Adherence of Candida albicans to denture base acrylics and silicone-based resilient liner materials with different surface finishes

Impact of multiscale surface topography characteristics on Candida albicans biofilm formation: From cell repellence to fungicidal activity

While there has been significant research conducted on bacterial colonization on implant materials, with a focus on developing surface modifications to prevent the formation of bacterial biofilms, the study of Candida albicans biofilms on implantable materials is still in its infancy, despite its growing relevance in implant-associated infections. C. albicans fungal infections represent a significant clinical concern due to their severity and associated high fatality rate. Pathogenic yeasts account for an increasing proportion of implant-associated infections, since Candida spp. readily form biofilms on medical and dental device surfaces. In addition, these biofilms are highly antifungal-resistant, making it crucial to explore alternative solutions for the prevention of Candida implant-associated infections. One promising approach is to modify the surface properties of the implant, such as the wettability and topography of these substrata, to prevent the initial Candida attachment to the surface. This review summarizes recent research on the effects of surface wettability, roughness, and architecture on Candida spp. attachment to implantable materials. The nanofabrication of material surfaces are highlighted as a potential method for the prevention of Candida spp. attachment and biofilm formation on medical implant materials. Understanding the mechanisms by which Candida spp. attach to surfaces will allow such surfaces to be designed such that the incidence and severity of Candida infections in patients can be significantly reduced. Most importantly, this approach could also substantially reduce the need to use antifungals for the prevention and treatment of these infections, thereby playing a crucial role in minimizing the possibility contributing to instances of antimicrobial resistance. STATEMENT OF SIGNIFICANCE: In this review we provide a systematic analysis of the role that surface characteristics, such as wettability, roughness, topography and architecture, play on the extent of C. albicans cells attachment that will occur on biomaterial surfaces. We show that exploiting bioinspired surfaces could significantly contribute to the prevention of antimicrobial resistance to antifungal and chemical-based preventive measures. By reducing the attachment and growth of C. albicans cells using surface structure approaches, we can decrease the need for antifungals, which are conventionally used to treat such infections.

Adhesion of Candida Albicans to digital versus conventional acrylic resins: a systematic review and meta-analysis

BACKGROUND

The present systematic review and meta-analysis investigated the available evidence about the adherence of Candida Albicans to the digitally-fabricated acrylic resins (both milled and 3D-printed) compared to the conventional heat-polymerized acrylic resins.

METHODS

This study followed the guidelines of the Preferred Reporting Items for Systematic Review and Meta-analyses (PRISMA). A comprehensive search of online databases/search tools (Web of Science, Scopus, PubMed, Ovid, and Google Scholar) was conducted for all relevant studies published up until May 29, 2023. Only in-vitro studies comparing the adherence of Candida albicans to the digital and conventional acrylic resins were included. The quantitative analyses were performed using RevMan v5.3 software.

RESULTS

Fourteen studies were included, 11 of which were meta-analyzed based on Colony Forming Unit (CFU) and Optical Density (OD) outcome measures. The pooled data revealed significantly lower candida colonization on the milled digitally-fabricated compared to the heat-polymerized conventionally-fabricated acrylic resin materials (MD = - 0.36; 95%CI = - 0.69, - 0.03; P = 0.03 and MD = - 0.04; 95%CI = - 0.06, - 0.01; P = 0.0008; as measured by CFU and OD respectively). However, no differences were found in the adhesion of Candida albicans between the 3D-printed digitally-fabricated compared to the heat-polymerized conventionally-fabricated acrylic resin materials (CFU: P = 0.11, and OD: P = 0.20).

CONCLUSION

The available evidence suggests that candida is less likely to adhere to the milled digitally-fabricated acrylic resins compared to the conventional ones.

The Effect of Exposure to Candida Albicans Suspension on the Properties of Silicone Dental Soft Lining Material

While functioning in the oral cavity, denture soft linings (SL) are exposed to contact with the microbiota. Dentures can offer perfect conditions for the multiplication of pathogenic yeast-like fungi, resulting in rapid colonisation of the surface of the materials used. In vitro experiments have also shown that yeast may penetrate SL. This may lead to changes in their initially beneficial functional properties. The aim of this work was to investigate the effect of three months of exposure to a Candida albicans suspension on the mechanical properties of SL material and its bond strength to the denture base polymer, and to additionally verify previous reports of penetration using a different methodology. Specimens of the SL material used were incubated for 30, 60 and 90 days in a suspension of Candida albicans strain (ATCC 10231). Their shore A hardness, tensile strength, and bond strength to acrylic resin were tested. The colonization of the surface and penetration on fractured specimens were analysed with scanning electron and inverted fluorescence microscopes. Exposure to yeast did not affect the mechanical properties. The surfaces of the samples were colonised, especially in crystallized structures of the medium; however, the penetration of hyphae and blastospores into the material was not observed.

Microbial Analysis of Obturators During Maxillofacial Prosthodontic Treatment Over an 8-Year Period

The aim of the study was to investigate the microbial colonization (by Candida species, anaerobic and facultative anaerobic bacteria) of maxillary obturators used for the restoration of maxillary defects, including during radiotherapy.

Retrospective cohort study.

Fifteen patients requiring a maxillary obturator prosthesis had swabs of their obturators and adjacent tissues taken at different stages of their treatment over a period of 8 years.

Identification of microbial species from the swabs was carried out using randomly amplified polymorphic DNA polymerase chain reaction (RAPD PCR) analysis, checkerboard DNA-DNA hybridization, CHROMagar Candida chromogenic agar, and DNA sequencing.

Candida species were detected in all patients and all patients developed mucositis and candidiasis during radiotherapy which was associated with an increase in colonization of surfaces with Candida spp., particularly C albicans. Microbial colonization increased during radiotherapy and as an obturator aged, and decreased following a reline, delivery of a new prosthesis, or antifungal treatment during radiotherapy.

Microbial colonization of maxillary obturators was related to the stage of treatment, age of the obturator material, radiotherapy and antifungal medications, and antifungal treatment may be recommended if C albicans colonization of palatal tissues is greater than 105 colony-forming units per cm2 following the first week of radiotherapy.

