Polymeric materials and films in dentistry: An overview

A state-of-the-art review of the recent advances in drug delivery systems for different therapeutic agents in periodontitis

Periodontitis (PD) is a chronic gum illness that may be hard to cure for a number of reasons, including the fact that no one knows what causes it, the side effects of anti-microbial treatment, and how various kinds of bacteria interact with one another. As a result, novel therapeutic approaches for PD treatment must be developed. Additionally, supplementary antibacterial regimens, including local and systemic medication administration of chemical agents, are necessary for deep pockets to assist with mechanical debridement of tooth surfaces. As our knowledge of periodontal disease and drug delivery systems (DDSs) grows, new targeted delivery systems like extracellular vesicles, lipid-based nanoparticles (NPs), metallic NPs, and polymer NPs have been developed. These systems aim to improve the targeting and precision of PD treatments while reducing the systemic side effects of antibiotics. Nanozymes, photodermal therapy, antibacterial metallic NPs, and traditional PD therapies have all been reviewed in this research. Medicinal herbs, antibiotics, photothermal therapy, nanozymes, antibacterial metallic NPs, and conventional therapies for PD have all been examined in this research. After that, we reviewed the key features of many innovative DDSs and how they worked for PD therapy. Finally, we have discussed the advantages and disadvantages of these DDSs.

Enhancement of in vitro and in vivo bone repair performance of decalcified bone/gelma by desferrioxamine

Autologous and allogeneic bone grafting is currently the clinical gold standard for the treatment of bone defects; however, it is limited by the scarcity of autologous sources and the risk of secondary trauma, as well as the complications of disease transmission and immune rejection associated with allogeneic grafts. The clinical management of bone defects remains a significant challenge. In this study, we prepared a demineralized bone matrix/gelatin methacrylate composite hydrogel loaded with deferoxamine (GelMA/DBM/DFO) using a freeze-drying method and investigated its properties. Assessments using CCK-8, live-dead fluorescence staining, alkaline phosphatase staining, and Alizarin Red staining indicated that the GelMA/DBM/DFO composite hydrogel demonstrated superior biocompatibility and in vitro osteogenic differentiation capacity compared with the GelMA/DBM composite hydrogel. We established a cranial defect model in Sprague-Dawley (SD) rats and examined peripheral blood indices, micro-computed tomography (Micro-CT), hematoxylin and eosin (HE) staining, Masson's trichrome staining, and immunohistochemical staining for bone morphogenetic protein-2 (BMP-2) and collagen type I (COL-1). Both hydrogels exhibited good biosafety and the GelMA/DBM/DFO hydrogel showed more effective repair of cranial defects in SD rats. This study provides a novel material for bone-defect repair.

Study of high-strength, low-shrinkage dental resin composites with bifunctional polysilsesquioxane

OBJECTIVES

The aim of this study was to develop a new composite resin to solve the problem of volume shrinkage of conventional dental restorative composite resins during the curing process in order to improve their mechanical properties and reduce the risk of restoration failure.

METHODS

We synthesized the mercapto-alkenyl click chemical reaction product (MN-POSS) of acrylate-based POSS (MAP-POSS) with N-Acetylcysteine (NAC) using a bifunctional polysilsesquioxane modification technique and improved its dispersion in the resin matrix by physicochemical methods. In addition, methacrylate-based epoxy POSS (ME-POSS) was further synthesized and used to modify acrylate dental resins to form a free radical-cation hybrid light-curing system.

RESULTS

The results showed that the composites modified with MN-POSS significantly improved mechanical strength, while the application of ME-POSS effectively reduced polymerization shrinkage, improved the water absorption and dissolution properties of the materials, and enhanced mechanical properties and hardness. This study provides new ideas and material solutions to improve the performance of dental restorative materials.

SIGNIFICANCE

Both of these improved solutions demonstrate the potential of bifunctional POSS as a modified filler, providing new ideas and methods for the design of future dental restorative materials.

Comprehensive review of polyetheretherketone use in dentistry

PURPOSE

This study aimed to comprehensively summarize the current state, shortcomings, and challenges regarding the use of polyetheretherketone (PEEK) in various fields of stomatology.

STUDY SELECTION

This study reviewed articles retrieved from PubMed, Google Scholar, Web of Science, and ScienceDirect databases. The main keywords used during the search included "polyetheretherketone (PEEK)," "dental materials," "orthodontics," "prosthodontics," "oral implantology," "oral and maxillofacial surgery," "periodontics" "osseointegration," and "surface modification."

