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Journal of Prosthetic Dentistry

Masticatory performance of denture wearers with the use of denture adhesives: A systematic review

Published:December 02, 2020DOI:https://doi.org/10.1016/j.prosdent.2020.10.011

      Abstract

      Statement of problem

      Denture adhesives are products used by wearers of removable dental prosthesis; however, systematic reviews on their influence on masticatory performance are lacking.

      Purpose

      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.

      Results

      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.

      Conclusions

      Denture adhesives significantly increased the masticatory performance of CD users.
      Clinical Implications
      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,
      • Del Fabbro M.
      • Testori T.
      • Kekovic V.
      • Goker F.
      • Tumedei M.
      • Wang H.
      A systematic review of survival rates of osseointegrated implants in fully and partially edentulous patients following immediate loading.
      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,
      • De Oliveira Júnior N.M.
      • Rodriguez L.S.
      • Marin D.O.M.
      • Paleari A.G.
      • Pero A.C.
      • Compagnoni M.A.
      Masticatory performance of complete denture wearers after using two adhesives: a crossover randomized clinical trial.
      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.
      • Torres-Sánchez C.
      • Montoya-Salazar V.
      • Torres-Lagares D.
      • Gutierrez-Pérez J.
      • Jimenez-Castellanos E.
      Comparison of masticatory efficacy among complete denture wearers with two adhesives and dentate individuals: a randomized, crossover, double-blind clinical trial.
      In situations where retention and stability have not been achieved satisfactorily, such as for patients with severely resorbed ridges,
      • Yamada M.
      • Takase K.
      • Suehiro F.
      • Nishimura M.
      • Murata H.
      Effects of denture adhesives and mouth moisturizers to human oral fibroblast and human keratinocyte cells using direct and indirect cell culture systems.
      ,
      • Fujimori T.
      • Hirano S.
      • Hayakawa I.
      Effects of a denture adhesive on masticatory functions for complete denture wearers - consideration for the condition of denture-bearing tissues-.
      xerostomia,
      • Bogucki Z.A.
      • Napadlek P.
      • Dabrowa T.
      A clinical evaluation of denture adhesives used by patients with xerostomia.
      lack of muscular control,
      • De Gomes P.S.
      • Figueiral M.H.
      • Fernandes M.H.R.
      • Scully C.
      Cytotoxicity of denture adhesives.
      ,
      • Nunes É.M.
      • Policastro V.B.
      • Scavassin P.M.
      • Leite A.R.P.
      • Mendoza Marin D.O.
      • Giro G.
      • et al.
      Crossover clinical trial of different methods of removing a denture adhesive and the influence on the oral microbiota.
      or oral deformations caused by tumors or trauma,
      • Yamada M.
      • Takase K.
      • Suehiro F.
      • Nishimura M.
      • Murata H.
      Effects of denture adhesives and mouth moisturizers to human oral fibroblast and human keratinocyte cells using direct and indirect cell culture systems.
      the use of denture adhesives (DAs) may be recommended to improve masticatory function.
      • Papadiochou S.
      • Emmanouil I.
      • Papadiochou I.
      Denture adhesives: a systematic review.
      DAs are widely available with different compositions and textures (cream, powder, or strip)
      • Tezvergil-Mutluay A.
      • Carvalho R.M.
      • Pashley D.H.
      Hyperzincemia from ingestion of denture adhesives.
      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.
      • Neill D.J.
      • Roberts B.J.
      The effect of denture fixatives on masticatory performance in complete denture patients.
      The benefits of using DAs have been reported to include increased retention and stability,
      • Munoz C.A.
      • Gendreau L.
      • Shanga G.
      • Magnuszewski T.
      • Fernandez P.
      • Durocher J.
      A clinical study to evaluate denture adhesive use in well-fitting dentures.
      • Chew C.L.
      • Boone M.E.
      • Swartz M.L.
      • Phillips R.W.
      Denture adhesives: their effects on denture retention and stability.
      • Chen F.
      • Wu T.
      • Cheng X.
      Cytotoxic effects of denture adhesives on primary human oral keratinocytes, fibroblasts and permanent L929 cell lines.
      increased user satisfaction,
