PMMA denture base material enhancement: a review of fiber, filler, and nanofiller addition

Comparison of ISO and ASTM standards in determining the flexural strength of denture base resin

Purpose:

The aim of this study was to compare the differences between the ASTM D790 and ISO 20795.1.2013 standards in evaluating the flexural strength of heat cure poly methyl methacrylate (PMMA) denture base resin.

Materials and methods:

30 heat cure denture base samples were fabricated in accordance to ISO 20795.1.2013 and ASTM D790 Standards. The specimens were finished and stored following the standardized protocol. The flexural strength was determined using universal testing machine at cross head speed of 1.50 mm/min and a span length of 40.00 mm. The mean flexural strength values were calculated in megapascals (MPa), and statistically analyzed.

Results:

The mean flexural strength of heat cure PMMA found with ISO and ASTM ranged between 60.492 MPa and 61.470 MPa. There was no significant difference between the two methods.

Conclusion:

The quantitative differences existed in the flexural strength of denture base resin between ISO 20795.1.2013 and ASTM 790 protocols but those differences had no statistical and clinical significance.

Effect of the combination of a crosslinking agent and a thiourethane additive on the properties of acrylic denture bases processed with microwave energy

Thiourethane (TU) additives and difunctional, polymerizable crosslinking agents have been demonstrated to increase toughness in methacrylate-based materials. The aim of this study was to evaluate the potential reinforcement of acrylic denture bases by combining thiourethane additives and 1,6 hexanediol dimethacrylate (HDDMA) as an additional crosslinking agent. One commercial acrylic resin (Nature-Cryl MC; GC America) was tested by adding 0 (control) or 10 wt% TU, each of them combined with 0 (control), 10, 20 and 30 wt% HDDMA, for a total of 8 experimental groups. Materials were processed using microwave energy (500 W for 3 min) using microwave-safe molds and flasks. Flexural strength, modulus and toughness were obtained in 3-point bending (ISO 4049) using bars measuring 2 × 2x25 mm (n = 6). Dynamic mechanical analysis was used to determine glass transition temperature (Tg), breadth of tan delta (as a measure of polymer heterogeneity) and crosslinking density in 1 × 3x15 mm bars (n = 6) tested in tension, using a 3 °C/min heating rate (-30 to 180 °C). Viscosity samples were evaluated in a parallel plate reometer. Data were analyzed by two-way ANOVA and Tukey's test (α = 0.05). Results showed that on the samples not containing TU, HDDMA up to 20 wt% increased the flexural strength and thoughness (and up to 30 wt% HDDMA increased the modulus). The addition of TU did not affect those properties (except for the increase in elastic modulus), but the combination TU + HDDMA led to decreased properties overall. The addition of HDDMA decreased the viscosity for all materials, and the presence of TU did not affect viscosity. The Tg increased linearly with the concentration of HDDMA, except in the groups containing TU - in general, the addition of TU reduced Tg. The crosslinking density increased with the addition of HDDMA for all materials, regardless of the presence of TU. The addition of TU significantly decreased crosslinking density. The breadth of tan delta was not affected by the addition of HDDMA, but significantly increased with the addition of TU. In conclusion, the chain-breaking effect of TU on polymerizing methacrylates was deleterious in the case of methyl methacrylate, since it forms a linear polymer. The addition of HDDMA up to 20 wt% and not combined with TU significantly improved the tested properties.

Zinc Oxide Nanoparticles Cytotoxicity and Release from Newly Formed PMMA-ZnO Nanocomposites Designed for Denture Bases

The goal of the study was to investigate the level of zinc oxide nanoparticles (ZnO NPs) release from polymethyl methacrylate (PMMA)-ZnO nanocomposites (2.5%, 5%, and 7.5% w/w), as well as from the ZnO NPs layer produced on pure PMMA, and the impact of the achieved final ZnO NPs concentration on cytotoxicity, before the potential use as an alternative material for denture bases. The concentration of ZnO nanoparticles released to the aqueous solution of Zn²⁺ ions was assessed using optical emission spectrometry with inductively coupled plasma (ICP-OES). In the control group (pure PMMA), the released mean for ZnO was 0.074 mg/L and for individual nanocomposites at concentrations of 2.5%, 5%, and 7.5% was 2.281 mg/L, 2.143 mg/L, and 3.512 mg/L, respectively. The median for the ZnO NPs layer produced on PMMA was 4.878 mg/L. In addition, in vitro cytotoxicity of ZnO NPs against the human HeLa cell line was determined through the reduction of 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) dye. The cytotoxicity studies demonstrate that ZnO nanoparticles in the concentrations up to 20 mg/L have no adverse effect on HeLa cells. When compared with the released and cytotoxic concentrations of ZnO NPs, it can be expected that ZnO released from dental prostheses to the oral cavity environment will have no cytotoxic effect on host cells.