Cyclic strain of poly (methyl methacrylate) surfaces triggered the pathogenicity of Candida albicans

Candida albicans is an opportunistic yeast and the primary etiological factor in oral candidiasis and denture stomatitis. The pathogenesis of C. albicans could be triggered by several variables, including environmental, nutritional, and biomaterial surface cues. Specifically, biomaterial interactions are driven by different surface properties, including wettability, stiffness, and roughness. Dental biomaterials experience repetitive (cyclic) stresses from chewing and biomechanical movements. Pathogenic biofilms are formed over these biomaterial surfaces under cyclic strain. This study investigated the effect of the cyclic strain (deformation) of biomaterial surfaces on the virulence of Candida albicans. Candida biofilms were grown over Poly (methyl methacrylate) (PMMA) surfaces subjected to static (no strain) and cyclic strain with different levels (ε˜x=0.1 and 0.2%). To evaluate the biomaterial-biofilm interactions, the biofilm characteristics, yeast-to-hyphae transition, and the expression of virulent genes were measured. Results showed the biofilm biomass and metabolic activity to be significantly higher when Candida adhered to surfaces subjected to cyclic strain compared to static surfaces. Examination of the yeast-to-hyphae transition showed pseudo-hyphae cells (pathogenic) in cyclically strained biomaterial surfaces, whereas static surfaces showed spherical yeast cells (commensal). RNA sequencing was used to determine and compare the transcriptome profiles of cyclically strained and static surfaces. Genes and transcription factors associated with cell adhesion (CSH1, PGA10, and RBT5), biofilm formation (EFG1), and secretion of extracellular matrix (ECM) (CRH1, ADH5, GCA1, and GCA2) were significantly upregulated in the cyclically strained biomaterial surfaces compared to static ones. Genes and transcription factors associated with virulence (UME6 and HGC1) and the secretion of extracellular enzymes (LIP, PLB, and SAP families) were also significantly upregulated in the cyclically strained biomaterial surfaces compared to static. For the first time, this study reveals a biomaterial surface factor triggering the pathogenesis of Candida albicans, which is essential for understanding, controlling, and preventing oral infections. STATEMENT OF SIGNIFICANCE: Fungal infections produced by Candida albicans are a significant contributor to various health conditions. Candida becomes pathogenic when certain environmental conditions change, including temperature, pH, nutrients, and CO2 levels. In addition, surface properties, including wettability, stiffness, and roughness, drive the interactions between Candida and biomaterials. Clinically, Candida adheres to biomaterials that are under repetitive deformation due to body movements. In this work, we revealed that when Candida adhered to biomaterial surfaces subjected to repetitive deformation, the microorganism becomes pathogenic by increasing the formation of biofilms and the expression of virulent factors related to hyphae formation and secretion of enzymes. Findings from this work could aid the development of new strategies for treating fungal infections in medical devices or implanted biomaterials.

Evaluation of surface roughness of differently manufactured denture base materials

STATEMENT OF PROBLEM

The popularity of computer-aided design and computer-aided manufacturing (CAD-CAM) dentures has led to the introduction of new denture materials and resins. However, studies on the surface characteristics of these materials and how they compare to dentures fabricated by more traditional methods are lacking.

PURPOSE

The purpose of this cross-sectional study was to determine whether the surface roughness (Ra) of denture base materials differed based on manufacturing technique.

MATERIAL AND METHODS

Disks of Ø10×2-mm (n=10) were fabricated using 6 different manufacturing techniques, including compression molding (Lucitone 199), injection molding (Ivocap High Impact), Computer Numerical Control (CNC) milling (Ivotion Base), and additive manufacturing on the Carbon M2 (Lucitone Digital Print), the SprintRay Pro55 S (Dentca Denture Base II), and the Envision One (Flexcera Base) systems. An automatic, noncontact laser confocal microscope (VK-X1000 Series; KEYENCE) was used to analyze the Ra surface roughness of each specimen at ×5 magnification. The images were imported into a multifile analyzer, horizontal and vertical roughness profiles were inserted into each scan, and Ra values were calculated and averaged by following the International Organization for Standardization (ISO) 4287 standard. A 1-way analysis of variance (ANOVA) was performed to compare the effect of manufacturing technique on surface roughness, followed by the Tukey multiple comparisons test (α=.05).

RESULTS

The additively manufactured Dentca Denture Base II (AM-DB) exhibited a statistically significantly higher Ra when compared with the other test groups (P<.001). The additively manufactured Flexcera Base (AM-FB) showed a higher Ra mean value when compared with injection molding (IM) (P=.036). No statistically significant difference in surface roughness was found among the other tested materials representing the different processing methods (P>.05).

CONCLUSIONS

The manufacturing method influences the Ra of denture base materials with varying results. The injection molding method resulted in the smoothest surface compared with additively manufactured and CNC-milled denture base materials.

Antifungal effects of eugenol on Candida albicans adherence to denture polymers

Background

The study's objective is to assess the adherence of C. albicans in different types of denture polymers and the effectiveness of eugenol and commercialized denture cleansers in the removal of C. albicans. Three types of denture base polymers (Lucitone® 199 (High-Impact PMMA), Impact® (conventional PMMA) and Eclipse® (UDMA)) and two hard denture reline materials (Kooliner® and Tokuyama® Rebase II Fast) were used in this study.

Methods

Three hundred samples were prepared (6 × 2 mm disc shape) and divided into five groups of denture polymers (n = 60) and further subjected into five treatment groups (Polident®, Steradent, distilled water, eugenol 5-minutes, and eugenol 10-min). Three samples were extracted from each treatment group for baseline data (n = 12). Baseline data were used to calculate the initial number of C. albicans adherence. A 0.5 ml immersion solution from each specimen was cultured on YPD agar and incubated for 48 h at 37 °C. Visible colonies were counted using a colony counter machine (ROCKER Galaxy 230).

Results

The result showed that the denture base polymer significantly affected the initial adherence (p = 0.007). The removal of C. albicans was also considerably affected by the denture base polymers and denture cleansers (p < 0.05). Lucitone®, Tokuyama®, and Kooliner® denture base polymers immersed for 3 min in eugenol showed the best results of removal.

Discussion

This study's overall results showed that all denture polymers used as denture bases had an effect on C. albicans initial adherence and removal from the denture base, and eugenol is comparable to commercialised denture cleansers in reducing the number of attached C. albicans on denture base polymers.

Microbial adhesion and viability on novel CAD/CAM framework materials for implant-supported hybrid prostheses

The aim of the study was to investigate the adhesion and viability of Streptococcus oralis and Candida albicans under in vitro conditions on CAD/CAM framework materials for implant-supported hybrid prostheses. Twenty-nine specimens were prepared from each of three different materials: ZR (zirconia), PEEK (polyether ether ketone) and CoCr₄ (CoCr₄ alloy). The experimental part included surface roughness (SR) and contact angle of water (CAW) measurements, followed by colony forming unit (CFU), cell viability assay and scanning electron microscopy (SEM) analyses of Strep. oralis and C. albicans biofilms on the materials' surfaces. Kruskal-Wallis and one-way analysis of variance (ANOVA) tests were used for differences between materials, and the correlation between measurements was estimated using Spearman's correlation coefficient. PEEK specimens revealed higher SR, CAW and CFU mean values, than ZR and CoCr₄ specimens. Strong positive correlation was found between SR and CFU and between CAW and CFU for both microbial species. Cell viability assay revealed similar values for both species across materials. Higher numbers of Strep. oralis and C. albicans on PEEK specimens confirm the impact of the higher surface roughness and contact angle values on the microbial adhesion and describes PEEK as less desirable than ZR and CoCr₄ from microbiological aspect.