      • Bartlett D.W.
      • Maggio B.
      • Targett D.
      • Fenlon M.R.
      • Thomas J.
      A preliminary investigation into the use of denture adhesives combined with dietary advice to improve diets in complete denture wearers.
      ,
      • Polyzois G.
      • Lagouvardos P.
      • Partalis C.
      • Zoidis P.
      • Polyzois H.
      Short-term assessment of the OHIP-14 scale on denture wearers using adhesives.
      , and reduction in the displacement of the prosthesis during function.
      • Marin D.O.M.
      • Leite A.R.P.
      • Paleari A.G.
      • Rodriguez L.S.
      • De Oliveira Junior N.M.
      • Pero A.C.
      • et al.
      Effect of a denture adhesive on the satisfaction and kinesiographic parameters of complete denture wearers: a cross-over randomized clinical trial.
      • Hasegawa S.
      • Sekita T.
      • Hayakawa I.
      Effect of denture adhesive on stability of complete dentures and the masticatory function.
      • Hoke P.
      • Tiede M.
      • Grender J.
      • Klukowska M.
      • Peters J.
      • Carr G.
      Using electromagnetic articulography to measure denture micromovement during chewing with and without denture adhesive.
      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.
      • Atassi M.
      • Milleman K.R.
      • Burnett G.R.
      • Sanyal S.
      • Milleman J.L.
      A randomized clinical study to evaluate the effect of denture adhesive application technique on food particle accumulation under dentures.
      ,
      The glossary of prosthodontic terms. Ninth edition.
      To evaluate MP, subjective methodologies based on user reports or responses from questionnaires,
      • Koronis S.
      • Pizatos E.
      • Polyzois G.
      • Lagouvardos P.
      Clinical evaluation of three denture cushion adhesives by complete denture wearers.
      • Torres-Sánchez C.
      • Montoya-Salazar V.
      • Torres-Lagares D.
      • Gutierrez-Pérez J.L.
      • Jimenez-Castellanos E.
      Satisfaction in complete denture wearers with and without adhesives: a randomized, crossover, double-blind clinical trial.
      • Kulak Y.
      • Özcan M.
      • Arikan A.
      Subjective assessment by patients of the efficiency of two denture adhesive pastes.
      or objective methodologies, based on specific test applications, with different natural and artificial foods can be used.
      • Neill D.J.
      • Roberts B.J.
      The effect of denture fixatives on masticatory performance in complete denture patients.
      ,
      • Tarkowska A.
      • Katzer L.
      • Ahlers M.O.
      Assessment of masticatory performance by means of a color-changeable chewing gum.
      • Gonçalves T.M.S.V.
      • Viu F.C.
      • Gonçalves L.M.
      • Garcia R.C.M.R.
      Denture adhesives improve mastication in denture wearers.
      • Oliveira N.M.
      • Shaddox L.M.
      • Toda C.
      • Paleari A.G.
      • Pero A.C.
      • Compagnoni M.A.
      Methods for evaluation of masticatory efficiency in conventional complete denture wearers: a systematized review.
      • Kapur K.K.
      A clinical evaluation of denture adhesives.
      • Yousof Y.
      • Salleh N.M.
      • Yusof F.
      Assessment of masticatory performance by geometric measurement of the mixing ability with 2-color chewing gum.
      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.
      • Oliveira N.M.
      • Shaddox L.M.
      • Toda C.
      • Paleari A.G.
      • Pero A.C.
      • Compagnoni M.A.
      Methods for evaluation of masticatory efficiency in conventional complete denture wearers: a systematized review.
      ,
      • Stjernfeldt P.E.
      • Sjögren P.
      • Wårdh I.
      • Boström A.M.
      Systematic review of measurement properties of methods for objectively assessing masticatory performance.
      The purpose of this systematic review was to evaluate the MP of CD users with DAs. The research hypothesis was that the use of a DA would significantly improve MP.

      Material and methods

      This systematic review was organized from the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist,
      • Moher D.
      • Liberati A.
      • Tetzlaff J.
      • Altman D.G.
      • Prisma T.
      Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement.
      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
      • Higgins J.P.T.
      • Altman D.G.
      • Gøtzsche P.C.
      • Jüni P.
      • Moher D.
      • Oxman A.D.
      The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials.
      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.

