A case history is presented of a patient who fabricated 3 prostheses from autopolymerizing acrylic resin intended for fingernail augmentation and then cemented them into her mouth with super glue. Patients must be warned not to attempt self-treatment for esthetics with self-fabricated prostheses because severe adverse and irreversible hard and soft tissue reactions may occur.
Contemporary dentistry revolves around esthetics. Although meager as compared with the arsenal at the disposal of our medical colleagues, the dental profession has its share of esthetic procedures and techniques.
Under the continuous influence of the media and a variety of other factors, today's patients are concerned with both their general health and their appearance. A constant and lifelong desire is to present a favorable appearance to others and to associate with people who effect a reciprocating pleasing reaction. The most outward reaction is effected by the face because the face is, unmistakably, us.1
Everyone wants to look younger and, in our society, people will go to extremes to improve their appearance.2 Today, vast improvements in instrumentation, restorative materials and techniques, and color knowledge have made it possible for the dental profession to consistently provide patients with life-like prostheses that are virtually undetectable.
Achieving a favorable esthetic result takes time, experience, an eye for beauty, and patient input. For patients who are determined to self-improve their appearance, the dental professional should expect the impossible, inconceivable, or improbable, often combined with ingenuity.
The authors previously published a case report of how a 52-year-old Caucasian man attempted to repair damage to his maxillary teeth with super glue.3 That was the first time any of the authors had observed such an unusual case of self-improvement. Approximately 1 year later, a second case was brought to our attention and included the patient fabricating 3 acrylic prostheses from a fingernail acrylic resin augmentation kit. She cemented the self-fabricated prostheses into her mouth with super glue.
Vernonite, a denture-base resin, was the first of the acrylic-resin compounds specifically formulated for dentistry to be introduced in the United States and was, perhaps, the first application of the monomer-polymer principle.4 It was developed by Harold M. Vernon and Lester B. Vernon, with the collaboration of members of the research and development staffs of Rohm & Haas Company.
Vernonite was formally introduced to the profession at the meeting of the American Dental Association in St Louis, Mo, in 19384 and was immediately followed by a continuous progression of other acrylic dental products. Today, acrylic resins are used daily by dentists in all specialties throughout the world.
Cold-curing (ie, autopolymerizing, self-curing, chemically activated) acrylic resins contain a tertiary amine chemical accelerator, usually N,N-dimethyl-p-toluidine, which is added to the monomer so polymerization can be completed at room temperature in a short period of time.
In recent years, cold-curing acrylic resins have found their way into the cosmetic industry for fingernail sculpting and lengthening. This is accomplished at beauty salons, in shops devoted exclusively to nail care, and by individuals from nail kits purchased at beauty shops, drug stores, other retail outlets, and over the Internet.
The US Food and Drug Administration warned against the use of fingernail products containing methyl methacrylate as early as 1974.5 Boards of cosmetology in some states have since outlawed these nail products.6 On May 22, 2003, Health Canada issued an advisory warning about cosmetic preparations containing methyl methacrylate.7 As a result, the sale and use of cosmetic nail preparations containing methyl methacrylate has been banned in Canada.
Although the dangers of using acrylic resin have been widely publicized in the media and within cosmetology and beauty magazines, widespread use of products containing methyl methacrylate for application to fingernails exists. Cosmetologists and individuals have been known to purchase cold-curing acrylic resin products from dental supply houses when their source of supply from conventional channels was interrupted and/or discontinued.
Super glue has been available on the mass market as a general adhesive since the late 1950s. It has experienced extraordinary claims regarding its strength and versatility. It has been said that a 1-inch-square bond can hold more than a ton. Super glue is available under many trade names, in many forms (ie, stick, liquid, gel), and from a number of major and minor manufacturers.
Super glue is claimed to have the ability to bond porous, nonporous, and flexible surfaces including glass, porcelain, fabric, metal, leather, wood, rubber, and a variety of resins. It can be purchased in super markets, in stationary stores, in convenience stores, in automotive supply outlets, and over the Internet. Its dangers are well known and appear on the packaging. Newer applications of super glue include wound closure instead of sutures and the detection of latent fingerprints in criminal investigations.
Super glue was evaluated for wound closure early in its history. However, the degradation of methyl cyanoacrylate into cyanoacrylate and formaldehyde could inflame the involved tissues before healing occurred. In the early 1960s, the formulation was changed to butyl cyanoacrylate for possible medical use, creating a less toxic product. The new composition was evaluated during the Vietnam conflict for control of bleeding until surgery could be performed. In 1998, the Food and Drug Administration approved the use of Dermabond (Closure Medical Corporation, Raleigh, NC) as an alternative to the suturing of small wounds.
The major ingredient of super glue is cyanoacrylate, a methacrylate resin that cures almost instantly. The catalyst is hydroxyl ions in water, which is present in trace amounts on the surface of virtually any object one wishes to bond. The cyanoacrylate molecules begin to link on contact with water, and the chains form a durable plastic mesh. The glue thickens and hardens until movement of the molecular chains ceases.
A case history is presented of a patient who fabricated 3 prostheses from autopolymerizing acrylic resin intended for fingernail augmentation and then cemented them into her mouth with super glue.