RESULTS

Numerous studies have highlighted the properties of PEEK that contribute to its usefulness in dentistry, including its high biocompatibility, fracture resistance, aesthetics, radiolucency, and bone-like mechanical properties. Promising applications of PEEK in dentistry include orthodontic archwires, interceptive orthodontic appliances, fixed lingual retainers, crowns, post and cores, fixed partial dentures, removable partial dentures, maxillofacial prostheses, dental implants, implant abutments, alveolar bone scaffolds, jaw reconstruction, temporomandibular joint reconstruction, periodontal splints, and occlusal splints. In addition, many in vitro and in vivo experiments have demonstrated that the in vivo bone integration capability can be effectively improved using advanced surface modification technologies.

CONCLUSIONS

PEEK has been explored in several dentistry fields owing to its excellent properties. PEEK and its modifications are most frequently used in clinical dentistry. However, most of its applications are based on in vitro or short-term in vivo evaluations. Additional long-term clinical data are required to demonstrate the applicability and superiority of PEEK in dentistry.

Antimicrobial Activity of Poly(methyl methacrylate) Doped with CuO and ZnO Nanoparticles

Oral health represents a significant factor in general health and life quality. A significant number of people are affected by tooth loss during their lifetimes, especially in the older population. Poly(methyl methacrylate) (PMMA) resins are the preferred option for replacing missing teeth due to the material stability, easy handling, low toxicity, and most importantly biocompatibility with human tissue. Even though PMMA is the preferable material for denture preparation, it is susceptible to microbial colonization, which can induce the development of oral infections. This study aimed to increase the antimicrobial effect of PMMA and compare the antimicrobial properties of PMMA incorporated with different amounts (2 and 5 wt %) of zinc oxide (ZnO; primary size 62.4 nm ± 16.7 nm) and copper oxide (CuO; primary size 434.0 nm ± 118.5 nm) nanoparticles to determine their antimicrobial effects on Gram-positive bacteria Staphylococcus aureus and yeast Candida albicans-pathogenic microbes often found on dentures. To understand the adhesion of microorganisms to PMMA-modified surfaces, the following surface properties were measured: roughness, contact angle, and ζ potential. In addition, CIE (the International Commission on Illumination) color parameters of the materials were determined. The bacterial adhesion was measured by viable plate counts and scanning electron microscopy. Our study showed that 5 wt % ZnO added to PMMA yields a promising denture material that is esthetically acceptable and shows antimicrobial properties toward both, Staphylococcus aureus and Candida albicans.

Impact Absorption Power of Polyolefin Fused Filament Fabrication 3D-Printed Sports Mouthguards: In Vitro Study

BACKGROUND/AIM

This study aims to evaluate and compare the impact absorption capacities of thermoformed ethylene vinyl acetate (EVA) mouthguards and 3D-printed polyolefin mouthguards used in sports dentistry applications. The objective is to determine whether 3D-printed polyolefin mouthguards offer superior impact toughness compared to traditional EVA mouthguards commonly used in sports settings.

MATERIALS AND METHODS

Six material samples were assessed: five pressure-formed EVA mouthguards (PolyShok, Buffalo Dental, Erkoflex, Proform, and Drufosoft) and one 3D-printed synthetic polymer (polyolefin). The materials were evaluated using a modified American Society for Testing and Materials (ASTM) D256 Test Method A for Izod pendulum impact resistance of plastics. Polyolefin samples were 3D-printed using fused filament fabrication (FFF) technology. Notably, the FFF process included samples printed with notches placed either parallel or perpendicular to the build direction. This orientation served as a study factor, allowing for comparison of material behavior under different printing conditions. Impact testing was conducted using an Izod impact tester to assess the materials' performance under controlled impact conditions.

RESULTS

The study achieved a high power (1.0) in power analysis, indicating strong sensitivity to detect significant differences. Among molded materials, PolyShok showed significantly lower impact toughness compared to others (p = 0.06). The mean impact absorption of EVA materials was 5.4 ± 0.3 kJ/m2, significantly lower than polyolefin materials, which demonstrated 12.9 ± 0.7 kJ/m2 and superior performance (p = 0.0). Horizontal-notched polyolefin samples exhibited higher impact strength compared to vertical-notched samples (p = 0.009).