      Results

      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
      • De Oliveira Júnior N.M.
      • Rodriguez L.S.
      • Marin D.O.M.
      • Paleari A.G.
      • Pero A.C.
      • Compagnoni M.A.
      Masticatory performance of complete denture wearers after using two adhesives: a crossover randomized clinical trial.
      ,
      • Torres-Sánchez C.
      • Montoya-Salazar V.
      • Torres-Lagares D.
      • Gutierrez-Pérez J.
      • Jimenez-Castellanos E.
      Comparison of masticatory efficacy among complete denture wearers with two adhesives and dentate individuals: a randomized, crossover, double-blind clinical trial.
      ,
      • Fujimori T.
      • Hirano S.
      • Hayakawa I.
      Effects of a denture adhesive on masticatory functions for complete denture wearers - consideration for the condition of denture-bearing tissues-.
      ,
      • Neill D.J.
      • Roberts B.J.
      The effect of denture fixatives on masticatory performance in complete denture patients.
      ,
      • Gonçalves T.M.S.V.
      • Viu F.C.
      • Gonçalves L.M.
      • Garcia R.C.M.R.
      Denture adhesives improve mastication in denture wearers.
      ,
      • Kapur K.K.
      A clinical evaluation of denture adhesives.
      studies were included in this systematic review. A flowchart detailing the search strategy is presented in Figure 1.
      Figure thumbnail gr1
      Figure 1Flowchart describing search and selection strategies.
      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.
      • Landis J.R.
      • Koch G.G.
      The measurement of observer agreement for categorical data.
      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
      • De Oliveira Júnior N.M.
      • Rodriguez L.S.
      • Marin D.O.M.
      • Paleari A.G.
      • Pero A.C.
      • Compagnoni M.A.
      Masticatory performance of complete denture wearers after using two adhesives: a crossover randomized clinical trial.
      ,
      • Torres-Sánchez C.
      • Montoya-Salazar V.
      • Torres-Lagares D.
      • Gutierrez-Pérez J.
      • Jimenez-Castellanos E.
      Comparison of masticatory efficacy among complete denture wearers with two adhesives and dentate individuals: a randomized, crossover, double-blind clinical trial.
      ,
      • Fujimori T.
      • Hirano S.
      • Hayakawa I.
      Effects of a denture adhesive on masticatory functions for complete denture wearers - consideration for the condition of denture-bearing tissues-.
      ,
      • Gonçalves T.M.S.V.
      • Viu F.C.
      • Gonçalves L.M.
      • Garcia R.C.M.R.
      Denture adhesives improve mastication in denture wearers.
      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
      • De Oliveira Júnior N.M.
      • Rodriguez L.S.
      • Marin D.O.M.
      • Paleari A.G.
      • Pero A.C.
      • Compagnoni M.A.
      Masticatory performance of complete denture wearers after using two adhesives: a crossover randomized clinical trial.
      ,
      • Torres-Sánchez C.
      • Montoya-Salazar V.
      • Torres-Lagares D.
      • Gutierrez-Pérez J.
      • Jimenez-Castellanos E.
      Comparison of masticatory efficacy among complete denture wearers with two adhesives and dentate individuals: a randomized, crossover, double-blind clinical trial.
      ,
      • Gonçalves T.M.S.V.
      • Viu F.C.
      • Gonçalves L.M.
      • Garcia R.C.M.R.
      Denture adhesives improve mastication in denture wearers.
      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
      • Torres-Sánchez C.
      • Montoya-Salazar V.
      • Torres-Lagares D.
      • Gutierrez-Pérez J.
      • Jimenez-Castellanos E.
      Comparison of masticatory efficacy among complete denture wearers with two adhesives and dentate individuals: a randomized, crossover, double-blind clinical trial.
      ,
      • Neill D.J.
      • Roberts B.J.
      The effect of denture fixatives on masticatory performance in complete denture patients.
      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
      • De Oliveira Júnior N.M.
      • Rodriguez L.S.
      • Marin D.O.M.
      • Paleari A.G.
      • Pero A.C.
      • Compagnoni M.A.
      Masticatory performance of complete denture wearers after using two adhesives: a crossover randomized clinical trial.
      ,
      • Torres-Sánchez C.
      • Montoya-Salazar V.
      • Torres-Lagares D.
      • Gutierrez-Pérez J.
      • Jimenez-Castellanos E.
      Comparison of masticatory efficacy among complete denture wearers with two adhesives and dentate individuals: a randomized, crossover, double-blind clinical trial.
      ,
      • Fujimori T.
      • Hirano S.
      • Hayakawa I.
      Effects of a denture adhesive on masticatory functions for complete denture wearers - consideration for the condition of denture-bearing tissues-.
      ,
      • Neill D.J.
      • Roberts B.J.
      The effect of denture fixatives on masticatory performance in complete denture patients.
      ,
      • Gonçalves T.M.S.V.
      • Viu F.C.
      • Gonçalves L.M.
      • Garcia R.C.M.R.
      Denture adhesives improve mastication in denture wearers.
      of the 6 studies concluded that the DA increased the participants’ MP. Among the secondary evaluations, this increase in MP was particularly noticed in dentures of low quality,
      • Neill D.J.
      • Roberts B.J.
      The effect of denture fixatives on masticatory performance in complete denture patients.
      especially in individuals with a poor denture bearing area.
      • Fujimori T.
      • Hirano S.
      • Hayakawa I.
      Effects of a denture adhesive on masticatory functions for complete denture wearers - consideration for the condition of denture-bearing tissues-.
      There was no significant difference in MP and the texture of the DA.
      • De Oliveira Júnior N.M.
      • Rodriguez L.S.
      • Marin D.O.M.
      • Paleari A.G.
      • Pero A.C.
      • Compagnoni M.A.
      Masticatory performance of complete denture wearers after using two adhesives: a crossover randomized clinical trial.
      However, there was an apparent difference in the composition of DA because a study
      • Torres-Sánchez C.
      • Montoya-Salazar V.
      • Torres-Lagares D.
      • Gutierrez-Pérez J.
      • Jimenez-Castellanos E.
      Comparison of masticatory efficacy among complete denture wearers with two adhesives and dentate individuals: a randomized, crossover, double-blind clinical trial.
      evaluated 2 commercially available brands with the same texture (cream) but different ingredients.
      Table 1Characteristics of included studies
      StudyType of StudyPatients ProsthesisN Mean Age ±Standard DeviationDenture AdhesiveDenture Adhesive CharacteristicsDenture Adhesive TextureTest “Food”Masticatory Performance Method
      Masticatory performance evaluated by degrees of crushing, using sieves method.
      ,
      Hole sizes of sieves used in study.
      Results
      Kapur, 1967
      • Kapur K.K.
      A clinical evaluation of denture adhesives.
      RCT (cross-over)Bimaxillary edentulous24 (16w/8m)