Anti-biofilm Action of Chenopodium ambrosioides Extract, Cytotoxic Potential and Effects on Acrylic Denture Surface

Considering the challenge to control Candida-associated denture stomatitis, the search for antifungal substances derived from natural sources has become a trend in the literature. In this study the following effects of Chenopodium ambrosioides extract (CAE) were investigated: action against biofilms of Candida albicans, its cytotoxic potential, and changes caused in acrylic resin. The CAE was characterized by High Performance Liquid Chromatography (HPLC). The susceptibility of C. albicans to CAE was investigated by Minimum Inhibitory Concentration and Minimum Fungicidal Concentration (MIC and MFC) tests. Acrylic resin disks were fabricated, and C. albicans biofilms were developed on these for 48 h. Afterward the disks were immersed for 10 min in: PBS (Negative Control); 1% Sodium Hypochlorite (1% SH, Positive Control) or CAE at MIC or 5xMIC. The biofilms were investigated relative to counts and metabolic activity. The cytotoxic potential in keratinocytes and fibroblasts was verified by MTT test. Change in color and roughness of the acrylic resin was analyzed after 28 days of immersion in CAE. The data were analyzed by the ANOVA considering a 5% level of significance. The main compounds detected by HPLC were kaempferol and quercetin. Both MIC and MFC obtained the value of 0.25 mg/mL. The MIC was sufficient to significantly reduce the counts and activity of the biofilm cells (p < 0.0001), while 5xMIC resulted in almost complete eradication, similar to 1% SH. Keratinocytes and fibroblasts exposed to the MIC and 5xMIC presented cell viability similar to that of the Control Group (p > 0.05). No important changes in acrylic resin color and roughness were detected, even after 28 days. It could be concluded that the immersion of acrylic resin in C. ambrosioides extract in its minimum inhibitory concentration was effective for the reduction of C. albicans biofilms without any evidence of cytotoxic effects or changes in roughness and color of this substrate.

Monomer Modifications of Denture Base Acrylic Resin: A Systematic Review and Meta-analysis

BACKGROUND

Methyl methacrylate monomer of denture base resins was modified with several monomers to achieve better physico-mechanical properties without compromising the biocompatibility. However, there are no consensuses on the best strategy to achieve best modified monomer.

PURPOSE

To identify and evaluate the differences in the properties between conventional and modified monomers and to verify the influence of several variables on the properties of denture base acrylic resin.

MATERIALS AND METHODS

This study was executed by following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. In-vitro studies that investigated the properties of conventional and modified monomers were selected. Searches were carried out in the Ebscohost, PubMed, Semantic scholar and J-stage databases. The search commenced from the year 1995 and the last search was done till November 2018. A comparison was performed between modified and unmodified monomers. The analyses were carried out using fixed-effect models.

RESULTS

The meta-analysis results showed high heterogeneity in all aspects, and higher flexural strength for monomers modified with 20% methacrylic acid.

CONCLUSION

Although the articles included in this meta-analysis showed high heterogeneity and high risk of bias, the in-vitro literature seems to suggest that use of modified monomers could improve the properties of denture base resins. Other variants of monomer modifications and their tested parameters were discussed in this systematic review as well. Dimensional accuracy is an unexplored variable to be evaluated extensively in the future researches.