CONCLUSIONS

3D-printed polyolefin mouthguards exhibited significantly higher impact toughness than thermoformed EVA mouthguards. While EVA materials demonstrated structural robustness, their lower impact resistance and observed tearing in other test specimens suggest the need for alternative testing standards to better reflect real-world conditions. 3D-printed mouthguards fabricated with build orientations perpendicular to the direction of impact demonstrate significantly enhanced impact absorption. Further research into manufacturing methods and testing protocols is recommended to optimize mouthguard performance under impact scenarios.

Development of an In Vitro Method for Assessing the Potential Irritation of Medical Devices and OTC Products Used in the Oral Cavity

The aim of this study was to evaluate an in vitro method using the EpiOralTM model, a three-dimensional cultured human buccal epithelium, for assessing the oral irritation potential of various products. We evaluated different concentrations of nine chemicals commonly found in over-the-counter (OTC) products and medical devices, including chlorhexidine digluconate, sodium hypochlorite, phosphoric acid, hydrogen peroxide, lactic acid, ethanol, sodium dodecyl sulfate, 1-decanol and methyl methacrylate. The method was able to identify the irritants with a clear dose-response relationship between cell viability and an increasing concentration of the chemicals in the tested solutions. Using three exposure times (1, 4 and 18 h) and calculating the ET-50 (time required to induce a 50% reduction in cell viability), the solutions were classified according to their irritant potency (strong, moderate, mild or non-irritant). The results showed excellent correlation with historical in vivo data by matching the potency classifications in most cases. This study highlighted the importance of multiple exposure times for accurate assessment, as some solutions with irritant chemicals require longer exposure to produce effects. By providing information on both the irritant potential and potency, this method proved useful for toxicologists in the risk assessment of OTC products and medical devices that come into contact with the oral cavity.

[Effect of mouthwash with cetylpyridine chloride on the surface microhardness of self-curing, heat-curing and CAD CAM polymethyl methacrylate. In vitro study]

Objective

To evaluate the effect of Vitis CPC Protect mouthwash on the surface microhardness of three types of polymethylmethacrylate (PMMA): self-curing (Alike), thermocuring (Vitalloy) and CAD/CAM (Telium CAD).

Methodology

90 PMMA discs were manufactured, divided into three groups of 30 discs, with dimensions of 2 mm thick and 10 mm in diameter. Each group was subdivided into three subgroups (n = 10): The first subgroup to measure baseline microhardness, the second was immersed in distilled water as a control, and the third in Vitis CPC Protect mouthwash. The discs were kept in 20 ml solutions for 6 hours at 37°C, simulating daily use of rinsing twice a day for 6 months. Vickers surface microhardness was measured before and after immersion using a Vickers durometer with a load of 50 g. Subsequently, the data were statistically analyzed using the One-Way ANOVA test and Tukey's Multiple Comparisons test.

Results

The initial microhardness values were: self-curing 14.05 ± 0.31, thermocuring 18.00 ± 0.60, and CAD/CAM 20.35 ± 1.80. After immersion in mouthwash, the values were: self-curing 13.81 ± 0.20, thermocuring 17.20 ± 0.38, and CAD/CAM 19.21 ± 0.60. ANOVA analyses and Tukey's test revealed statistically significant differences in the microhardness of thermocured PMMA and CAD/CAM (p < 0.05).

Conclusion

The mouthwash with cetylpyridinium chloride affects the surface microhardness of thermally polymerized and CAD/CAM PMMA, with the latter being the more resistant to these effects. However, since the decrease is minimal, the use of mouthwash would not be contraindicated for patients with provisional PMMA restorations.

Comparison of marginal fit between milled and three-dimensional printed polymethylmethacrylate prostheses for single crowns, anterior bridges, and pier abutment bridges: An in vitro study

AIM

The purpose of this in vitro study was to compare the marginal fit of various three-dimensional (3D) printed and milled polymethylmethacrylate (PMMA) dental prostheses.

SETTINGS AND DESIGN

The study was conducted in an in vitro study setting.

MATERIALS AND METHODS

With a sample size of 45 for each fabrication method, this investigation compared the marginal fit of milled (Group 1) and 3D printed (Group 2) PMMA dental prostheses across different designs. The selection of samples was based on G*Power calculations. Tooth preparations were conducted on a typodont jaw set, followed by digital scanning and design processes. Computer-aided design and computer-aided manufacturing milling and 3D printing were employed for the fabrication of prostheses. The assessment of marginal accuracy at specific points was performed using a stereomicroscope.

STATISTICAL ANALYSIS USED

Independent t-tests were used to evaluate marginal discrepancies between milled and printed prosthetic designs at specific tooth surfaces. Univariate analysis of variance assessed marginal discrepancies across prosthesis designs and fabrication methods, with the Tukey post hoc test for significantly different results (α =0.05).