      63.3 ±8.91 y
      (Fasteeth; NR)NRPowderSoft: 3 g portion of peanuts
      Patients asked to perform 20 mastication strokes.
      S: 10 mesh

      Kapur and Soman index
      None
      DA did not change ME in wearers of CDs.
      (Wertnet’s adhesive cream; Block Drug Co, Inc)CreamHard: 3 g portion of carrots
      Patients asked to perform 40 mastication strokes.
      S: 5 mesh

      Kapur and Soman index
      Control: WA
      Neill and Roberts, 1973
      • Neill D.J.
      • Roberts B.J.
      The effect of denture fixatives on masticatory performance in complete denture patients.
      RCT (cross-over)Bimaxillary edentulous52 (32w/20m)

      46 y
      NRNatural origin:

      Karaya gum
      PowderLean ham
      Patients asked to perform 20 mastication strokes.
      S: 10 meshPositive
      DA increased ME in wearers of CDs.
      Control: WA
      Fujimori et al, 2002
      • Fujimori T.
      • Hirano S.
      • Hayakawa I.
      Effects of a denture adhesive on masticatory functions for complete denture wearers - consideration for the condition of denture-bearing tissues-.
      RCT (cross-over)Bimaxillary edentulous

      New CDs
      16(NR, Correct Sionogi)NRCream3 g peanuts
      Patients asked to perform 20 mastication strokes.
      S: 10 meshPositive
      DA increased ME in wearers of CDs.
      Control: WA
      Gonçalves et al, 2014
      • Gonçalves T.M.S.V.
      • Viu F.C.
      • Gonçalves L.M.
      • Garcia R.C.M.R.
      Denture adhesives improve mastication in denture wearers.
      RCT (cross-sectional)Bimaxillary edentulous