Investigating the Mechanical Properties of ZrO2-Impregnated PMMA Nanocomposite for Denture-Based Applications

Acrylic resin PMMA (poly-methyl methacrylate) is used in the manufacture of denture bases but its mechanical properties can be deficient in this role. This study investigated the mechanical properties (flexural strength, fracture toughness, impact strength, and hardness) and fracture behavior of a commercial, high impact (HI), heat-cured denture base acrylic resin impregnated with different concentrations of yttria-stabilized zirconia (ZrO₂) nanoparticles. Six groups were prepared having different wt% concentrations of ZrO₂ nanoparticles: 0% (control), 1.5%, 3%, 5%, 7%, and 10%, respectively. Flexural strength and flexural modulus were measured using a three-point bending test and surface hardness was evaluated using the Vickers hardness test. Fracture toughness and impact strength were evaluated using a single edge bending test and Charpy impact instrument. The fractured surfaces of impact test specimens were also observed using a scanning electron microscope (SEM). Statistical analyses were conducted on the data obtained from the experiments. The mean flexural strength of ZrO₂/PMMA nanocomposites (84 ± 6 MPa) at 3 wt% zirconia was significantly greater than that of the control group (72 ± 9 MPa) (p < 0.05). The mean flexural modulus was also significantly improved with different concentrations of zirconia when compared to the control group, with 5 wt% zirconia demonstrating the largest (23%) improvement. The mean fracture toughness increased in the group containing 5 wt% zirconia compared to the control group, but it was not significant. However, the median impact strength for all groups containing zirconia generally decreased when compared to the control group. Vickers hardness (HV) values significantly increased with an increase in ZrO₂ content, with the highest values obtained at 10 wt%, at 0 day (22.9 HV_0.05) in dry conditions when compared to the values obtained after immersing the specimens for seven days (18.4 HV_0.05) and 45 days (16.3 HV_0.05) in distilled water. Incorporation of ZrO₂ nanoparticles into high impact PMMA resin significantly improved flexural strength, flexural modulus, fracture toughness and surface hardness, with an optimum concentration of 3–5 wt% zirconia. However, the impact strength of the nanocomposites decreased, apart from the 5 wt% zirconia group.

Carbon nanotube incorporation in PMMA to prevent microbial adhesion

Although PMMA-based biomaterials are widely used in clinics, a major hurdle, namely, their poor antimicrobial (i.e., adhesion) properties, remains and can accelerate infections. In this study, carboxylated multiwalled carbon nanotubes (CNTs) were incorporated into poly(methyl methacrylate) (PMMA) to achieve drug-free antimicrobial adhesion properties. After characterizing the mechanical/surface properties, the anti-adhesive effects against 3 different oral microbial species (Staphylococcus aureus, Streptococcus mutans, and Candida albicans) were determined for roughened and highly polished surfaces using metabolic activity assays and staining for recognizing adherent cells. Carboxylated multiwalled CNTs were fabricated and incorporated into PMMA. Total fracture work was enhanced for composites containing 1 and 2% CNTs, while other mechanical properties were gradually compromised with the increase in the amount of CNTs incorporated. However, the surface roughness and water contact angle increased with increasing CNT incorporation. Significant anti-adhesive effects (35~95%) against 3 different oral microbial species without cytotoxicity to oral keratinocytes were observed for the 1% CNT group compared to the PMMA control group, which was confirmed by microorganism staining. The anti-adhesive mechanism was revealed as a disconnection of sequential microbe chains. The drug-free antimicrobial adhesion properties observed in the CNT-PMMA composite suggest the potential utility of CNT composites as future antimicrobial biomaterials for preventing microbial-induced complications in clinical settings (i.e., Candidiasis).

Reinforcement of PMMA Denture Base Material with a Mixture of ZrO2 Nanoparticles and Glass Fibers

This study is aimed at evaluating the hybrid reinforcement effects of zirconium oxide nanoparticles (nano-ZrO₂) and glass fibers (GFs) at different ratios on the flexural and impact strengths of a polymethylmethacrylate (PMMA) denture base. A total of 160 specimens were fabricated from heat-polymerized acrylic resins using the water bath technique. For the control group, the specimens did not receive any additions; for the test group, different concentrations of nano-ZrO₂/GFs at 5% of the PMMA polymer were added. The concentrations of nano-ZrO₂/GFs were as follows: 5%–0%, 4%–1%, 3%–2%, 2.5%–2.5%, 2%–3%, 1%–4%, and 0%–5%. The flexural strength was measured using the three-point bending test. The impact strength was measured using the Charpy impact test. Results were tabulated and analyzed using one-way analysis of variance (ANOVA) and the Tukey–Kramer multiple comparison test (p ≤ 0.05). The flexural and impact strengths of PMMA-nano-ZrO₂ + GF composites were significantly improved when compared with those of pure PMMA (p < 0.05). The maximum flexural strength (94.05 ± 6.95 MPa) and impact strength (3.89 ± 0.46 kJ/m²) were obtained with PMMA (2.5%)/nano-ZrO₂ + 2.5% GF mixtures and could be used for removable prosthesis fabrication.