Hydrophobicity of denture base resins: A systematic review and meta-analysis

Objectives:

The aim of this article is to review the factors that attract Candida albicans to denture base resin (DBR) and to verify the influence of different surface treatments, chemical modification, or structural reinforcements on the properties of DBR.

Materials and Methods:

Searches were carried out in PubMed, Scopus, WOS, Google Scholar, EMBASE, and J-stage databases. The search included articles between 1999 and 2020. This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. The keywords used during the search were “Candida albicans,” “Denture base,” “PMMA,” “Acrylic resin,” “Surface properties,” “hydrophobicity/hydrophilicity,” “contact angle,” and “surface free energy.” English full-text articles involving in-vitro studies with different acrylic resin modifications were included, whereas abstracts, dissertations, reviews, and articles in languages other than English were excluded. A meta-analysis was performed where appropriate.

Results:

Out of the 287 articles, 21 articles conformed to inclusion criteria. Sixteen articles were subjected to meta-analysis using random-effects model at 95% confidence interval. Results showed that DBR coatings/plasma coatings were effective methods to modify surface properties with estimated contact angle (CA) of 59.37° [95% confidence interval (CI): 53.69, 65.04]/55.87° (95% CI: 50.68, 61.06) and surface roughness (R_a) of 0.55 µm (95% CI: 0.52, 0.58)/0.549 µm (95% CI: 0.5, 0.59), respectively. Antifungal particle incorporation into poly(methylmethacrylate) DBR also produced similar effects with an estimated R_a of 0.16 µm (95% CI: 0.134, 0.187).

Conclusion:

The three properties responsible for C. albicans adhesion to DBR were R_a, CA, and surface free energy in terms of hydrophobicity. Therefore, the correlations between the hydrophobicity of DBR and C. albicans adhesion should be considered during future investigations for Candida-related denture stomatitis.

Antifungal Activity of Denture Base Resin Containing Nanozirconia: In Vitro Assessment of Candida albicans Biofilm

Objective

To evaluate the antimicrobial effects of different concentrations of zirconium dioxide nanoparticles (nano-ZrO₂) reinforcement of poly(methyl) methacrylate (PMMA) on surface roughness and C. albicans biofilm.

Methods

20 heat-polymerized acrylic resin discs were conventionally made and divided into 4 groups (n = 5) according to nano-ZrO₂ concentration: control (0% filler) and 3 experimental groups (2.5% (Z2.5), 5.0% (Z5.0), and 7.5% (Z7.5)). An optical profilometer was used for surface roughness evaluation, followed by Candida adherence assay. Specimens were sterilized, then immersed in cultured yeast (C. albicans), and incubated at 37°C for 48 hours. After that, discs were rinsed before extracting the clustered pellets of Candida. The attached C. albicans was counted using the direct method after spreading on agar media and incubating for 48 hours. Statistical analysis was performed using one-way ANOVA and Tukey's post hoc test at α = 0.05.

Results

Surface roughness was significantly increased with all modified groups compared with control (P < 0.01), which showed the lowest roughness value (0.027 ± 0.004 μm). There was no significant difference in the roughness value among reinforced groups (2.5, 5.0, and 7.5%) (P > 0.05), with Z7.5 showing the highest roughness value (0.042 ± 0.004 μm). Candida count was reduced as the nano-ZrO₂ increased but not significantly (P=0.15).

Conclusions

The addition of different concentrations of nano-ZrO₂ particles to PMMA increased the surface roughness compared with control; in contrast, insignificant reduction of C. albicans biofilm was detected.

Influence of the Manufacturing Method on the Adhesion of Candida albicans and Streptococcus mutans to Oral Splint Resins

Microbial adhesion to oral splints may lead to oral diseases such as candidiasis, periodontitis or caries. The present in vitro study aimed to assess the effect of novel computer-aided design/computer-aided manufacturing (CAD/CAM) and conventional manufacturing on Candida albicans and Streptococcus mutans adhesion to oral splint resins. Standardized specimens of four 3D-printed, two milled, one thermoformed and one pressed splint resin were assessed for surface roughness by widefield confocal microscopy and for surface free energy by contact angle measurements. Specimens were incubated with C. albicans or S. mutans for two hours; a luminometric ATP assay was performed for the quantification of fungal and bacterial adhesion. Both one-way ANOVA with Tukey post hoc testing and Pearson correlation analysis were performed (p < 0.05) in order to relate manufacturing methods, surface roughness and surface free energy to microbial adhesion. Three-dimensional printing and milling were associated with increased adhesion of C. albicans compared to conventional thermoforming and pressing, while the S. mutans adhesion was not affected. Surface roughness and surface free energy showed no significant correlation with microbial adhesion. Increased fungal adhesion to oral splints manufactured by 3D printing or milling may be relevant for medically compromised patients with an enhanced risk for developing candidiasis.

Antagonistic effect of isolated and commercially available probiotics on the growth of Candida albicans on acrylic resin denture surfaces

STATEMENT OF PROBLEM

Biofilms can be retained on dental prostheses leading to the development of infections. The indiscriminate use of antifungal drugs can result in the development of microorganisms that are resistant to these antimicrobial agents. Whether probiotics are a suitable alternative for reducing the prevalence of oral candidiasis is unclear.

PURPOSE

The purpose of this in vitro study was to evaluate the influence of 6 different live strains of probiotics and 2 commercially available probiotic supplements used for inhibiting the growth of Candida albicans biofilm in heat-polymerized acrylic resin denture base material and to determine whether biofilm byproducts modify the surface of specimens.

MATERIAL AND METHODS

Biofilms of C. albicans were formed on acrylic resin specimens in the presence of probiotics and quantified by colony-forming units (CFUs), and the surface roughness (Ra) of the specimens was assessed before and after the formation of biofilms. The CFU and roughness data were analyzed by analysis of variance and the Tukey HSD test (α=.05).

RESULTS

A significant decrease in the number (CFU/mL) of C. albicans cells was found when they were cultured with 4 probiotics: B. lactis (P=.045), B. longum (P<.001), L. casei (P<.001), and L. helveticus (P<.001) and with the commercially available probiotic Prolive (P=.05). The Ra of specimens decreased after exposure to different microbial biofilms (P≤.05) except in 3 experimental groups.

CONCLUSIONS

In general, the tested probiotics had an antagonistic effect on the growth of C. albicans, and the surface of acrylic resin was altered after exposure to biofilm byproducts.