      New CDs
      30
      Sample size calculation.
      (13w/17m)

      68.1 ±7.9 y
      (Corega; GlaxoSmithKline)NRCream17 cubes of Optocal
      Patients asked to perform 20 mastication strokes.
      ,
      Material based on silicone material (Optosil; Kulzer GmbH).
      S: 5.6-0.5 mm

      Broadness variable
      Positive
      DA increased ME in wearers of CDs.
      (Corega; GlaxoSmithKline)Strip
      Control: WA
      De Oliveira Junior et al, 2014
      • De Oliveira Júnior N.M.
      • Rodriguez L.S.
      • Marin D.O.M.
      • Paleari A.G.
      • Pero A.C.
      • Compagnoni M.A.
      Masticatory performance of complete denture wearers after using two adhesives: a crossover randomized clinical trial.
      RCT (cross-over)Bimaxillary edentulous

      New CDs
      40
      Sample size calculation.
      (32w/18m)

      66.05 ±8.3 y
      (Ultra Corega cream tasteless; GlaxoSmithKline)NRCream5 Almonds
      Patients asked to perform 20 mastication strokes.
      S1: 4.0 mm

      S2: 2.8 mm
      Hole size of sieve used to calculate MP.


      S3: 2.0 mm

      S4: 1.0 mm

      Kapur and Soman index
      Positive
      DA increased ME in wearers of CDs.
      (Ultra Corega powder tasteless; GlaxoSmithKline)Powder
      Control: WA
      Torres-Sánchez et al, 2017
      • Torres-Sánchez C.
      • Montoya-Salazar V.
      • Torres-Lagares D.
      • Gutierrez-Pérez J.
      • Jimenez-Castellanos E.
      Comparison of masticatory efficacy among complete denture wearers with two adhesives and dentate individuals: a randomized, crossover, double-blind clinical trial.
      RCT (double blind; cross-over)Bimaxillary edentulous

      New CDs
      17
      Sample size calculation.
      (11w/6m)

      51.41 ±4.7 y
      (Fittydent; Fittydent International GmbH)Natural origin: CMC+SA: polyvinyl acetateCreamIH (Orthoprint; Zhermack SpA)
      Patients asked to perform 20 mastication strokes.
      S1: 2.4 mm