RESULTS

Milled single crowns exhibited superior accuracy (61.50 ± 4.852 μ) compared to printed ones (65.74 ± 7.311 μ) (t = -1.868, P = 0.037). Similar trends were observed for other designs, emphasizing the impact of both prosthesis design and fabrication method on marginal fit. Notable discrepancies were found on the distal surfaces of the anterior bridge crossing midline design (t = -3.262, P = 0.003).

CONCLUSION

Milled prostheses exhibited superior marginal fit as compared to 3D printed prostheses, with differences within clinically acceptable limits.

Microstructural characterization, mechanical and microbiological properties of acrylic resins added with reduced graphene oxide

To evaluate the microstructural characterization, mechanical properties and antimicrobial activity of acrylic resins incorporated with different concentrations of reduced graphene oxide (rGO). Specimens were made of self-cured and heat-cured acrylic resins for the control group and concentrations of 0.5%, 1%, and 3%. The microstructural characterization was evaluated by scanning electron microscopy (SEM) and energy-dispersive X-ray (EDS). For mechanical testing, flexural strength, and Knoop hardness tests were performed. Microbiological evaluations were performed by colony forming units (CFU) analysis, tetrazolium salt reduction (XTT), and SEM images. The modified acrylic resins showed increased mechanical properties at low concentrations (p < 0.05) and with reduced S. mutans (p < 0.05). Reduced graphene oxide interfered with the mechanical performance and microbiological properties of acrylic resins depending on the concentration of rGO, and type of polymerization and microorganism evaluated. The incorporation of graphene compounds into acrylic resins is an alternative to improve the antimicrobial efficacy and performance of the material.

Influence of Composition on the Patterns of Electrokinetic Potential of Thermosensitive N-(Isopropyl)Acrylamide Derivatives with Poly(Ethylene Glycol) Dimethacrylate and N-(2-Hydroxyethyl)Acrylamide

The synthesis of poly(N-isopropyl acrylamide) (pNIPA)-based polymers via the surfactant-free precipitation polymerization (SFPP) method produced thermosensitive nanospheres with a range of distinctive physicochemical properties. Nano- and microparticles were generated using various initiators, significantly influencing particle characteristics, including the hydrodynamic diameter (DH), which varied from 87.7 nm to 1618.1 nm. Initiators, such as potassium persulfate and 2,2'-azobis(2-methylpropionamidine) dihydrochloride, conferred anionic and cationic functionalities, respectively, impacting the electrokinetic potential (EP) of the particles. Notably, certain particles with cationic initiators exhibited negative EP values at 18 °C, attributed to residual initiator components that affected the surface charge distribution. The presence of hydrophilic N-(2-hydroxyethyl)acrylamide (HEAA) segments also influenced solubility and phase transition behaviors, with critical dependencies on the HEAA/NIPA (N-isopropyl acrylamide) molar ratios. EP measurements taken at 18 °C and 42 °C revealed substantial differences, primarily governed by the initiator type and polymer composition. Observed variations in particle stability and size were associated with the choice of crosslinking agents and comonomer content, which affected both DH and EP in distinct ways. This study provides insights into key factors influencing colloidal stability and electrostatic interactions within thermosensitive polymer systems, underscoring their potential applications in biomedical and industrial fields.

Accuracy of repaired maxillary dentures from two different repairing techniques: In vitro study

Background

Denture fracture is a common problem with acrylic dentures. The fractured denture can be repaired using various techniques such as self-cure acrylic resin acrylic resin and fiber-reinforced acrylic resin.

Purpose

The purpose of this study was to compare the accuracy of dentures repaired with self-cure acrylic resin and fiber-reinforced acrylic resin processed using two different techniques (long-cure and microwave processing).

Materials and methods

A total of 20 maxillary complete dentures were processed with two techniques; heat (long cycle) processing (10 dentures) and microwave processing (10 dentures). The maxillary cast and denture surface were scanned with Medit intraoral (Medit i700, Medit, South Korea) and STL files were created. Then, the dentures were sectioned at the midline and repaired using self-cure acrylic resin and fiber-reinforced acrylic resin and scanned with Medit intraoral. Finally, adaptation deviations were analyzed from computer software (Geomagic Control X, 3D Systems Inc., USA). The adaptation deviations in each group (long cure and microwave) were compared using an Independent T-test. Two-way ANOVA was done to see whether curing techniques and repairing methods affect the accuracy of repair. A P-value of 0.05 was considered significant.