Behavior of PMMA Denture Base Materials Containing Titanium Dioxide Nanoparticles: A Literature Review

Titanium dioxide nanoparticles (TiO₂NP) have gained interest in the dental field because of their multiple uses in addition to their antimicrobial effect. One of the applications in dentistry involves the incorporation into poly methyl methacrylate (PMMA) resin. However, there is a lack of evidence on their effects on the behavior of the resulting nanocomposite. Therefore, the present review aims to screen literatures for data related to PMMA/TiO₂ nanocomposite to figure out the properties of TiO₂ nanoparticles, methods of addition, interaction with PMMA resin matrix, and finally the addition effects on the properties of introduced nanocomposite and evidence on its clinical performance. Regardless of the latest research progress of PMMA/TiO₂ nanocomposite, the questionable properties of final nanocomposite and the lack of long-term clinical evidence addressing their performance restrict their wide clinical use. A conclusive connection between nanoparticle size or addition method and nanocomposite properties could not be established.

Impact Strength and Dimensional Accuracy of Heat-Cure Denture Base Resin Reinforced With ZrO2 Nanoparticles: An In Vitro Study

Background:

Polymerization shrinkage and fracture are the two common trouble shoots with denture base resins. Polymerization shrinkage affects the dimensional accuracy and fit of the prosthesis. The effect of zirconia (ZrO₂) nanoparticles on polymerization shrinkage is not documented yet.

Purpose:

The aim and objective of this study were to evaluate the impact strength and dimensional accuracy of heat-cured poly methyl methacrylate (PMMA) on reinforcement with ZrO₂ nanoparticles.

Materials and Methods:

Conventional heat-cure denture base resin (control) and the polymer reinforced with 3, 5, and 7 wt% of ZrO₂ nanoparticles were prepared and used in this study. Forty bar-shaped specimens were prepared and tested for impact strength using Charpy’s type impact tester. Forty denture bases were fabricated and checked for dimensional accuracy by measuring the distance between the denture base and the cast in two different sections using the travelling microscope.

Results:

The impact strength decreased with increased concentration of ZrO₂ and found to be least at 7 wt% concentration (2.01 ± 0.26 J/mm²). The distance between the denture base and the cast significantly decreased both in the posterior palatal seal region (0.060 ± 0.007 cm) and mid-palatine section region (0.057 ± 0.006 cm) with ZrO₂ nanoparticles reinforcement and was found to be least at 7 wt% concentration.

Conclusion:

Reinforcement of heat-cured PMMA with ZrO₂ nanoparticles significantly increased the dimensional accuracy and decreased the impact strength.

Effect of Denture Base Reinforcement Using Light Cured E- Glass Fibers on the Level of Salivary Immunoglobulin A

BACKGROUND

A gap still exists between in vitro and clinical studies concerning the biocompatibility of the material in the oral environment and their potential to cause immunological undesirable side effects. The uses of glass fibres to improve the mechanical properties of acrylic resin denture base polymers are well documented in vitro.

AIM

The present study aimed to evaluate the effect of denture base reinforcement using light-cured E- glass fibres mesh on the level of salivary immunoglobulin A (S-IgA) in patients wearing complete dentures.

MATERIAL AND METHODS

Fourteen completely edentulous patients, in need of complete dentures, participated in the study. The patients were divided into two groups (n = 7) according to the treatment protocol. In the first group, patients received conventional heat-cured acrylic resin dentures. In the second group, the mandibular dentures were reinforced using light cured resin impregnated E glass fibres mesh. In both groups, salivary samples were collected using passive drool technique. The level IgA was assessed by enzyme-linked immunosorbent assay (ELISA) technique at different time intervals. Statistical analysis was carried out using one-way ANOVA followed by Tukey`s post-hoc test and independent t-test. The significant level was set at P ≤ 0.05.

