Hindawi

e Scientific World Journal

Volume 2019, Article ID 6913080, 11 pages
https://doi.org/10.1155/2019/6913080

Review Article
Denture Liners: A Systematic Review Relative to Adhesion and
Mechanical Properties

Simone Kreve and Andréa C. Dos Reis

Department of Dental Materials and Prosthodontics, Ribeirão Preto Dental School, University of São Paulo (USP), Ribeirão Preto,
SP, Brazil
Correspondence should be addressed to Andréa C. Dos Reis; [email protected]

Received 11 November 2018; Revised 25 January 2019; Accepted 13 February 2019; Published 3 March 2019

Academic Editor: Giovanna Orsini

Copyright © 2019 Simone Kreve and Andréa C. Dos Reis. This is an open access article distributed under the Creative Commons
Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is
properly cited.

Purpose. The objective of this systematic review is to compare results concerning the properties of adhesion, roughness, and
hardness of dental liners obtained in the last ten years. Methods. Searches on the databases LILACS, PubMed/Medline, Web of
Science, and Cochrane Database of Systematic Reviews were supplemented with manual searches conducted between February and
April of 2018. The inclusion criteria included experimental in vitro and in vivo, clinical, and laboratory studies on resilient and/or
hard liners, assessment of hardness, roughness, and/or adhesion to the denture base, and physical/mechanical changes resulting
from the disinfection process and changes in liners’ composition or application. Results. A total of 406 articles were identified
and, from those, 44 are discussed. Twenty-four studies examined the bond strength, 13 surface roughness, and 19 the hardness.
Of these 44 studies, 12 evaluated more than one property. Different substances were used in the attempt to improve adhesion.
Considering roughness and hardness, the benefits of sealants have been tested, and the changes resulting from antimicrobial agents’
incorporation have been assessed. Conclusion. Adhesion to the prosthesis base is improved with surface treatments. Rough surfaces
and changes in hardness compromise the material’s serviceability.

1. Introduction [14–17]. The term “soft liners” refers to a class of resilient

materials used to reline denture base surfaces in contact with
Liners have been widely used in dentistry to reshape pros- the occlusal stress-bearing oral mucosa [18].
theses surfaces in contact with soft tissues of the oral cavity Liners can be either hard [6, 16], usually made of poly-
[1]. Failure in adhesion, rough surfaces, and changes in methylmethacrylate [9, 10, 19, 20], or resilient [20–24], when
hardness are favorable factors for microbial accumulation plasticizers are added to the resin and the silicone elastomers
and compromise the liner’s durability and the oral health [22, 24, 25]. Resilient liners are intended to be elastic, absorb
condition such as denture stomatitis [2], implant loss [3, 4], energy, and act on the cushion effect [24]. Resilient reline
peri-implantitis [4], and osseointegration delay, as well as materials are also classified as short- or long-term products.
respiratory problems [5] that can interfere with the rehabil- Long-term resilient denture liner materials maintain their
itation treatment success and quality of life. resilience for more than 30 days and can be used for up to
Liners are also used for prostheses fractures, remodeling 1 year, while short-term liners are recommended for use for
of bone crests [6–8], and cleft palate [9], in cases of excessive up to 30 days [26].
resorption of the alveolus and occurrence of lesions on the Liners are noninvasive and relatively more economical if
mucosa [9, 10], and in tissue conditioning during implant compared to make a new denture [23, 27, 28]. Patients prefer
healing [11], among others, acting to dissipate part of the resilient liners over the hard ones, because they improve
impact of mastication [8, 12]. They are processed in labo- comfort [14, 21, 28, 29].
ratories (heat-polymerized) [13] and/or dentist offices (self- However, they have some disadvantages, like presence of
polymerized) because of their easy and quick application surface defects and porosity, residual taste after use, tendency
2 The Scientific World Journal