Results

The adaptation deviation was slightly higher in the fiber-reinforced acrylic resin group (0.565 ± 0.093) than in the self-cure acrylic resin group (0.536 ± 0.066). However, there was no statistical difference in the adaptation deviations of repaired dentures with self-cure acrylic resin and fiber-reinforced acrylic resin in the long-curing (P-value 0.245) and the microwave (P-value 0.638). Similarly, the adaptation deviation was slightly higher in the long-curing group (0.577 ± 0.075) than in the microwave group (0.524 ± 0.079). However, there was a statistically significant difference in the adaptation deviation of repaired dentures between long-curing and microwave techniques with self-cure acrylic resin (P-value 0.016) but no difference in fiber-reinforced acrylic resin (P-value 0.127). The result of Two-way ANOVA shows that there is no statistically significant interaction between curing techniques (long curing and microwave) and repairing methods (self-cure acrylic resin and fiber-reinforced acrylic resin) for adaptation deviations (P-value 0.646). However, the curing techniques show statistically significant differences (P-value 0.039).

Conclusion

Acrylic dentures can be repaired with self-cure resin or fiber-reinforced self-cure resin using various processing methods. The accuracy of the denture after repair is unaffected by the repairing method (self-cure acrylic resin and fiber-reinforced acrylic resin) but the accuracy of the denture after repair is affected by the curing techniques (long-curing and microwave). In self-cure resin, the microwave processing showed higher adaptation deviation and less accuracy, whereas the long-curing processing showed lower adaptation deviation and high accuracy.

Advances in Bioceramics for Bone Regeneration: A Narrative Review

Large osseous defects resulting from trauma, tumor resection, or fracture render the inherent ability of the body to repair inadequate and necessitate the use of bone grafts to facilitate the recovery of both form and function of the bony defect sites. In the United States alone, a large number of bone graft procedures are performed yearly, making it an essential area of investigation and research. Synthetic grafts represent a potential alterative to autografts due to their patient-specific customizability, but currently lack widespread acceptance in the clinical space. Early in their development, non-autologous bone grafts composed of metals such as stainless steel and titanium alloys were favorable due to their biocompatibility, resistance to corrosion, mechanical strength, and durability. However, since their inception, bioceramics have also evolved as viable alternatives. This review aims to present an overview of the fundamental prerequisites for tissue engineering devices using bioceramics as well as to provide a comprehensive account of their historical usage and significant advancements over time. This review includes a summary of commonly used manufacturing techniques and an evaluation of their use as drug carriers and bioactive coatings-for therapeutic ion/drug release, and potential avenues to further enhance hard tissue regeneration.

Mechanically Stable and Biocompatible Polymer Brush Coated Dental Materials with Lubricious and Antifouling Properties

Surface modification plays a crucial role in enhancing the functionality of implanted interventional medical devices, offering added advantages to patients, particularly in terms of lubrication and prevention of undesired adsorption of biomolecules and microorganisms, such as proteins and bacteria, on the material surfaces. Utilizing polymer brushes for surface modification is currently a promising approach to maintaining the inherent properties of materials while introducing new functionalities to surfaces. Here, surface-initiated atom transfer radical polymerization (SI-ATRP) technology to effectively graft anionic, cationic, and neutral polymer brushes from a mixed silane initiating layer is employed. The presence of a polymer brush layer significantly enhances the lubrication performance of the substrates and ensures a consistently low coefficient of friction over thousands of friction cycles in aqueous environments. The antimicrobial efficacy of polymer brushes is evaluated against gram-positive Staphylococcus aureus (S. aureus) and gram-negative Escherichia coli (E. coli). It is observed that polym er brushes grafted to diverse substrate surfaces displays notable antibacterial properties, effectively inhibiting bacterial attachment. Furthermore, the polymer brush layer shows favorable biocompatibility and anti-inflammatory characteristics, which shows potential applications in dental materials, and other fields such as catheters and food packaging.