RESULTS

Acrylic resin dentures and reinforced ones demonstrated an increase in the mean values of IgA level at the end of the follow-up intervals. And this increase was statistically significant (P ≤ 0.05). Although, the reinforced dentures revealed higher mean values, there was no statistically significant difference between the two groups (P > 0.05).

CONCLUSIONS

Within the limitations of the present study, the following could be concluded: (1) the insertion of complete dentures induced changes in the level of IgA; and (2) denture base reinforcement using light cured resin impregnated E-glass fibres mesh had a similar effect to that of heat cured acrylic resin on the level of IgA.

Effect of Nanodiamond Addition on Flexural Strength, Impact Strength, and Surface Roughness of PMMA Denture Base

PURPOSE

To assess the effect of addition of different concentrations of nanodiamonds (NDs) on flexural strength, impact strength, and surface roughness of heat-polymerized acrylic resin.

MATERIALS AND METHODS

120 specimens were fabricated from heat-polymerized acrylic resin. They were divided into a control group of pure polymethylmethacrylate (PMMA; Major.Base.20) and three tested groups (PMMA-ND) with 0.5%wt, 1%wt, and 1.5%wt of added ND to PMMA. Flexural strength was determined using the three-point bending test. Impact strength was recorded by using a Charpy type impact test. Surface roughness test was performed using a Contour GT machine. One-way ANOVA and Tukey's post-hoc analysis (p ≤ 0.05) were used for statistical analysis.

RESULTS

Acrylic resin reinforced with 0.5% ND displayed significantly higher flexural strength than the unreinforced heat-polymerized specimens, acrylic resin reinforced with 1% ND and the 1.5% ND (p < 0.0001). The impact strength of unreinforced heat-polymerized specimens was significantly higher than all nano-composite materials (p < 0.0001) with no significant difference between 1% ND and the 1.5% ND (p > 0.05). The addition of 0.5% ND and 1% ND significantly decreased the surface roughness in comparison to both control and the 1.5% ND groups (p < 0.0001) while no significant differences between 0.5% ND and 1% ND (p > 0.05) were reported. Nano-composite material (0.5% ND) showed significantly lower surface roughness when compared to other specimens.

CONCLUSIONS

The addition of NDs to acrylic denture base improved the flexural strength and surface roughness at low concentrations (0.5%), while the impact strength was decreased with ND addition.

Flexural and Surface Properties of PMMA Denture Base Material Modified with Thymoquinone as an Antifungal Agent

PURPOSE

To evaluate the effect of addition of different concentrations of thymoquinone (TQ) on the flexural strength, elastic modulus, surface roughness, and hardness of PMMA denture base material.

MATERIALS AND METHODS

A total of 160 rectangular specimens were prepared from heat-polymerized acrylic resin, with dimensions of 65 × 10 × 2.5 mm³ for flexural strength testing and 10 × 20 × 3 mm³ for surface property testing. The specimens were divided into eight groups of 20 specimens: one control group without addition of TQ and seven test groups prepared by adding TQ to acrylic powder in concentrations of 0.5, 1, 1.5, 2, 2.5, 3, and 5 wt%. The polymer was added to the monomer before being mixed, packed, and processed using the conventional water bath method. A universal testing machine was used to measure flexural strength and elastic modulus. A profilometer and a Vickers hardness tester were used to measure surface roughness and hardness, respectively. One-way ANOVA and the Tukey-Kramer multiple-comparison test were used for statistical analysis, with statistical significance at p ≤ 0.05.

RESULTS

Addition of TQ to PMMA denture base material significantly decreased flexural strength and elastic modulus at high concentrations (p < 0.01), while no significant differences were observed at low concentrations (0.5%, 1% TQ) in comparison with the control group. At high TQ concentrations, surface roughness increased while hardness decreased (p < 0.0001), and no significant differences were observed at low concentrations (0.5%, 1% TQ) in comparison with the control group. The most favorable addition values were 0.5% and 1% TQ in all TQ groups.