to pick up odors [14, 30], water uptake [14, 24, 31], poor Systematic Reviews, using the following keywords: “denture
adhesion to acrylic resin [9, 31], proneness to change of color liner” OR “reline” AND “soft liner” OR “surface roughness”
[7, 23], difficulty to clean [32], and premature hardening due OR “bond strength” OR “hardness” OR “hard liner.”
to plasticizers’ solubilization [10, 31]. The literature survey was conducted from February to
A successful relining depends on the bond strength April of 2018 and included articles published between 2008
between the liner and the resin base [1, 6, 33, 34]. The lack and 2018, in the Journal Citation Reports (JCR) indexed
of bonding leads to debonding, diminishing the procedure’s journals. This period was chosen for the review since the
longevity, and may occur due to an inefficient bond to the articles within that time interval depict the results of the main
denture, or low cohesive strength [31]. According to Ahmad findings previously. Supplemental searches were conducted;
et al. [1], better adhesion is obtained when the materials’ the reference and citations’ lists of the selected papers were
chemical properties are similar. Adhesion of liners to base reviewed in order to select potential inclusions.
polymers depends on the chemical composition of materials
involved [19] and is influenced by the resin type, thermal 2.1.2. Types of Interventions. This systematic review was
cycle, and surface treatment [19, 31]. Excessive roughness performed to answer the following questions: In patients
results in microbial colonization and difficult hygiene. Liners wearing removable prostheses fitted with denture liners, does
are unstable in aqueous solutions; the hardness increases the bond strength of those materials alter? What has been
after water, saliva, and cleaning agents’ absorption. Denture used in the past 10 years to improve adhesion of denture liners
relining can be a factor of predisposition for prosthetic to denture base? Do the modifications in the denture liners
stomatitis. to improve the adhesion to the base of the prosthesis impair
The sealants’ application [28, 29], surface treatments hardness and roughness values?
[35, 36], and physical-mechanical changes resulting from
disinfection [17, 32, 37], among others, improve adhesiveness,
reduce roughness, and maintain the liners’ initial hardness. 2.1.3. Comparison. This study compares with the standard
Based on what has been presented, preserving the liners’ treatment, which in this case is applying the liner according
physical-mechanical properties is a challenge. Considering to the manufacturer’s instructions.
its immediacy, simplified process, and economy, since the
relining allows the use of the same prosthesis, it could be 2.1.4. Outcome Measures. The outcome measures were the
expected to grow demand especially more in dependent effect of the intervention (denture liner) with some modifi-
elderly care. This subject approach through a systematic cation, as well as comparison between the effects of surface
review allows analyzing many studies’ outcomes that have treatments with different substances on the properties of
been carried out in attempt to improve these materials’ adhesion, roughness, and hardness. The main outcomes were
limitations, such as debonding of denture base and changes defined when the article included in this review presented
in roughness and hardness that compromise its elasticity, some adhesion, surface roughness, or/and hardness evalua-
assisting the clinicians in choosing the best product or tion and showed a substantial result.
technique. This systematic review covers studies published in
the past 10 years aiming to assess the state of the art of liners, 2.1.5. Types of Studies. We selected and assessed papers pub-
properties of adhesion, roughness, and hardness. lished in English that met the inclusion criteria: experimental
in vitro and in vivo, clinical, and laboratory studies on resilient
2. Materials and Methods and/or hard liners, assessment of hardness, roughness, and/or
adhesion to the denture base, and physical/mechanical
The question posed was as follows: Do the denture liners’ changes resulting from the disinfection process and changes
modifications alter the adhesion, roughness, and hardness in liners’ composition or application.
properties? Studies based exclusively on materials for denture base,
This systematic review was conducted according to the unpublished data, critiques, case reports, and expert opinion
PRISMA (Preferred Reporting Items for Systematic Reviews papers should be excluded due to their high risk of bias [38].
and Meta-Analyses) report [38, 39] and registered on the Systematic reviews should also not be included.
PROSPERO database: CRD42018108821.
The review question, objectives of the study, eligibility 2.1.6. Study Selection. The study selection was carried out
criteria, and search and data analysis strategy were clearly independently by two authors who adhered to the prede-
stated in advance and incorporated in the protocol’s content. fined eligibility criteria. Any disagreements between the two
reviewers regarding the inclusion of studies were resolved by
discussion.
2.1. Defining Eligibility Criteria

2.1.1. Search Methods. Studies reporting the properties of 2.1.7. Assessment of Bias in Individual Studies. Risks were
adhesion, roughness, and hardness of dental liners were minimized by strictly following the keywords, the coherence
identified by searching electronic databases and scanning ref- of the selected abstracts, and analysis of articles published in
erence lists of articles. Four databases were searched, LILACS, selective editorial policy journals; this guarantees the quality
PubMed/Medline, Web of Science, and Cochrane Database of of the individual studies.
The Scientific World Journal 3

Total papers found using Records screened on other sources’

electronic databases = 406 search = 55

After exclusion of duplicate

papers = 381

Papers screening by authors to

Papers excluded = 91
filter according to criteria = 151

Articles that met the inclusion

criteria = 44

Studies included in qualitative

synthesis = 44

Figure 1: Flow of information through the different phases of the systematic review.