Precision Antifungal Treatment Significantly Extends Voice Prosthesis Lifespan in Patients Following Total Laryngectomy

Indwelling silicone valves called voice prostheses (VPs) are the gold standard for speech rehabilitation in patients with laryngeal cancer following total laryngectomy. Reported VP lifespans amongst these patients are highly variable but when devices fail patients experience loss of voice and an increase risk of chest infection. Early failure of VP is a current clinical concern that is associated with regular hospital visits, reduced quality of life and associated medical cost. Poly-microbial biofilms comprised of both bacterial and fungal microorganisms readily colonize VPs and are linked to loss of device performance and its early failure in addition to providing a reservoir for potential infection. Our detailed analysis of poly-microbial biofilm composition on 159 early failing VPs from 48 total laryngectomy patients confirmed Candida albicans as the predominant fungal species and Staphylococcus aureus as the most common bacterial colonizer within our patient cohort. Using a combination of microbiological analysis, patient data and a high-throughput antifungal test assay mimicking in vivo conditions we established an evidence based precision antifungal treatment approach to VP management. Our approach has allowed us to implement a personalized VP management pathway, which increases device in situ lifespan by an average of 270%. Our study represents a significant step forward in both our understanding of the cause of VP failure and a new effective treatment pathway that offers tangible benefit to patients.

Guanidine derivative inhibits C. albicans biofilm growth on denture liner without promote loss of materials' resistance

To reduce the burden of denture stomatitis and oral candidiasis, an aqueous solution containing polyhexamethylene guanidine hydrochloride (PHMGH) was investigated as an antifungal disinfectant against the leading cause of these oral conditions, Candida albicans. The solutions formulated with concentrations ranging from 0.125 to 0.50 wt% enabled increasing disinfection at the initial 5min-contact with 72h-mature candida biofilms formed on denture liner specimens. After 10 min-contact, the solution at lower concentration has reached total fungal elimination. The results also indicated that the denture liners preserved their mechanical property after the maximum contact time with the solution at the highest tested concentration. The PHMGH aqueous solutions at 0.125 wt% could be applied to promote interim denture liner disinfection without promoting the loss of materials' mechanical property.

The Role of Biofilms and Material Surface Characteristics in Microbial Adhesion to Maxillary Obturator Materials: A Literature Review

BACKGROUND

Maxillofacial prosthetics includes restoration of maxillary defects resulting from resection of palate and nasosinus neoplasms with obturator prostheses which may be colonized by microorganisms and function as a reservoir of infection. Patients with neoplasms commonly also require radiotherapy that can result in changes in saliva quality and quantity and changes in the oral microbial flora. The altered flora, in individuals immunocompromised from cancer therapy, increases their risk of prosthesis-related infections.

OBJECTIVES

In this review article, we explore microbial biofilms, their main components, mechanisms of microbial adhesion, and stages of biofilm development. We also discuss the different materials that are used for manufacturing maxillary obturators, their characteristic features, and how these can affect microbial adhesion. Furthermore, we shed some light on the factors that affect microbial adhesion to the surface of maxillary obturators including tissue proteins, protein adsorption, and the acquired enamel pellicle.

CONCLUSIONS

The conclusions drawn from this literature review are that it is imperative to minimize the risk of local and systemic infections in immunocompromised patients with cancer having maxillary defects. It is also important to determine the role of saliva in microbial adhesion to obturator materials as well as develop materials that have a longer life span with surface characteristics that promote less microbial adhesion than current materials.

In Vitro Evaluation of Adhesion of Candida albicans on CAD/CAM PMMA-Based Polymers

PURPOSE

To compare the amount of adherent Candida albicans to different CAD/CAM poly(methyl methacrylate) (PMMA)-based polymers and conventional heat-polymerized PMMA after long-term thermal cycling.

MATERIALS AND METHODS

The specimens were subjected to 10,000 thermal cycles (5-55°C) and divided into two groups, uncoated and pellicle-coated. Surface roughness and contact angles of the specimens were measured. The surface morphology was observed with scanning electron microscopy (SEM). An adhesion test was performed by incubating the disk specimens in C. albicans suspensions at 37°C for 2 hours, and the adherent cells were counted under an optical microscope. The data were analyzed statistically using a variance analysis and Tukey HSD post hoc comparison test. The correlation between measurements was tested using a Pearson correlation analysis (α = 0.05).

RESULTS

CAD/CAM polymers generally showed statistically significant lowest Ra and contact angle values, whereas conventional PMMA showed the highest Ra and contact angle values in the uncoated group (p < 0.05). Pellicle coating essentially increased contact angle of all materials and reduced the differences in a number of Candida cells on the materials (p < 0.05). Candida adhesion was statistically significantly greatest on conventional PMMA when compared to CAD/CAM polymers. A strong positive correlation was found between the surface roughness of the specimens (p < 0.05) and the amount of adhered cells, whereas no correlation was found between hydrophobicity of the specimens and the amount of adhered cells (p > 0.05).

CONCLUSIONS

CAD/CAM PMMA-based polymers may be preferable to reduce Candida-associated denture stomatitis in long-term use.

Effect of Silver-Emitting Filler on Antimicrobial and Mechanical Properties of Soft Denture Lining Material

Colonization of silicone-based soft lining materials by pathogenic yeast-type fungi is a common problem associated with the use of dentures. In this study, silver sodium hydrogen zirconium phosphate (SSHZP) was introduced into polydimethylsiloxane-based material as an antimicrobial filler at concentrations of 0.25, 0.5, 1, 2, 4, 6, 8, 10, 12, and 14% (w/w). The in vitro antimicrobial efficacy was investigated. Candida albicans was used as a characteristic representative of pathogenic oral microflora. Staphylococcus aureus and Escherichia coli were used as the typical Gram-positive and Gram-negative bacterial strains, respectively. The effect of filler addition on the Shore A hardness, tensile strength, tensile bond strength, sorption, and solubility was investigated. An increase in the filler concentration resulted in an increase in hardness, sorption, and solubility, and for the highest concentration, a decrease in bond strength. The favorable combination of antimicrobial efficacy with other properties was achieved at filler concentrations ranging from 2% to 10%. These composites exhibited mechanical properties similar to the material without the antimicrobial filler and enhanced in vitro antimicrobial efficiency.

Effectiveness of non-fluoride and fluoride dentifrices for denture hygiene

OBJECTIVE

To compare the effectiveness of commonly used herbal/non-fluoride with fluoride dentifrices in order to eliminate pathogenic oral microorganisms from denture base material.