A 49-year-old female presented for treatment at Temple University School of Dentistry in July 2005. The patient reported a long history of oral problems including tooth decay, pain, changes in tooth alignment and occlusion, sore jaw muscles, burning tongue, gingival bleeding, mobile and abscessed teeth, and halitosis. Her last dental visit occurred in June 2003 for “tooth build up.”
Radiographic examination (Figure 1) revealed a number of decayed teeth, previously prepared teeth, and retained roots. With the exception of the lower anteriors and first bicuspids, and the lower left first and second molars, all of the remaining teeth had undergone endodontic treatment. Many of the teeth appeared to be nonrestorable. Clinical examination revealed acrylic prostheses in the upper anterior, upper- and lower-right posterior, and lower-left posterior quadrants. The mouth appeared clean with little inflammation.
The patient fabricated the upper anterior and upper- and lower-right posterior acrylic prostheses after losing faith in the dentist who had treated her for many years and recently retired from private practice. The prostheses were made in October 2004 and, due to the lack of adequate tooth structure for retention, the patient used super glue for cementing the prostheses.
The patient purchased nail acrylic from a beauty supply store. After mixing an adequate amount of powder and liquid, she formed a rectangular mass and molded it over the maxillary anterior segment of teeth from the right lateral incisor to the left first bicuspid. The patient adapted the pliable resin to the teeth with finger pressure and manipulation of her upper lip. The patient then closed into occlusion until her remaining teeth were in maximum contact. The midline was marked with an indelible pencil. When the acrylic started to polymerize and generate heat, she removed the resin dough from her mouth and let the polymerization continue to completion on a table top.
The patient used a motor, which was included in a pedicure kit, and the accompanying burs, stones, and wheels to shape and polish the individual teeth (Figures 2 and 3). The patient attempted to duplicate the anatomy and morphology of the acrylic prosthesis using the prosthesis previously constructed by her dentist as a guide. She was no longer able to wear the prosthesis fabricated by her dentist due to the loss of tooth structure.
The upper-right posterior prosthesis (second molar to first bicuspid) and the lower-right posterior prosthesis (second bicuspid and first molar) were fabricated in the same manner. The patient used the ill-fitting prostheses previously fabricated by her dentist as a guide for the anatomy of the individual teeth (Figures 4 and 5). The patient said she did not spend as much time with the lower right prosthesis as she did with the others because “it did not show when I talked.” It took the patient approximately 3 hours each to fabricate the upper anterior and upper-right posterior prostheses.
After the patient was satisfied with the esthetics, each prosthesis was polished with the stones and rubber wheels that were included in the pedicure kit. The prostheses were cemented by placing a drop of super glue into each tooth socket when the patient was satisfied with the esthetics and occlusion. The upper anterior prosthesis was cemented first, followed by the right upper- and lower-posterior prostheses.
The patient was satisfied with the prostheses she fabricated and thought they looked as good as those previously made by her dentist. The patient claims she was extremely careful to “maintain the indentations from the opposing jaw” in the resin when she carved each individual tooth. The authors were impressed with the anatomy, esthetics, and the occlusion achieved by the patient and would have given her a satisfactory grade.
The patient has good oral hygiene and claims she brushes several times a day and uses a water irrigation device once daily.
The anterior prosthesis lasted 10 months, and the patient remade it between her first and second visits to Temple University School of Dentistry. She said the original anterior prosthesis was more esthetic (which the patient had when the photographs were taken). The anterior remake took the patient only 1 hour.
The problem of adjusting to tooth loss in our modern society is becoming extremely difficult because of the high values placed on youth, beauty, and virility.2 We are a youth-oriented and age-fearing culture with a passion to be esthetically pleasing to ourselves and others. This case history is an example of a patient going to an extreme to improve her appearance.
Sculpted fingernails made from acrylic resin are very hard. It is extremely difficult for cosmetologists and lay persons to modify and adjust them. If removal of an acrylic resin fingernail is desired, solvents may not be successful. The cosmetologist or lay person may have to grind the acrylic down to the real fingernail. This is difficult, tedious, and time consuming, and fingernail damage may occur.
Exposure to methyl methacrylate monomer may cause irritation of the eyes, nose, throat, and respiratory tract. Repeated exposure can result in drowsiness and dizziness. Methyl methacrylate monomer can irritate the skin, resulting in redness, irritation, itching, and inflammation of the contacted areas. Although individuals who use acrylic resin products on occasion may be at risk of adverse health effects, the risk is greater for those who frequently modify fingernails or are exposed to methyl methacrylate monomer during their daily work routine.
Patients must be warned not to attempt self-treatment for esthetics with self-fabricated prostheses because severe adverse and irreversible hard and soft tissue reactions may occur.
Sheldon Winkler, DDS, is a professor of Restorative Dentistry at Temple University School of Dentistry, 3223 North Broad Street, Philadelphia, PA 19140. He formerly served as professor and chairman of the Department of Prosthodontics at Temple University. Address correspondence to Dr Winkler (firstname.lastname@example.org).
Robert Wood, DMD, is an assistant professor of Restorative Dentistry and assistant director of the Removable Prosthodontic Clinic, Anne M. Facchiano, DMD, is a clinical assistant professor of Restorative Dentistry, Kenneth G. Boberick, DMD, is an associate professor of Restorative Dentistry, and Amita R. Patel, BS, is a senior dental student at Temple University School of Dentistry in Philadelphia, PA.