Each of the included studies was then assessed for commonly employed resilient resin-base liner. Tokuyama
potential internal methodological bias such as the adequacy Rebase II (Tokuyama) was the most used chairside hard
of randomization, incomplete outcome, and appropriate liner.
method of blinding. Other materials such as Kooliner (GC America), Reline
Soft (GC America), COE-SOFT (GC America), Sofreliner
(Tokuyama), Mucopren Soft (Kettenbach), Elite Soft (Zher-
3. Results mack), and New Truliner (BOSWOTH) were also assessed
often [1, 6, 12, 23, 25, 27, 37, 40, 41, 43, 46–48].
A total of 406 studies were identified on the initial screening.
Types of intervention were as follows: comparison
All abstracts were analyzed according to the PRISMA state-
between the effects of surface treatments with different
ment [38, 39]. Publications were identified as being relevant
substances [12, 20, 35, 36, 49], bond tests between liners and
through the initial screening of titles and abstracts followed
different prosthetic materials [1, 10, 31], and assessment of
by screening of the full text. After exclusion of duplicates,
the initial roughness of materials and that resulting from
151 articles were selected for a complete assessment and,
disinfection methods [17, 32, 44].
from these, 44 are discussed (Figure 1, Tables 1, 2, 3, and
4). Twenty-four studies examined the bond strength, 13
surface roughness, and 19 the hardness. Of these 44 studies, 4. Discussion
12 evaluated more than one property. Most studies com-
prised in vitro evaluations, and only 3 were in vivo studies Denture liners’ materials have been widely used despite
[25, 41, 42]. their substantial shortcomings. The use of solvents seems
The articles were subdivided into categories since each to improve the adhesion of the reliner to the PMMA base.
article could address more than one property [8, 17, 19, 27, Most cleansing agents compromise the hardness and elastic
29, 34, 35, 41, 43–45]. modulus. In addition, changes in roughness can lead to
Considering the different commercial brands, Ufi Gel microbial colonization, increase the risk of oral and systemic
(VOCO) was the most commonly employed silicone- infections, and decrease quality of life. Among the various
based liner, and Trusoft (BOSWORTH) was the most disinfection methods, minor changes in the hardness and
4 The Scientific World Journal

Table 1: Included studies related to the bond strength.

Author/year Method Study objectives Outcomes

Higher bond strengths with similar
compositions. PMMA (Meliodent),
Bond strength, denture to reline
Ahmad et al./2009 Shear bond strength highest bond strength with
materials
(Meliodent RR), and UDMA
(Eclipse) with Eclipse reline
Bond strength, liners to
Sofreliner Tough, highest bond
Lassila et al./2010 Tensile bond strength fiber-reinforced and unreinforced
strength, and Eversoft, lowest
PMMA
Więckiewicz et Adhesion of silicone lining to denture A-Soft Line 30, the best adhesive
Tensile and shear bond strength
al./2014 base properties
Bond strength, lower as storage time
Effect of storage on bond strength
Mese and Guzel/2008 Tensile bond strength increased. Greater changes, acrylic
and hardness, resilient liners
resilient liner
Bond strength, silicone denture liner, Highest bond strength with adhesive.
Atsü and Keskin/2013 Tensile bond strength effects of surface treatment after Surface treatment did not improve
thermocycling bond strength
Comparing experimental silicone Silastic MDX4-4210 silicone, greater
Santawisuk et al./2013 Tensile bond strength
with lining materials mechanical properties
Bond strength immersing denture in Methylmercaptan causes liner
Ohkubo et al./2009 Shear bond strength
methylmercaptan detachment
Accelerated aging times on bond Mucopren Soft, higher tensile bond
Takahashi et al./2011 Tensile bond strength
strength of soft liners strength than Trusoft
Bond strengths’ values varied. Bond
Bond strength of reline resin to
improved, tribochemical silica
Hamanaka et al./2016 Shear bond strength test injection-molded thermoplastic
coating and 4-META/MMA-TBB
denture
resin
Methylmethacrylate and ethyl acetate
Surface treatments on adhesion of
Cavalcanti et al./2014 Tensile bond strength improved the adhesion of a silicone
silicone denture liners
denture liner to PMMA
GC Reline Soft, highest bond
Bond strength, long-term soft
Kim et al./2014 [33] Tensile bond strength strength. GC Reline Ultrasoft and
denture lining
Mucopren Soft, the lowest
Tensile strength of UV-37, the lowest.
Tensile bond strength and adhesive Physical/mechanical properties, No difference in adhesive strength
Kanie et al./2009
strength experimental light-curing soft lining between UV-35 and UV-37 at 1 day
and 12 months
Without surface sealer Mucopren
Bond strength and surface roughness Soft and Dentuflex, highest bond
Dayrell et al./2012 Tensile bond strength
of soft liners, sealer coating strength; Ufi Gel, intermediate; and
Comfort Denso, the lowest
Microwave postpolymerization (PP) New Truliner, smaller strength with
Takahashi et al./2009 Flexural strength test on strength, acrylic resin intact and PP microwave and effective only for
relined Kooliner
Bond strength, relining resins,
Bond strength, reline resins and
Tensile bond strength and transverse Acrytone, comparison,
Kim et al./2014 [40] thermoplastic denture similar to
bond strength heat-polymerized acrylic and
acrylic resin. Polyamide, lowest
polyamide
Bond of resilient denture liners to All, adequate bond strength, used
Maeda et al./2012 Peel bond strength
denture clinically for three years
Tanimoto et al./2009 Peel bond strength Adhesive denture and denture liner GC Reline Ultrasoft, lower adhesion
Bond strength, reline resin,
Koodaryan and Acetic acid, the greatest bond
Shear bond strength test polyamide and surface modification,
Hafezeqoran/2016 strength of MMA
acetic acid
The Scientific World Journal 5