      S2: 1.2 mm

      S3: final container

      Edlund and Lamm index
      Positive
      DA increased ME in wearers of CDs.
      (Corega; GlaxoSmithKline)Natural origin: CMC+SA: copolymer of vinyl methyl ether and maleic anhydrideCream
      Control: WA
      CD, complete dentures; CMC, carboxymethylcellulose; DA, denture adhesive; IH, irreversible hydrocolloid; m, men; MP, masticatory performance; NR, not reported; RCT, randomized clinical trial; S, sieve specification; SA, synthetic agent; w, women; WA, without denture adhesive; Y, years.
      a Sample size calculation.
      b Patients asked to perform 20 mastication strokes.
      c Patients asked to perform 40 mastication strokes.
      d Material based on silicone material (Optosil; Kulzer GmbH).
      e Masticatory performance evaluated by degrees of crushing, using sieves method.
      f Hole sizes of sieves used in study.
      g Hole size of sieve used to calculate MP.
      h DA did not change ME in wearers of CDs.
      i DA increased ME in wearers of CDs.
      The risk of bias in the studies showed a high rate of “unclear” assessments. In the items random sequence generation and allocation concealment (selection bias), only 1 study
      • De Oliveira Júnior N.M.
      • Rodriguez L.S.
      • Marin D.O.M.
      • Paleari A.G.
      • Pero A.C.
      • Compagnoni M.A.
      Masticatory performance of complete denture wearers after using two adhesives: a crossover randomized clinical trial.
      clearly described these processes by using computer-generated numbers. Regarding the performance bias item, only 1 study
      • Torres-Sánchez C.
      • Montoya-Salazar V.
      • Torres-Lagares D.
      • Gutierrez-Pérez J.
      • Jimenez-Castellanos E.
      Comparison of masticatory efficacy among complete denture wearers with two adhesives and dentate individuals: a randomized, crossover, double-blind clinical trial.
      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
      • De Oliveira Júnior N.M.
      • Rodriguez L.S.
      • Marin D.O.M.
      • Paleari A.G.
      • Pero A.C.
      • Compagnoni M.A.
      Masticatory performance of complete denture wearers after using two adhesives: a crossover randomized clinical trial.
      ,
      • Torres-Sánchez C.
      • Montoya-Salazar V.
      • Torres-Lagares D.
      • Gutierrez-Pérez J.
      • Jimenez-Castellanos E.
      Comparison of masticatory efficacy among complete denture wearers with two adhesives and dentate individuals: a randomized, crossover, double-blind clinical trial.
      described the accomplishment of this stage. All included studies had a low risk of bias in the incomplete outcome data (attrition bias) item, and half of the studies
      • De Oliveira Júnior N.M.
      • Rodriguez L.S.
      • Marin D.O.M.
      • Paleari A.G.
      • Pero A.C.
      • Compagnoni M.A.
      Masticatory performance of complete denture wearers after using two adhesives: a crossover randomized clinical trial.
      ,
      • Torres-Sánchez C.
      • Montoya-Salazar V.
      • Torres-Lagares D.
      • Gutierrez-Pérez J.
      • Jimenez-Castellanos E.
      Comparison of masticatory efficacy among complete denture wearers with two adhesives and dentate individuals: a randomized, crossover, double-blind clinical trial.
      ,
      • Gonçalves T.M.S.V.
      • Viu F.C.
      • Gonçalves L.M.
      • Garcia R.C.M.R.
      Denture adhesives improve mastication in denture wearers.
      presented a low risk of bias in the selective outcome reporting item (Table 2).
      Table 2Assessment of risk of bias in included studies based on Cochrane Risk of Bias Tools
      StudyRandom Sequence Generation (Selection Bias)Allocation Concealment (Selection Bias)Blinding of Participants and Personnel (Performance Bias)Blinding of Outcome Assessment (Detection Bias)Incomplete Outcome Data (Attrition Bias)Selective Outcome Reporting (Reporting Bias)
      Kapur, 1967
      • Kapur K.K.
      A clinical evaluation of denture adhesives.
      Neill and Roberts, 1973
      • Neill D.J.
      • Roberts B.J.
      The effect of denture fixatives on masticatory performance in complete denture patients.
      Fujimori et al, 2002
      • Fujimori T.
      • Hirano S.
      • Hayakawa I.
      Effects of a denture adhesive on masticatory functions for complete denture wearers - consideration for the condition of denture-bearing tissues-.
      Gonçalves et al, 2014
      • Gonçalves T.M.S.V.
      • Viu F.C.
      • Gonçalves L.M.
      • Garcia R.C.M.R.
      Denture adhesives improve mastication in denture wearers.
      De Oliveira Junior et al, 2014
      • De Oliveira Júnior N.M.
      • Rodriguez L.S.
      • Marin D.O.M.
      • Paleari A.G.
      • Pero A.C.
      • Compagnoni M.A.
      Masticatory performance of complete denture wearers after using two adhesives: a crossover randomized clinical trial.
      Torres-Sánchez et al, 2017
      • Torres-Sánchez C.
      • Montoya-Salazar V.
      • Torres-Lagares D.
      • Gutierrez-Pérez J.
      • Jimenez-Castellanos E.
      Comparison of masticatory efficacy among complete denture wearers with two adhesives and dentate individuals: a randomized, crossover, double-blind clinical trial.
      High risk of bias (red); uncertain risk of bias (yellow); low risk of bias (green).