CONCLUSIONS

Addition of TQ did not affect the flexural and surface properties of PMMA denture base material at low concentrations (0.5%, 1% TQ) and could be incorporated into PMMA denture base material as an antifungal agent.

The Physical Properties of PMMA Denture base Resin Incorporated with Vanillin

Long-term use of a denture base can be a reservoir of microbes due to porosities and mechanical wear of denture surfaces. Vanillin has an antimicrobial effect. However, its influence on physical properties after incorporated in PMMA has not yet been evaluated. The purpose of this study was to investigate physical properties of PMMA by incorporating vanillin in different concentrations. Material and method. There were three groups of PMMA with ten specimens per group. Flexural strength and flexural modulus were tested by using a 3-point bending machine, and surface hardness was determined by Vickers hardness test. One-way ANOVA and Kruskal Wallis tests were used to analyze all data at 0.05 significance level. Result. The 0.1% vanillin group yielded a significant difference in Vickers hardness number (17.15 HV) as compared to 0.5% vanillin group (16.30 HV) and without vanillin (15.30 HV). In contrast, the flexural strength and modulus showed no significant difference among test groups upon incorporation of vanillin. Conclusion. The vanillin incorporated PMMA group demonstrated higher surface hardness, compared to the group without vanillin. In addition, there were no significant differences in flexural strength and flexural modulus among the three groups. This study also found no adverse effect in physical properties of the vanillin incorporated PMMA.

Effect of polymerization technique and glass fiber addition on the surface roughness and hardness of PMMA denture base material

The current study evaluated the effects of autoclave polymerization both with and without glass fiber (GF) reinforcement on the surface roughness and hardness of acrylic denture base material. Ninety disc specimens (30×2.5 mm) were prepared from Vertex resin and divided according to polymerization techniques into a water bath, short and long autoclave polymerization groups. Tested groups were divided into three subgroups according to the GF concentration (0, 2.5, and 5 wt%). Profilometer and Vickers hardness tests were performed to measure surface roughness and hardness. ANOVA and Tukey-Kramer multiple comparison tests analyzed the results, and p≤0.05 was considered statistically significant. Autoclave polymerization significantly decreased the surface roughness and increased the hardness of acrylic resin without GF reinforcement (p<0.05). However, 5 wt% GF addition significantly increased surface roughness and decreased hardness of the autoclave polymerized denture base resin (p<0.05). Surface properties of Polymethyl methacrylate (PMMA) denture base material improved with autoclave polymerization and negatively affected with GFs addition.

Mechanical and Physicochemical Properties of Newly Formed ZnO-PMMA Nanocomposites for Denture Bases

AIM

The aim of this study was to investigate the selected properties of zinc oxide- polymethyl methacrylate (ZnO-PMMA) nanocomposites that can influence the microorganism deposition on their surface.

MATERIALS AND METHODS

Non-commercial ZnO-NPs were prepared, characterized and used for the preparation of PMMA nanocomposite. Roughness, absorbability, contact angle and hardness of this new nanomaterial were evaluated. PMMA without ZnO-NPs served as control.

OUTCOMES

Compared to unenriched PMMA, incorporation of ZnO-NPs to 7.5% for PMMA nanocomposite increases the hardness (by 5.92%) and the hydrophilicity. After modification of the material with zinc oxide nanoparticles the roughness parameter did not change. All tested materials showed absorption within the range of 1.82 to 2.03%, which meets the requirements of International Organization for Standardization (ISO) standards for denture base polymers.

CONCLUSIONS

The results showed no significant deterioration in the properties of acrylic resin that could disqualify the nanocomposite for clinical use. Increased hydrophilicity and hardness with absorbability within the normal range can explain the reduced microorganism growth on the denture base, as has been proven in a previous study.

Effect of zirconium oxide nanoparticles addition on the optical and tensile properties of polymethyl methacrylate denture base material

Background

Polymethyl methacrylate (PMMA) is widely used for the fabrication of removable prostheses. Recently, zirconium oxide nanoparticles (nano-ZrO₂) have been added to improve some properties of PMMA, but their effect on the optical properties and tensile strength are neglected.

Objective

The aim of this study was to investigate the effect of nano-ZrO₂ addition on the translucency and tensile strength of the PMMA denture base material.