Table 1: Continued.
Author/year Method Study objectives Outcomes
Bond strength, denture-reline resins, MF:MA ratio 25:75, enhances bond
Osathananda and
Shear bond strength test methyl formate-methyl acetate strength, denture and UNIFAST
Wiwatwarrapan/2014
(MF-MA) Trad, or Ufi Gel Hard
Denture base, silicone liner, similar
Bond strength, silicone denture liner,
Akin et al./2013 Tensile bond strength bond strength. Lasing Eclipse resin,
surface treatments
increased bond strength
Kooliner, no difference in bond
Sodium perborate, bond strength, strength, immersion or sodium
Pisani et al./2009 Tensile bond strength degree infiltration, acrylic perborate.
resin/denture liners Mucopren Soft, highest tension, and
Elite Soft the lowest
Bond strength-antimicrobial soft Antimicrobial did not affect bond
Alcântara et al./2012 Peel bond strength
liner, denture strength, resilient liner and denture
Tensile strength reduced. Bond
strength of Ufi Gel, 40 ppm silver
Chladek et al./2013 Tensile bond strength Silver nanoparticle into denture liners nanoparticle composites did not
differ. Increase in bond strength,
aging

roughness properties were observed when incorporating they lack chemical adhesion [19, 31, 35], and adhesive flaws
antimicrobial agents into the liners. can be associated with the bonding agent [12]. Adhesive fail-
ures between the liner (silicone-type resilient denture liners)
and prosthesis (heat-polymerized polymethylmethacrylate
4.1. Denture Liner Adhesion Mechanism. Aging [1] alters the
(PMMA)) increased from 13.8% to 60% after 30 days of
adhesive properties of denture base polymers and liners [49]
storage in water [49], suggesting that their bonding gradually
leading to flaws on the materials interface [41, 49, 50].
weakens over time.
The bond between the prosthesis and liner begins with
the dissolution of the resin by the solvent, swelling of Air abrasion with silica and silanization failed to improve
surface layers, and evaporation of the solvent. The liner bond strength of silicone resilient lining to the prosthesis
monomers diffuse, penetrate the resin pores, and form (heat-cure acrylic), and the defects produced by the 30 𝜇m
an interpenetrating polymeric network [51]. The larger the particles were not sufficient for the liner material penetration
surface swelling, the deeper the porous layer and, as a conse- [20].
quence, the better the adhesion between the liner and denture Organic solvents such as MMA (methylmethacrylate)
base. and ethyl acetate improve silicone liners’ adhesion to PMMA
The bond strength between the liner and denture base was because they lead to softening and porosities that enhance
assessed [12, 15, 31, 49, 50] through primer application, where adhesive penetration [33, 35]. Lassila et al. [12] found
the layer of the GC resin primer was applied on the polyamide enhanced adhesion using ethyl acetate as bonding agent; Kim
surfaces [52], through an adhesive such as a bonding agent et al. [40] found better results using a primer or adhesive to
that is a reline material partner [12], through sandblasting adhere silicone liners to PMMA surfaces since they reduce
of the acrylic base resin surfaces with 50 𝜇m Al2 O3 particles the bubbles’ formation during relining.
[20], through organic solvents, such as the application of
an acetone solution and ethyl acetate solution [35], through 4.1.2. Treatments to Improve Denture Liners’ Adhesion to
application of a mixture of methyl formate and methyl acetate the Prosthesis. Treatment with acetic acid was compara-
solution [51], and with changes in the prosthesis material like ble to that with tribochemical silica coating [52]. On
PMMA, preimpregnated with unidirectional glass fiber [12]. the other hand, polymethylmethacrylate (PMMA) sur-
According to Ohkubo et al. [30], dentures used for faces showed better adhesion with methyl formate-methyl
an extended period of time are difficult to reline because acetate (MF-MA) than with resin liner bonding agents
microorganisms produce methyl mercaptan, which causes [51], composed of acetone and 2-HEMA, which is not
liner detachment even after the primer dissolution. Since volatile and obstructs the polymeric chains’ interlocking,
bacteria penetrate to approximately 3 mm deep [30], more thus reducing bonding. There is no residual solution for
efficacy is obtained by reducing the base thickness and MF-MA.
applying a high penetration primer, such as those based on