      Discussion

      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.
      • Chen F.
      • Wu T.
      • Cheng X.
      Cytotoxic effects of denture adhesives on primary human oral keratinocytes, fibroblasts and permanent L929 cell lines.
      Its mechanism of action is that it reacts with saliva, increasing its viscosity and thereby promoting a greater adhesive force between the intaglio surface of the prosthesis and the oral mucosa
      • Torres-Sánchez C.
      • Montoya-Salazar V.
      • Torres-Lagares D.
      • Gutierrez-Pérez J.
      • Jimenez-Castellanos E.
      Comparison of masticatory efficacy among complete denture wearers with two adhesives and dentate individuals: a randomized, crossover, double-blind clinical trial.
      and consequently increasing retention and stability. This increase in retention and stability
      • Papadiochou S.
      • Emmanouil I.
      • Papadiochou I.
      Denture adhesives: a systematic review.
      allows greater safety in mastication and improved comminution of food.
      • Fujimori T.
      • Hirano S.
      • Hayakawa I.
      Effects of a denture adhesive on masticatory functions for complete denture wearers - consideration for the condition of denture-bearing tissues-.
      ,
      • Neill D.J.
      • Roberts B.J.
      The effect of denture fixatives on masticatory performance in complete denture patients.
      Increased satisfaction in the subjective masticatory performance of CD users using DA has been reported.
      • Munoz C.A.
      • Gendreau L.
      • Shanga G.
      • Magnuszewski T.
      • Fernandez P.
      • Durocher J.
      A clinical study to evaluate denture adhesive use in well-fitting dentures.
      ,
      • Koronis S.
      • Pizatos E.
      • Polyzois G.
      • Lagouvardos P.
      Clinical evaluation of three denture cushion adhesives by complete denture wearers.
      • Torres-Sánchez C.
      • Montoya-Salazar V.
      • Torres-Lagares D.
      • Gutierrez-Pérez J.L.
      • Jimenez-Castellanos E.
      Satisfaction in complete denture wearers with and without adhesives: a randomized, crossover, double-blind clinical trial.
      • Kulak Y.
      • Özcan M.
      • Arikan A.
      Subjective assessment by patients of the efficiency of two denture adhesive pastes.
      More homogeneous food comminution
      • Gonçalves T.M.S.V.
      • Viu F.C.
      • Gonçalves L.M.
      • Garcia R.C.M.R.
      Denture adhesives improve mastication in denture wearers.
      and consequently better food digestion leads to improved general health, as demonstrated in studies using the questionnaires OHIP EDENT
      • Bartlett D.W.
      • Maggio B.
      • Targett D.
      • Fenlon M.R.
      • Thomas J.
      A preliminary investigation into the use of denture adhesives combined with dietary advice to improve diets in complete denture wearers.
      and OHIP 14.
      • Polyzois G.
      • Lagouvardos P.
      • Partalis C.
      • Zoidis P.
      • Polyzois H.
      Short-term assessment of the OHIP-14 scale on denture wearers using adhesives.
      The use of DAs also promotes the improvement of other masticatory factors, thereby promoting the cushion effect with less displacement of the CD, as described by Munoz et al.
      • Munoz C.A.
      • Gendreau L.
      • Shanga G.
      • Magnuszewski T.
      • Fernandez P.
      • Durocher J.
      A clinical study to evaluate denture adhesive use in well-fitting dentures.
      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.
      • Munoz C.A.
      • Gendreau L.
      • Shanga G.
      • Magnuszewski T.
      • Fernandez P.
      • Durocher J.
      A clinical study to evaluate denture adhesive use in well-fitting dentures.
      ,
      • Atassi M.
      • Milleman K.R.
      • Burnett G.R.
      • Sanyal S.
      • Milleman J.L.
      A randomized clinical study to evaluate the effect of denture adhesive application technique on food particle accumulation under dentures.
      Additionally, the use of DA also decreases the growth of microorganisms, especially Candida albicans, the pathogen that causes denture stomatitis.
      • Torres-Sánchez C.
      • Montoya-Salazar V.
      • Torres-Lagares D.
      • Gutierrez-Pérez J.
      • Jimenez-Castellanos E.
      Comparison of masticatory efficacy among complete denture wearers with two adhesives and dentate individuals: a randomized, crossover, double-blind clinical trial.
      The main concern with the use of DAs has been the difficulty in removing DA residue.
      • Koronis S.
      • Pizatos E.
      • Polyzois G.
      • Lagouvardos P.
      Clinical evaluation of three denture cushion adhesives by complete denture wearers.
      ,