Materials and methods

Eighty specimens (40 dumbbell-shaped and 40 discs) were prepared out of heat-polymerized acrylic resin and divided into four groups per test (n=10). The control group for each test included unreinforced acrylic, while the test groups were reinforced with 2.5, 5, and 7.5 wt% nano-ZrO₂. Acrylic resin was mixed according to manufacturer’s instructions, packed, and processed by conventional method. After polymerization, all specimens were finished, polished, and stored in distilled water at 37°C for 48±2 hours. Tensile strength (MPa) was evaluated using the universal testing machine while the specimens’ translucency was examined using a spectrophotometer. Statistical analysis was carried out by SPSS using the paired sample t-test (p≤0.05). A scanning electron microscope was used to analyze the morphological changes and topography of the fractured surfaces.

Results

This study showed that the mean tensile strength of the PMMA in the test groups of 2.5%NZ, 5%NZ, and 7.5%NZ was significantly higher than the control group. The tensile strength increased significantly after nano-ZrO₂ addition, and the maximum increase seen was in the 7.5%NZ group. The translucency values of the experimental groups were significantly lower than those of the control group. Within the reinforced groups, the 2.5%NZ group had significantly higher translucency values when compared to the 5%NZ and 7.5%NZ groups.

Conclusion

The addition of nano-ZrO₂ increased the tensile strength of the denture base acrylic. The increase was directly proportional to the nano-ZrO₂ concentration. The translucency of the PMMA was reduced as the nano-ZrO₂ increased.

Clinical significance

Based on the results of the current study, the tensile strength was improved with different percentages of nano-ZrO₂ additions. However, translucency was adversely affected. Therefore, it is important to determine the appropriate amount of reinforcing nano-ZrO₂ that will create a balance between achieved properties – mechanical and optical.

Inhibitory effect of zirconium oxide nanoparticles on Candida albicans adhesion to repaired polymethyl methacrylate denture bases and interim removable prostheses: a new approach for denture stomatitis prevention

BACKGROUND

Despite drawbacks, cold-cured acrylic resin is still the most common material used in denture repair. Zirconia nanoparticles were among the reinforcements added to increase the strength of the resin. The effect on Candida due to the addition of zirconia nanoparticles to the resin has not been investigated.

PURPOSE

The aim of this study was to evaluate the effect of zirconia nanoparticles added to cold-cured acrylic resin on Candida albicans adhesion.

MATERIALS AND METHODS

A total of 120 acrylic resin specimens with dimensions measuring 22×10×2.5 mm3 were prepared and divided into two equal groups. One group (repair) comprised heat-polymerized specimens that were sectioned at the center and prepared to create a 2 mm repair area that was repaired with cold-cured resin reinforced with 0% wt, 2.5% wt, 5% wt, and 7.5% wt zirconia nanoparticles. The second group contained intact cold-cured acrylic resin specimens reinforced with 0% wt, 2.5% wt, 5% wt, and 7.5% wt zirconia nanoparticles. Specimens were incubated at 37°C in artificial saliva containing C. albicans, and the effect of zirconia nanoparticles on C. albicans was assessed using two methods: 1) a slide count method and 2) a direct culture test. Variations in the number of living Candida were observed in relation to the different concentrations of zirconia nanoparticles. Analysis of variance (ANOVA) and post hoc Tukey's tests were performed for data analysis. If the P-value was ≤0.05, then the difference was considered as statistically significant.

RESULTS

It was found that C. albicans adhesion to repaired specimens was significantly decreased by the addition of zirconia nanoparticles (P<0.00001) in comparison with the control group. Intact cold-cured groups and groups repaired with cold-cured resin reinforced with 7.5% wt zirconia nanoparticles showed the lowest Candida count. Tukey's test showed a significant difference between the repaired group and the intact cold-cured group, while the later demonstrated a lower Candida count.

CONCLUSION

The addition of zirconia nanoparticles to cold-cured acrylic resin is an effective method for reducing Candida adhesion to repaired polymethyl methacrylate (PMMA) denture bases and cold-cured removable prosthesis.

CLINICAL SIGNIFICANCE

Based on the results of the current study, zirconia nanoparticles have an antifungal effect, which could be incorporated in the repair material for repairing denture bases and in PMMA removable prostheses as a possible approach for denture stomatitis prevention.