Another way to enhance the liners’ adhesion to the pros-
dichloromethane.
theses is application of laser Er: YAG that alters prostheses
surfaces, creating defects. Akin et al. [53] showed an increase
4.1.1. Silicone Liners. Silicone liners are mechanically supe- in the silicone-based liners’ bond strength to a UDMA base
rior and more durable than resin liners [35, 43]. However, following laser application.
6 The Scientific World Journal

Table 2: Included studies related to the hardness and roughness for soft denture liners.

Author/year Method used Study objectives Outcomes

No hardness difference, experimental
Hardness values in Shore A Compare fluorinated monomer soft
Kasuga et al./2011 fluorinated soft lining materials,
durometer lining materials, conventional
Molloplast B
Storage duration on tensile bond
Hardness values in Shore A Hardness, higher with increased
Mese and Guzel/2008 strength and hardness, acrylic resin
durometer duration of immersion
and silicone liners
Tensile strength, tear resistance, and Hardness, ESE increased with
Hardness values in Shore A
Santawisuket al./2013 hardness of experimental silicone amount of silica filler (from 6 to 10
durometer
elastomers (ESE) phr)
Roughness, methacrylate-based
Sealer coating, roughness of soft
Kutlu et al./2016 Surface roughness tester liners increased, denture cleanser.
lining
Sealer coating, no effect, roughness
Hardness values in Shore A Sealer reduced saliva softening effect,
Mante et al./2008 PermaSeal, hardness of soft reline
durometer methacrylate-based soft reline
Hardness values in Shore A Hardness and bond strength of Hardness, 28-day increased
Kim et al./2014 [33]
durometer long-term soft denture lining compared to 24-hour
Hardness values in Shore A Evaluate experimental light-curing Hardness, UA-16, UV-32, and UV-35
Kanie et al./2009
durometer soft lining materials (ESLMs) similar to commercial denture liner
Weight loss, roughness similar to
Hardness values in Shore A R. communis dentifrice (10%) on
Corega. Colgate, Corega Brite,
Badaró et al./2017 durometer and surface roughness abrasiveness, hardness, and color
roughness from 0.26 to 0.34 𝜇m.
tester change of a denture liner
Brushing, no effect, hardness
Palaseal coating, no effect, liners
Sealer coating, bond strength and
Dayrell et al./2012 Surface roughness tester roughness. Without sealer coating,
roughness of liners
no difference observed on roughness
No differences, initial roughness,
Lucitone, Sofreliner, Tokuyama
Rebase II, and New Truliner.
Roughness of denture resin, hard and
Machado et al./2012 Surface roughness tester Immersion 4%, chlorhexidine
resilient lining materials
increased roughness. Ufi Gel Hard
and Sofreliner, after 1 and 2
disinfection cycles
Hardness values in Shore A
Cazacu et al./2009 Heat curable silicone, tested as a liner Hardness, 59 ShA
durometer
Roughness, sealed COE-SOFT
Roughness, soft liners with and increased baseline, 1 month. Ufi-Gel
Mainieri et al./2011 Surface roughness tester
without surface sealer after brushing with and without sealer coating, after
6 months
Roughness, Tokuyama Rebase II and
Ufi Gel Hard similar or > New
Roughness denture, hard and
Machado et al./2011 Surface roughness tester Truliner. Lucitone and Tokuyama
resilient lining materials
Rebase II, no affected immersion
desinfection
Hardness values in Shore A Ageing effect, hardness, absorption,
Mancuso et al./2012 Thermocycling influenced hardness
durometer solubility, and color denture liners
Hardness values in Shore A Thermal cycling increased hardness,
Leite et al./2010 Hardness values
durometer Elite Soft. Decrease for Kooliner
Hardness values in Shore A Color stability, hardness and Hardness increased. Hypochlorite
Pisani et al./2012 durometer and surface roughness roughness, denture liners cleansers’ altered hardness. Elite Soft, highest
tester immersion roughness
Hardness, chlorhexidine diacetate or
Hardness values in Shore A Hardness, no changes, antimicrobial
Bertolini et al./2014 chlorhexidine hydrochloride soft
durometer agents
lining
Hardness values in Shore A Mechanical changes denture liners, Hardness, greater 25 Sh. A, 10 ppm,
Chladek et al./2013
durometer silver nanoparticle 40 ppm
Softone roughness increased,
Hardness values in Shore A
Hardness and roughness, liners with miconazole and chlorhexidine.
Urban et al./2014 durometer and surface roughness
antimicrobial Trusoft did not increase. Hardness
tester
and roughness, little changes
The Scientific World Journal 7