MATERIALS AND METHODS

Heat-polymerized acrylic resin specimens (n = 288) were divided into three groups and each group inoculated with three various microorganisms (n = 96 for each) Candida albicans, Staphylococcus aureus and Pseudomonas aeruginosa (P. aeruginosa). Contaminated specimens were randomly assigned to the application of six herbal/non-fluoride and three fluoride dentifrices. These specimens were divided into two groups: negative and positive control (n = 3 for each). All acrylic specimens were incubated at 37 °C for 24 h for samples inoculated with bacterial strains and 37 °C for 48 h for samples inoculated with yeast strains. After the incubation period, all brain-heart infusion broths that contained disinfectant acrylic specimens were cultured on 5% sheep blood agar for bacterial counts and Sabouraud dextrose agar for yeast counts. The number of colony-forming units per millilitre (CFU/mL) were calculated. The results were analysed by Mann-Whitney U and Kruskal-Wallis tests (p = .05).

RESULTS

Both herbal/non-fluoride and fluoride dentifrices were effective against Candida albicans. However, fluoride dentifrices were comparatively better than the herbal/non-fluoride dentifrices against Staphylococcus aureus and P. aeruginosa.

CONCLUSIONS

Herbal dentifrices could be used, especially among the elderly who lack a degree of manual dexterity during the rinsing of dentifrice chemicals from their dentures.

A pre-therapeutic coating for medical devices that prevents the attachment of Candida albicans

BACKGROUND

Hospital acquired fungal infections are defined as "never events"-medical errors that should never have happened. Systemic Candida albicans infections results in 30-50% mortality rates. Typically, adhesion to abiotic medical devices and implants initiates such infections. Efficient adhesion initiates formation of aggressive biofilms that are difficult to treat. Therefore, inhibitors of adhesion are important for drug development and likely to have a broad spectrum efficacy against many fungal pathogens. In this study we further the development of a small molecule, Filastatin, capable of preventing C. albicans adhesion. We explored the potential of Filastatin as a pre-therapeutic coating of a diverse range of biomaterials.

METHODS

Filastatin was applied on various biomaterials, specifically bioactive glass (cochlear implants, subcutaneous drug delivery devices and prosthetics); silicone (catheters and other implanted devices) and dental resin (dentures and dental implants). Adhesion to biomaterials was evaluated by direct visualization of wild type C. albicans or a non-adherent mutant edt1 -/- that were stained or fluorescently tagged. Strains grown overnight at 30 °C were harvested, allowed to attach to surfaces for 4 h and washed prior to visualization. The adhesion force of C. albicans cells attached to surfaces treated with Filastatin was measured using Atomic Force Microscopy. Effectiveness of Filastatin was also demonstrated under dynamic conditions using a flow cell bioreactor. The effect of Filastatin under microfluidic flow conditions was quantified using electrochemical impedance spectroscopy. Experiments were typically performed in triplicate.

RESULTS

Treatment with Filastatin significantly inhibited the ability of C. albicans to adhere to bioactive glass (by 99.06%), silicone (by 77.27%), and dental resin (by 60.43%). Atomic force microcopy indicated that treatment with Filastatin decreased the adhesion force of C. albicans from 0.23 to 0.017 nN. Electrochemical Impedance Spectroscopy in a microfluidic device that mimic physiological flow conditions in vivo showed lower impedance for C. albicans when treated with Filastatin as compared to untreated control cells, suggesting decreased attachment. The anti-adhesive properties were maintained when Filastatin was included in the preparation of silicone materials.

CONCLUSION

We demonstrate that Filastatin treated medical devices prevented adhesion of Candida, thereby reducing nosocomial infections.

Antimicrobial efficacy and mechanical properties of BAC-modified hard and soft denture liners

This study investigated the antimicrobial efficacy and mechanical strength of hard and soft denture liners modified with benzalkonium chloride (BAC). The specimens (1 mm thickness, 8 mm diameter) were prepared by mixing 0.5, 1, 2 and 5 wt% BAC with soft (Sofreliner Medium, Tokuyama) and hard (Rebase II, Tokuyama) denture liners (n = 5/group). BAC was not added to the controls. Candida albicans ATCC 28366 (A ₅₅₀ = 0.5) and Streptococcus mutans Ingbritt suspensions (A ₅₅₀ = 0.35) were pipetted onto the specimens, and incubated for 4 h. The viable cells were collected, and determined by plate-culturing (CFU). The tests were repeated after the specimens were soaked in distilled water for 7 days. The mechanical strengths were evaluated by tear and 4-point flexural strength tests for soft and hard liners, respectively. The data were analyzed with ANOVA and Tukey's HSD tests at p = 0.05. C. albicans viability was lost in all groups of BAC-modified soft liners (p < 0.001), and S. mutans viability was reduced (p < 0.01), except of soaked BAC 0.5 wt% group (p > 0.05). For the hard liner, BAC 5 wt% killed the C. albicans and S. mutans cells both before and after soaked in water (p < 0.001). BAC 2 wt% showed comparable tear strength with the soft liner control (p > 0.05). BAC did not reduce the flexural strength of the hard liner (p > 0.05), except of BAC 5 wt% group (p < 0.01). BAC can be a promising agent reducing the C. albicans and S. mutans viability on the soft and hard denture liner surfaces.

Candida albicans biofilm heterogeneity does not influence denture stomatitis but strongly influences denture cleansing capacity

Approximately 20  % of the UK population wear some form of denture prosthesis, resulting in denture stomatitis in half of these individuals. Candida albicans is primarily attributed as the causative agent, due to its biofilm -forming ability. Recently, there has been increasing evidence of C. albicans biofilm heterogeneity and the negative impact it can have clinically; however, this phenomenon has yet to be studied in relation to denture isolates. The aims of this study were to evaluate C. albicans biofilm formation of clinical denture isolates in a denture environment and to assess antimicrobial activity of common denture cleansers against these tenacious communities. C. albicans isolated from dentures of healthy and diseased individuals was quantified using real-time PCR and biofilm biomass assessed using crystal violet. Biofilm development on the denture substratum poly(methyl methacrylate), Molloplast B and Ufi-gel was determined. Biofilm formation was assessed using metabolic and biomass stains, following treatment with denture hygiene products. Although C. albicans was detected in greater quantities in diseased individuals, it was not associated with increased biofilm biomass. Denture substrata were shown to influence biofilm biomass, with poly(methyl methacrylate) providing the most suitable environment for C. albicans to reside. Of all denture hygiene products tested, Milton had the most effective antimicrobial activity, reducing biofilm biomass and viability the greatest. Overall, our results highlight the complex nature of denture- related disease, and disease development cannot always be attributed to a sole cause. It is the distinct combination of various factors that ultimately determines the pathogenic outcome.

An In-vitro Evaluation of Retention, Colonization and Penetration of Commonly Used Denture Lining Materials By Candida albicans

INTRODUCTION

Colonization of the surface by Candida albicans and related Candida species is one of the major concerns of denture lining materials.

AIM

We evaluated retention, colonization and penetration of the four denture lining materials namely Molloplast B, Permaflex, GC Soft Liner and Ufi Gel Hard C by Candida albicans.

