in the studied groups, the group that used DA was able to take more bites before displacement of the CD. Despite this, studies with an objective assessment of weighing the food content did not identify a significant difference in the decrease in the accumulation of food particles on the intaglio surface of a well-fitting CD.
Limitations of this systematic review include the variation in the methodologies of the included clinical studies addressing this topic, with most of them presenting an unclear risk of bias, emphasizing the need for more clinical trials on this topic. Stjernfeldt et al
Appropriate patient guidance regarding the use and prescription of zinc-free DAs, especially in countries where zinc-containing DAs are still marketed, is essential. Additionally, the patient should be evaluated periodically because the use of DAs can mask poorly adapted removable dental prostheses or those requiring replacement.
Supported by the Departments of Oral Rehabilitation, University of Pernambuco, Pernambuco, Brazil. Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES), Brazil, partially supported the study with a scholarship. Financing Code 001.