Table 3: Included studies related to the hardness and roughness for hard denture liners.

Author/year Method used Study objectives Outcomes

Effect of water-bath
Vickers hardness tester and surface postpolymerization (PP), degree of Hardness increased by PP except Ufi
Urban et al./2009
roughness tester conversion, flexural strength, and Gel Hard
microhardness, reline resins
Hardness, Lucitone 550, not affected.
Hardness and surface roughness, Kooliner and DuraLiner II, increased,
Vickers hardness tester and surface microwave and chemical except Lucitone 550. Microwave 2
Machado et al./2009
roughness tester disinfection, reline resins, denture cycles, increased roughness.
resin Tokuyama did not increase.
Hardness, small decrease, 30 days
Roughness, reduction, brushing and
Roughness, denture cleansers, reline
Izumida et al./2014 Surface roughness tester sodium perborate and/or
resin
chlorhexidine gluconate
Initial roughness, no differences,
Lucitone and Sofreliner, Tokuyama
Roughness, denture, hard chairside Rebase II and New Truliner.
Machado et al./2012 Surface roughness tester
and resilient lining materials Chlorhexidine 4%, increased
roughness, Ufi Gel Hard and
Sofreliner, after disinfection
Roughness (brushing, immersion). Roughness, decreased to L. Hardness,
Dias Panariello et Knoop hardness and surface
Hardness, color, Lucitone 550 (L), NaOCl and perborate, decreased to
al./2015 roughness tester
and reline resin L. Hardness, decreased for T
Roughness, Tokuyama Rebase II and
Ufi Gel similar or < New Truliner.
Roughness denture, hard chairside
Machado et al./2011 Surface roughness tester Roughness, Lucitone and Tokuyama
and resilient lining materials
Rebase II, not affected by immersion
and disinfection

Table 4: Included studies related to in vivo studies.

Author/year Observation period Method used Study objectives Outcomes
Evaluation criteria: physical
integrity, surface detail,
adhesion, color, odor, plaque
Clinical performance Roughening, posterior
Mutlay et al./2008 3, 6, and 12 months accumulation, resilience,
denture liners, 12 months region
hygiene, mucosal condition,
and signs of fungal
colonization
Roughness, Dentuflex and
Dentusoft, similar. Trusoft,
Rats used palatal plates, 14
Bail et al./2014 A roughness tester Roughness, soft liners rougher than Dentusoft. Ufi
days
Gel P, lowest roughness
(14-day)
Hardness, changes
Original and 1-month Denture liners changes,
Ogawa et al/2016 Shore D hardness influenced, patients’
hardness, after oral exposure 1-month clinical setting
characteristics