MATERIAL AND METHODS

a) Evaluation of retention: Five test discs of each material with smooth surface on one side and rough on the other were prepared and surface roughness (Ra) was measured with profilometer. Retention of C. albicans to discs was monitored after one hour of incubation (37°C) with standardized (2.8 x 10⁶ cfu/ml) washed cell suspension. Discs were stained with acridine orange and attached cells were counted using inverted microscope; b) Evaluation of colonization and penetration: Eight test discs of each material in sterile artificial saliva, were inoculated with C. albicans and incubated for six weeks. Two sections were cut across each test disc to provide three replicate samples. Candida cells on cut disc sections were fixed, dehydrated, air dried and viewed via fluorescence microscope; c) Evaluation of antifungal action: Two test discs of each material were placed onto diagnostic sensitivity testing the agar plate. After incubation at 37°C for 24 hours, the zone of inhibition formed around the samples were measured at four places, and the mean calculated.

RESULTS

a) All rough surfaces showed higher retention of C. albicans than smooth surfaces. Among the smooth surfaces, Molloplast B and GC Soft Liner showed highest and lowest retention of C. albicans respectively (p=0.0090). Among the rough surfaces, the variation in the retention of C. albicans was not statistically significant; b) Penetration of C. albicans was observed through all three sections of the test discs of each material. There was no statistically significant difference among the test materials; c) Molloplast B and Permaflex produced a mean zone of inhibition of 16.9±4.8mm and 14.80±3.8mm respectively.

CONCLUSION

a) Smoother surfaces retain fewer cells than rough surfaces; b) Denture lining materials permit infiltration of Candida through their structure; c) Denture lining materials have insignificant anti-fungal properties.

Evaluation of antibiofilm and mechanical properties of new nanocomposites based on acrylic resins and silver vanadate nanoparticles

OBJECTIVE

The purpose of this study was evaluate, for the first time, the impact of incorporation of nanostructured silver vanadate (β-AgVO3) in antibiofilm and mechanical properties of dental acrylic resins (poly(methyl methacrylate), PMMA).

DESIGN

The β-AgVO3 was synthesized and characterized by X-ray diffraction (XRD), Fourier transform infrared spectroscopy (FTIR), scanning electron microscopy, and microanalysis (SEM/EDS). Resins specimens were prepared with 0-10% wt.% β-AgVO3 and characterized by SEM, XRD and optical microscopy. The antibiofim activity of the samples against Candida albicans and Streptococcus mutans was investigated by XTT reduction test, colony-forming units (CFUs), and confocal laser scanning microscopy (CLSM). The flexural strength, hardness, and surface roughness of the samples containing β-AgVO3 were compared with the pure PMMA matrix.

RESULTS

The incorporation of 10% β-AgVO3 significantly reduced the metabolic activity of C. albicans and S. mutans (p<0.05). There was a reduction in microbial load (CFU/mL) of microorganisms for the different concentrations used (p<0.05), which was confirmed by confocal microscopy. The addition of β-AgVO3 did not change the mechanical properties of hardness and surface roughness of the resins (p>0.05). However, flexural strength decreased with the addition of amounts greater than 1% (p<0.05).

CONCLUSIONS

β-AgVO3 additions in dental acrylic resin may have an impact on inhibition of biofilm of main microorganisms associated with dental prostheses. However, the viability of clinical use should be evaluated in function of changed promoted in some mechanical properties.

Effects of thermal cycling on surface roughness, hardness and flexural strength of polymethylmethacrylate and polyamide denture base resins

BACKGROUND

The purpose of this study was to evaluate the effects of thermal cycling on the surface roughness, hardness and flexural strength of denture resins.

METHODS

Polyamide (PA; Deflex and Valplast) and polymethylmethacrylate (PMMA; QC-20 and Acron MC) denture materials were selected. A total of 180 specimens were fabricated and then divided into 3 groups. The first group (group 1) acted as a control and was not thermocycled. The second group (group 2) was subjected to thermocycling for 10,000 cycles in artificial saliva and 5,000 cycles in distilled water. The last group (group 3) was thermocycled for 20,000 cycles in artificial saliva and 10,000 cycles in distilled water. The surface roughness were measured with a profilometer. The hardness of the resins were measured with a Vickers Hardness Tester using a 100-gf load. The flexural strength test was performed using the universal test machine with a crosshead speed of 5 mm/min. Data were analyzed using statistical software. The results of the measurements in the 3 different tests were analyzed by Kruskal-Wallis test with Bonferroni correction. Multiple comparisons were made by Conover and Wilcoxon tests.

RESULTS AND CONCLUSIONS

There was a significant difference between the PMMA and PA groups in terms of surface roughness, hardness and transverse strength before and after thermal cycling (p&lt;0.001). Thermal cycling did not change the surface roughness, hardness and flexural strength values of either the PMMA or PA group (p&gt;0.001).

Surface Coating of Gypsum-Based Molds for Maxillofacial Prosthetic Silicone Elastomeric Material: The Surface Topography

PURPOSE

This study aimed to compare the surface roughness of maxillofacial silicone elastomers fabricated in noncoated and coated gypsum materials. This study was also conducted to characterize the silicone elastomer specimens after surfaces were modified.

MATERIALS AND METHODS

A gypsum mold was coated with clear acrylic spray. The coated mold was then used to produce modified silicone experimental specimens (n = 35). The surface roughness of the modified silicone elastomers was compared with that of the control specimens, which were prepared by conventional flasking methods (n = 35). An atomic force microscope (AFM) was used for surface roughness measurement of silicone elastomer (unmodified and modified), and a scanning electron microscope (SEM) was used to evaluate the topographic conditions of coated and noncoated gypsum and silicone elastomer specimens (unmodified and modified) groups. After the gypsum molds were characterized, the fabricated silicone elastomers molded on noncoated and coated gypsum materials were evaluated further. Energy-dispersive X-ray spectroscopy (EDX) analysis of gypsum materials (noncoated and coated) and silicone elastomer specimens (unmodified and modified) was performed to evaluate the elemental changes after coating was conducted. Independent t test was used to analyze the differences in the surface roughness of unmodified and modified silicone at a significance level of p < 0.05.

RESULTS

Roughness was significantly reduced in the silicone elastomers processed against coated gypsum materials (p < 0.001). The AFM and SEM analysis results showed evident differences in surface smoothness. EDX data further revealed the presence of the desired chemical components on the surface layer of unmodified and modified silicone elastomers.

CONCLUSIONS

Silicone elastomers with lower surface roughness of maxillofacial prostheses can be obtained simply by coating a gypsum mold.