      • Kulak Y.
      • Özcan M.
      • Arikan A.
      Subjective assessment by patients of the efficiency of two denture adhesive pastes.
      Therefore, it is necessary to have an adequate protocol to remove residue after use to prevent the proliferation of microorganisms.
      • Nunes É.M.
      • Policastro V.B.
      • Scavassin P.M.
      • Leite A.R.P.
      • Mendoza Marin D.O.
      • Giro G.
      • et al.
      Crossover clinical trial of different methods of removing a denture adhesive and the influence on the oral microbiota.
      Nunes et al
      • Nunes É.M.
      • Policastro V.B.
      • Scavassin P.M.
      • Leite A.R.P.
      • Mendoza Marin D.O.
      • Giro G.
      • et al.
      Crossover clinical trial of different methods of removing a denture adhesive and the influence on the oral microbiota.
      concluded that the combination of chemical and mechanical protocols (brushing with coconut soap or toothpaste) for users of cream-type DA was more efficient for hygiene than brushing with only water.
      Several methods have been described for assessing the MP of DAs, including subjective methodologies using structured questionnaires,
      • Koronis S.
      • Pizatos E.
      • Polyzois G.
      • Lagouvardos P.
      Clinical evaluation of three denture cushion adhesives by complete denture wearers.
      3D motion capture system,
      • Hasegawa S.
      • Sekita T.
      • Hayakawa I.
      Effect of denture adhesive on stability of complete dentures and the masticatory function.
      recording of mandibular movements by using a kinesiograph,
      • Marin D.O.M.
      • Leite A.R.P.
      • Paleari A.G.
      • Rodriguez L.S.
      • De Oliveira Junior N.M.
      • Pero A.C.
      • et al.
      Effect of a denture adhesive on the satisfaction and kinesiographic parameters of complete denture wearers: a cross-over randomized clinical trial.
      and evaluation of micromovements of the CD during mastication.
      • Hoke P.
      • Tiede M.
      • Grender J.
      • Klukowska M.
      • Peters J.
      • Carr G.
      Using electromagnetic articulography to measure denture micromovement during chewing with and without denture adhesive.
      However, the comminution and sieve method has been considered the standard method for evaluating MP,
      • Oliveira N.M.
      • Shaddox L.M.
      • Toda C.
      • Paleari A.G.
      • Pero A.C.
      • Compagnoni M.A.
      Methods for evaluation of masticatory efficiency in conventional complete denture wearers: a systematized review.
      and the 2-color chewing gum method has also been reported to be a valid and reliable method of measurement.
      • Yousof Y.
      • Salleh N.M.
      • Yusof F.
      Assessment of masticatory performance by geometric measurement of the mixing ability with 2-color chewing gum.
      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
      • Stjernfeldt P.E.
      • Sjögren P.
      • Wårdh I.
      • Boström A.M.
      Systematic review of measurement properties of methods for objectively assessing masticatory performance.
      in their systematic review of methods for assessing masticatory performance also reached this conclusion.
      Despite the benefits of using DAs, caution should be exercised when using them, as systemic complications related to the abusive use of zinc-containing DAs have been reported.
      • Tezvergil-Mutluay A.
      • Carvalho R.M.
      • Pashley D.H.
      Hyperzincemia from ingestion of denture adhesives.
      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.
      • Neill D.J.
      • Roberts B.J.
      The effect of denture fixatives on masticatory performance in complete denture patients.
      ,
      • Munoz C.A.
      • Gendreau L.
      • Shanga G.
      • Magnuszewski T.
      • Fernandez P.
      • Durocher J.
      A clinical study to evaluate denture adhesive use in well-fitting dentures.

      Conclusions

      Based on the results of this systematic review, the following conclusion was drawn:
      • 1.
        The use of denture adhesives significantly increases the masticatory performance of removable denture wearers.

      CRediT authorship contribution statement

      Rayanna Thayse Florêncio Costa: Conceptualization, Data curation, Methodology. Taciana Emília Leite Vila-Nova: Data curation, Methodology, Writing - original draft. Arthur José Barbosa de França: Methodology, Writing - original draft. Bruno Gustavo da Silva Casado: Supervision, Project administration, Formal analysis. Rafaella de Souza Leão: Writing - review & editing. Sandra Lúcia Dantas de Moraes: Formal analysis, Writing - review & editing.

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