Considering experimental urethane acrylate oligomers- tribochemical silica and 4-META/MMA-TBB (4-methacryl-
based photopolymerized soft liners, no significant difference oxyethyl trimellitate anhydride in methylmethacrylate ini-
in adhesion was observed after 1 day or 12 months of storage in tiated by tri-n-butyl borane) resin is recommended [36].
water at 37∘ C [34]. This material seems to increase the liners’ Polyamides are chemical resistant materials due to their high
durability, which is usually of a few months. degree of crystallinity [33].
Ahmad et al. [1] found flaws in the liners’ adhesion
to a UDMA (photopolymerized urethane dimethacrylate)
4.1.3. Liners’ Adhesion to Different Types of Prostheses. To prosthesis due to its highly reticular nature that hinders the
improve bonding between polyamide prostheses and self- monomer penetration. In contrast, Akin et al. [53] found
polymerizable resin liners, the prosthesis treatment with similar adhesion of the resilient liner to UDMA or PMMA
8 The Scientific World Journal

prostheses. Adhesion of hard liners to thermoplastic acrylic of 10 seconds) [56]. Machado et al. [44] found an increase
resin was similar to that of conventional thermopolymerized in roughness of the hard liner due to porosities formed
acrylic resin; however, results were different for polyamide from the release of residual monomers and plasticizers and
since these polymers are chemically resistant [33]. from the increase in temperature during disinfection with
A weak adhesion between the resilient resin-base liner microwaves. The increase in roughness was observed when
and prothesis was explained by the absence of monomers organic solvents such as MMA were applied on PMMA as
associated with nonreticulated amorphous polymers [50]. an attempt to improve adhesiveness to silicone-based liners
Nonetheless, glass fiber-reinforced PMMA showed increased [35], because these solvents degrade the surface and alter its
adhesion to the liner since the fibers were previously filled morphology.
with nonreticulated polymers containing PMMA islands in Values found for roughness of resin and silicone liners
micrometric scale [12]. These exposed fibers were better [22] exceeded the ideal clinical parameter (0.2 𝜇m) [57].
dissolved by ethyl acetate. High values were also found by other authors [27, 44, 58].
Kutlu et al. [28] prepared the specimens on glass plates
4.1.4. Antimicrobial Agents. It is important to assess changes and obtained values above 0.2 𝜇m. Machado et al. [58]
in adhesion of prostheses and liners resulting from medicine found initial roughness of 3.54 𝜇m in a resin-base liner.
incorporation. Antimicrobial additives can be a low-cost, Methacrylate resilient liners are rougher than silicone liners
effective alternative that does not require the patients’ coop- due to their chemical structure, residual monomer content,
eration [12]. Pisani et al. [54] showed no changes in resin liner polymerization method, monomers’ volatility, and mixing
bonding considering immersion time or sodium perborate technique [24, 43].
use, indicating that these do not affect the materials’ disso-
lution. Alcântara et al. [55] showed that the addition of nys- 4.2.1. Sealants’ Application. Surface sealants protect liners
tatin, miconazole, ketoconazole, or chlorhexidine diacetate in against water absorption and damage from chemicals, saliva,
several dosages had no effect on the liner’s adhesion to the food, and brushing and coating defects and reduce porosities
prosthesis. and fissures [18, 29]. Their application reduced roughness
produced by brushing in silicone and resin liners, with a
4.1.5. Considerations Relative to Denture Liners’ Adhesion. more pronounced effect for siloxane-based material [18]. On
Poor adhesion creates a favorable environment to microor- the other hand, Kutlu et al. [28] showed no reduction in
ganisms and compromises the liner’s durability. For silicone roughness when a sealant was applied to silicone-based and
liners, the use of solvents seems to improve their adhesion to methacrylate-based liners. These findings are in agreement
PMMA, since it favors the adhesive penetration and creates a with another study [43]. Several situations increase liners’
mechanical blockage. For PMMA surfaces, the substitution roughness, a favoring factor for bacteria accumulation. There
of the most commonly found monomer (acetone and 2- is still no consensus on whether roughness is reduced when a
HEMA) for a solution with better agent evaporation improves surface sealant is applied.
adhesion allowing the interlocking of the polymer chains.
4.3. Hardness. According to the specific ISO standards, liners
4.2. Surface Roughness. There are several methods to remove can be categorized as type A (soft) or type B (extra soft)
contaminants from the liners, but it is important to assess for measurements taken 24 hours after the preparation of
their effects on the surface since cleaning solutions can specimens (ISO 10139-2:2009) [59].
penetrate the resin and change its morphology. In addition, A compilation associated with resilient liners comprises
immersion time and concentration can alter the polymer changes in hardness over time [42]. Hardness can be defined
structure [32]. as penetration resistance [10], it increased in resin liners
Self-polymerizable hard liners’ roughness increases subjected to warm-water bath following polymerization, and
after immersion in sodium perborate and radiation with it was associated with the reduction in residual monomers
microwaves due to the immersion temperature and oxygen [6]. Mancuso et al. [60] also found an increase after aging
release by the perborate [17]. Bubbling from the oxygen that was associated with differences in type and content of
release is a mechanical cleaning mechanism [17]. Izumida plasticizers, leaching, and liquid absorption [17, 60]. Hard-
et al. [32] found a reduction in roughness associated with ness of experimental photopolymerizable soft liners based on
brushing and disinfection with sodium perborate and/or urethane acrylate oligomers was similar to that of silicone
chlorhexidine gluconate and related it to cross-linked agents or acrylic resilient liners [34]. Conversely, Cazacu et al. [45]
that reduce the acrylic resin solubility in organic solvents. found higher hardness values for a thermostable silicone
Brushing with only toothpaste and water increased tested as liner, equivalent to that of addition silicone.
roughness of silicone liner [32, 37], since toothpaste is Chemical cleaning is the first choice to avoid liner dam-
composed of sodium carbonate, an abrasive agent. age. Immersion impacts malleability, ductility, and resistance
No changes in roughness were found in one heat- to traction [19]. Immersion in different solutions increased
polymerized denture base acrylic resin (Lucitone 550b) and the liners’ hardness [17, 44, 46]. On the other hand, Rezende-
another autopolymerized reline resin (Tokuyama Rebase Fast Pinto et al. [27] found a reduction in self-polymerizable
II) with different cleaning agents and this was associated hard liners’ hardness regardless of chemical solution or water
with the short immersion time (1, 3, 21, 45, and 90 cycles immersion, before and after 30 cycles. Water diffuses through
The Scientific World Journal 9