Long-Term Soft Denture Lining Materials

Long-term soft denture lining (LTSDL) materials are used to alleviate the trauma associated with wearing complete dentures. Despite their established clinical efficacy, the use of LTSDLs has been limited due to the unfavorable effects of the oral environment on some of their mechanical and performance characteristics. The unresolved issue of LTSDL colonization by Candida albicans is particularly problematic. Silicone-based LTSDL (SLTSDL) materials, which are characterized by more stable hardness, sorption and solubility than acrylic-based LTSDLs (ALTSDLs), are currently the most commonly used LTSDLs. However, SLTSDLs are more prone to debonding from the denture base. Moreover, due to their limitations, the available methods for determining bond strength do not fully reflect the actual stability of these materials under clinical conditions. SLTSDL materials exhibit favorable viscoelastic properties compared with ALTSDLs. Furthermore, all of the lining materials exhibit an aging solution-specific tendency toward discoloration, and the available cleansers are not fully effective and can alter the mechanical properties of LTSDLs. Future studies are needed to improve the microbiological resistance of LTSDLs, as well as some of their performance characteristics.

In vitro antifungal evaluation of seven different disinfectants on acrylic resins

Objective. The aim of this study was to evaluate alternative methods for the disinfection of denture-based materials. Material and Methods. Two different denture-based materials were included in the study. Before microbial test, the surface roughness of the acrylic resins was evaluated. Then, the specimens were divided into 8 experimental groups (n = 10), according to microorganism considered and disinfection methods used. The specimens were contaminated in vitro by standardized suspensions of Candida albicans ATCC#90028 and Candida albicans oral isolate. The following test agents were tested: sodium hypochlorite (NaOCl 1%), microwave (MW) energy, ultraviolet (UV) light, mouthwash containing propolis (MCP), Corega Tabs, 50% and 100% white vinegar. After the disinfection procedure, the number of remaining microbial cells was evaluated in CFU/mL. Kruskal-Wallis, ANOVA, and Dunn's test were used for multiple comparisons. Mann Whitney U test was used to compare the surface roughness. Results. Statistically significant difference (P < 0.05) was found between autopolymerised and heat-cured acrylic resins. The autopolymerised acrylic resin surfaces were rougher than surfaces of heat-cured acrylic resin. The most effective disinfection method was 100% white vinegar for tested microorganisms and both acrylic resins. Conclusion. This study showed that white vinegar 100% was the most effective method for tested microorganisms. This agent is cost-effective and easy to access and thus may be appropriate for household use.

Prevention and treatment of Candida colonization on denture liners: a systematic review

STATEMENT OF PROBLEM

Denture liners are well known for their poor physical properties that favor the accumulation of plaque and colonization by Candida species, which can irritate the oral tissues and lead to denture stomatitis.

PURPOSE

A systematic review was conducted to determine the feasibility of a prevention protocol for Candida colonization in denture liners and an effective treatment after the fungi has colonized the material.

MATERIAL AND METHODS

Clinical and in vitro investigations that assessed the treatment and/or prevention of Candida colonization and biofilm formation in denture liners were selected according to the PRISMA statement. Seven electronic databases were searched from 1950 to April 2012 with the keywords "denture liner" OR "reline*" OR "tissue conditioner" AND "Candida" OR "denture stomatitis" OR "oral candidiasis" OR "antifungal agents" OR "denture clean*".

RESULTS

The incorporation of nystatin (in general, 500 000 units) into tissue conditioners to prevent the onset of the disease and immersion in sodium hypochlorite for disinfection were the methods most often described in this systematic review, and both methods were able to prevent or inhibit Candida colonization, depending on their concentrations. The 0.5% sodium hypochlorite concentration can disinfect tissue conditioners and denture liners. Microwave irradiation has also been described an alternative method of disinfection. Because of a lack of standardized results (especially with regard to the method used to perform microbial counts), a meta-analysis could not be performed.

CONCLUSIONS

The literature suggests that the use of 0.5% sodium hypochlorite can help disinfect denture liners and tissue conditioners. The incorporation of nystatin in those materials is also able to treat or prevent oral candidiasis. However, as most of the studies were in vitro, there is insufficient reliable evidence to truly provide recommendations regarding the ideal cleaning method or whether the addition of antifungal agents is worthwhile. Well-designed randomized controlled trials are needed to provide answers to these questions.

Effectiveness of coating acrylic resin dentures on preventing Candida adhesion

PURPOSE

The aim of this study was to prevent the adhesion of C. albicans on acrylic resin dentures by modifying their surfaces.

MATERIALS AND METHODS

Ninety acrylic resin plates were divided into three groups. Group I: conventionally processed acrylic resin plates. Group II: plates painted with 2-Octyl Cyanoacrylate adhesive. Group III: plates painted with Adper Single Bond Adhesive. All specimens were immersed separately in containers filled with artificial saliva that contained C. albicans and then incubated for 11 days at 37°C. Three methods of evaluation were used to count the adhered Candida: direct culture, slide count, and serial dilutions.

RESULTS

C. albicans in 1/10, 1/10², and 1/10³ dilutions showed overgrowth in group I, while overgrowth was noted only with 1/10 dilution in group III. For group III, mean colony numbers of 123, 22, 3.4, and 0 were found for the 1/10², 1/10³, 1/10⁴, and 1/10⁵ dilutions, respectively. Regarding the slide counts, group I showed a mean fungal count of 166 compared to 40 for group III with 1/10 dilution, 21 compared to 9 with 1/10³ dilution, 8.6 compared to 0.7 with 1/10³ dilution, and 1.2 compared to 0 with 1/10⁴ dilution. No plates in group II showed any candidal colonies regardless of the method of evaluation (0%). These differences were statistically significant (p < 0.0001).

CONCLUSION

Coating the acrylic resin dentures with Adper Single Bond Adhesive was effective in reducing C. albicans adhesion to dentures, while coating with 2-Octyl Cyanoacrylate adhesive completely inhibited such adhesion.

Evaluation of PCR-ELISA as a tool for monitoring transmission of Wuchereria bancrofti in District of Gampaha, Sri Lanka

OBJECTIVE

To compare Wuchereria bancrofti (W. bancrofti) infection rates of Culex quinquefasciatus, using dissection and PCR-ELISA in two consecutive time periods (from 2007 to 2008 and from 2008 to 2009).

METHODS

Mosquitoes were collected in 30 sentinel and 15 non-sentinel sites in 15 Medical Officer of Health areas of Gampaha District known for the presence of W. bancrofti transmission in two consecutive time period of 2007 to 2008 and 2008 to 2009. Captured mosquitoes were dissected to determine the W. bancrofti larvae (L1, L2, L3). PCR was carried out using DNA extracted from mosquito pools (15 body parts/pool) utilizing the primers specific for Wb-SspI repeat. PCR products were analyzed by hybridization ELISA using fluorescein-labeled wild type specific probes. The prevalence of infected/infective mosquitoes in PCR pools (3 pools/site) was estimated using the PoolScreen™ algorithm and a novel probability-based method.