the resin until it saturates it and this results in surface enhance the growth of fungi such as Candida albicans on the
softening. presence of saliva [63, 64].
Clinically, changes in hardness can also be caused by
temperature fluctuations in the oral cavity and changes in pH
5. General Considerations
[29], and, in the laboratory, they may still be affected by the
type and concentration, immersion time, and composition Failure of adhesion between the prosthesis and liner will
of the cleaning solution. Changes in acrylic resilient liners compromise the procedure durability and favor microbial
occurred after 1 month of use by patients; and smoking colonization. Adhesive failure may be associated with the
patients showed higher hardness values, probably due to bonding agent. The use of solvents in silicone-based liners
heat exposure. The frequent use of cleaners kept the liners seems to improve the adhesion of these to the PMMA
soft and delayed their hardening process. Complete max- base. A surface treatment is required to adhere liners to
illary prostheses users presented higher values, associated the polyamide denture base, either with acetic acid or with
with the materials’ package. It is known that the pressure tribochemical silica. For PMMA surfaces, better adhesion is
exerted by the denture during mastication accelerates the obtained with the same chemical properties of the liner and
liner degradation. Complete monomaxillary prostheses exert denture base. It is important to preserve the hardness values,
greater occlusal strength than the bimaxillary prostheses. so that the liner can maintain its elastic property.
However, the authors showed no association between hard- Roughness surfaces and hardness changes favor micro-
ness and occlusal force after 1 month of the liner applica- bial colonization and stomatitis. The selection of the liner
tion. An increase in saliva acidity was associated with an should be based on the procedure’s objective, considering
increase in hardness, but this association cannot be gener- serviceability, and expected results. The diversity of methods
alized. Finally, use during sleep increased hardness, which presented the properties in a diverse manner, showing that
was associated with individual and environmental factors subsequent studies are necessary to meet better utilization
[42]. and indication of liners regarding hardness, roughness, and
Maintenance of materials’ hardness is critical for their adhesion. Based on the present results, further in vivo inves-
longevity; its effect, with and without sealants, varied among tigations with randomized controlled trials are necessary to
studies [18, 29]. Sealant application on resilient methacrylate compare the performance and properties of these denture
can be effective in preserving hardness, since the solvent liners’ modifications in clinical use.
evaporates and creates a superficial layer resistant to degra-
dation [29].
Conflicts of Interest
Given that soft liners’ hardness is approximately 40 Shore
hardness units (DIN 53505 and ASTM D2240/75), Santaw- The authors report no conflicts of interest.
isuk et al. [25] have enhanced the mechanical properties of an
experimental silicone by adding synthetic silica. Comparing
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