RESULTS

Of 45 batches of mosquitoes dissected, W. bancrofti infected mosquitoes were found in 19 and 13 batches, with an infection rate of 13.29% and 3.10% with mean larval density of 8.7 and 1.0 larvae per mosquito for two study periods in the Gampaha District. Total of 405 pools of head, thorax and abdomen were processed by PCR-ELISA for each year. Of these, 51 and 31 pools were positive for W. bancrofti in the two study periods respectively. The association of dissection based prevalence rates with PCR based rates as determined by the Pearson correlation coefficient were 0.176 and 0.890 respectively for the two periods.

CONCLUSIONS

Data indicate that PCR-ELISA is more sensitive than the traditional dissection techniques for monitoring transmission intensity.

Evaluation of Candida albicans adherence on the surface of various maxillofacial silicone materials

OBJECTIVES

Fungal infection resulting from Candida adherence on material surface is one of the most important medical risks for maxillofacial prosthesis wearers. Despite wide usage, there is a sparse data evaluating C. albicans adherence on various commercial maxillofacial silicone materials that have different surface contact angles. The objective of this study was to investigate the relationship between surface contact angle and fungal adherence on widely used maxillofacial silicone materials.

MATERIALS AND METHODS

Three maxillofacial silicone materials titled VST-50, A-2006, and A-2186F were used for fabrication of disc-shaped specimens. Surface contact angle of specimens were measured by the goniometric method. Adhesion quantity of two different C. albicans strains was evaluated with a colorimetric method using XTT/Coenzyme Q0. The Kruskal-Wallis and Mann-Whitney U tests were used for statistical analysis of data.

RESULTS

The lowest surface contact angle values with the highest Candida adhesion quantity were measured on the specimens fabricated with A-2006 silicone material. Statistically significant differences were found among three maxillofacial silicone materials in terms of both surface contact angle values and adhesion quantity (P<0.01).

CONCLUSION

There is a close relationship between surface contact angle and quantity of Candida adherence. However, it should be noted that various factors arising from material properties may affect the complex nature of the Candida adhesion process.

The effect of antifungal agents on surface properties of poly(methyl methacrylate) and its relation to adherence of Candida albicans

PURPOSE

Candida-associated denture stomatitis is the most prevalent form of oral candidosis affecting 65% of denture wearers. Failure of therapy and recurrence of infection are not uncommon and the continuous use of antifungal agents may affect the surface properties of the denture material and may contribute to Candida adhesion. This study aimed to investigate surface properties of poly(methyl methacrylate) PMMA denture material before and after exposure to antifungal agents and its relation to in vitro adhesion of Candida albicans.

METHODS

Four groups of acrylic specimens (20 mm × 20 mm × 2.5mm) were prepared (25 specimens in each group). Specimens were immersed in nystatin (group 1), fluconazole (group 2), distilled water (group 3) and group 4 was not exposed. Specimens were tested for surface roughness, contact angle, surface hardness and in vitro Candida adherence to PMMA.

RESULTS

The results showed that nystatin had no statistically significant effect on surface hardness (P>0.05), but had a statistically significant effect on surface roughness, contact angle, and Candida adhesion to PMMA (P<0.05). On the other hand, fluconazole had no statistically significant effect on surface hardness or roughness (P>0.05), but had a statistically significant effect on contact angle, and Candida adhesion to PMMA (P<0.05). Distilled water had no statistically significant effect on surface hardness, roughness, contact angle, or Candida adhesion to PMMA (P>0.05).

CONCLUSIONS

Exposure of PMMA to nystatin may induce changes in roughness, wettability while exposure to fluconazole may affect surface free energy and therefore may increase Candida adhesion to it.

Candida albicans adherence on silicone elastomers: effect of polymerisation duration and exposure to simulated saliva and nasal secretion

OBJECTIVES

The surfaces of maxillo-facial prostheses made of silicone elastomers exposed to soft tissues may interact with saliva and nasal secretion. These body fluids may lead to colonisation of microorganisms on their surfaces leading to their degradation or infection. This study investigated Candida albicans adhesion onto commercial maxillo-facial silicone elastomers based on different polymerisation processes.

METHODS

Room-temperature polymerised maxillo-facial silicone elastomers (N=48) (10 mm x 10 mm x 2 mm) processed at different durations [VerSilTal VST-30 (20 min), VST-50 (12h overnight), VST-50F (6h)] were studied. C. albicans was chosen as a model organism for this study. The specimens were randomly divided into two subgroups and incubated in either 1.5 ml simulated saliva or nasal secretion containing C. albicans (ATCC 60193, set to 0.5 OD, 540 nm in advance) for 2h. Candida assays and adherence assays were made by inoculating C. albicans into Mueller Hinton Broth, Fluka added 500 mmol sucrose overnight. After fixation, specimens were stained by using sterilised Methylene Blue stain (Merck) and evaluated under optical microscope and SEM. For each material, on each specimen 15 different areas (mm(2)) were counted. Data were analysed using one-way ANOVA, paired sample t-test and Tukey's HSD (alpha=0.05).

RESULTS

Material type (p<0.05) and exposure media (p<0.05) showed a significant influence on the C. albicans adherence. VST-30 material showed the most C. albicans adherence in both saliva and nasal secretion (mean rank: 99.84 and 53.47, respectively) (p<0.05) and VST-50 had the least colonisation in both media (10.35 and 5.57, respectively). Microscopic evaluation showed clusters of blastospore cells of C. albicans being more spread out on VST-30 whereas cells were more localised on VST-50 and VST-50F.

SIGNIFICANCE

Among the tested materials, 12h room-temperature polymerised silicone elastomer resulted in less C. albicans adherence in both artificial saliva and nasal secretion.

Molecular and Cellular Mechanisms That Lead to Candida Biofilm Formation

Fungal infections in the oral cavity are mainly caused by C. albicans, but other Candida species are also frequently identified. They are increasing in prevalence, especially in denture-wearers and aging people, and may lead to invasive infections, which have a high mortality rate. Attachment to mucosal tissues and to abiotic surfaces and the formation of biofilms are crucial steps for Candida survival and proliferation in the oral cavity. Candida species possess a wide arsenal of glycoproteins located at the exterior side of the cell wall, many of which play a determining role in these steps. In addition, C. albicans secretes signaling molecules that inhibit the yeast-to-hypha transition and biofilm formation. In vivo, Candida species are members of mixed biofilms, and subject to various antagonistic and synergistic interactions, which are beginning to be explored. We believe that these new insights will allow for more efficacious treatments of fungal oral infections. For example, the use of signaling molecules that inhibit biofilm formation should be considered. In addition, cell-wall biosynthetic enzymes, wall cross-linking enzymes, and wall proteins, which include adhesins, proteins involved in biofilm formation, fungal-bacterial interactions, and competition for surface colonization sites, offer a wide range of potential targets for therapeutic intervention.