Functional Scaffolds for Bone Tissue Regeneration: A Comprehensive Review of Materials, Methods, and Future Directions

Bone tissue regeneration is a rapidly evolving field aimed at the development of biocompatible materials and devices, such as scaffolds, to treat diseased and damaged osseous tissue. Functional scaffolds maintain structural integrity and provide mechanical support at the defect site during the healing process, while simultaneously enabling or improving regeneration through amplified cellular cues between the scaffold and native tissues. Ample research on functionalization has been conducted to improve scaffold-host tissue interaction, including fabrication techniques, biomaterial selection, scaffold surface modifications, integration of bioactive molecular additives, and post-processing modifications. Each of these methods plays a crucial role in enabling scaffolds to not only support but actively participate in the healing and regeneration process in bone and joint surgery. This review provides a state-of-the-art, comprehensive overview of the functionalization of scaffold-based strategies used in tissue engineering, specifically for bone regeneration. Critical issues and obstacles are highlighted, applications and advances are described, and future directions are identified.

Surface Prereacted Glass Ionomer Varnish as a Multifaceted Anticaries Agent: Investigating its Inhibitory Effects on Demineralization and Biofilm Formation on Primary Tooth Enamel

Background

Dental caries remains a significant oral health concern, particularly in young children. With an increasing interest in preventive strategies, pediatric and preventive dentistry research is now more focused on developing newer materials and techniques to coat the primary teeth to prevent the onset of new carious lesions. While traditional preventive measures such as fluoride application and sealants have been effective in reducing caries incidence, there is still a need for innovative approaches.

Aim

To evaluate the effectiveness of surface prereacted glass ionomer (S-PRG) light-cured varnish in inhibiting demineralization of primary teeth enamel.

Materials and methods

In this study, primary teeth samples were randomly divided into two groups: the control group received no coating, while the test group received an S-PRG filler coat. The samples were allowed to demineralize, and various analyses, including Fourier transform infrared (FTIR) spectroscopy, scanning electron microscope (SEM), energy-dispersive X-ray analysis (EDX), and Vickers microhardness analysis, were conducted. Additionally, biofilms of Streptococcus mutans and Enterococcus faecalis were developed on solid surfaces such as microtiter plates, glass, and dentures, and the quantity of bacterial biofilm was measured using crystal violet assay and fluorescence microscopy.

Results

The study results showed that the primary teeth samples in both groups had a significantly greater calcium content than the controls. The S-PRG group demonstrated a significant reduction in the development of biofilms of S. mutans and E. faecalis, as well as bacterial attachment to glass and denture surfaces compared to the control group, as indicated by crystal violet assay and fluorescence microscopy.

Conclusion

The findings of this study suggest that S-PRG filler-containing coating materials have the potential to prevent demineralization and inhibit S. mutans and E. faecalis biofilm formation on primary tooth enamel.

Clinical significance

These results are promising and may have implications for the prevention of dental caries in young children.

How to cite this article

Fernandes RM, Kumar S, Suvarna R, et al. Surface Prereacted Glass Ionomer Varnish as a Multifaceted Anticaries Agent: Investigating its Inhibitory Effects on Demineralization and Biofilm Formation on Primary Tooth Enamel. Int J Clin Pediatr Dent 2024;17(9):1049-1056.

Modification of polymethylmethacrylate bone cement with halloysite clay nanotubes

BACKGROUND

Polymethylmethacrylate (PMMA) bone cement is used in orthopedics and dentistry to get primary fixation to bone but doesn't provide a mechanically and biologically stable bone interface. Therefore, there was a great demand to improve the properties of the PMMA bone cement to reduce its clinical usage limitations and enhance its success rate. Recent studies demonstrated that the addition of halloysite nanotubes (HNTs) to a polymeric-based material can improve its mechanical and thermal characteristics.

OBJECTIVES

The purpose of the study is to assess the compressive strength, flexural strength, maximum temperature, and setting time of traditional PMMA bone cements that have been manually blended with 7 wt% HNT fillers.

METHODS

PMMA powder and monomer liquid were combined to create the control group, the reinforced group was made by mixing the PMMA powder with 7 wt% HNT fillers before liquid mixing. Chemical characterization of the HNT fillers was employed by X-ray fluorescence (XRF). The morphological examination of the cements was done using a scanning electron microscope (SEM). Analytical measurements were made for the compressive strength, flexural strength, maximum temperature, and setting time. Utilizing independent sample t-tests, the data was statistically assessed to compare mean values (p < 0.05).

RESULTS

The findings demonstrated that the novel reinforced PMMA-based bone cement with 7 wt% HNT fillers showed higher mean compressive strength values (93 MPa) and higher flexural strength (72 MPa). and lower maximum temperature values (34.8 °C) than the conventional PMMA bone cement control group, which was (76 MPa), (51 MPa), and (40 °C), respectively (P < 0.05). While there was no significant difference in the setting time between the control and the modified groups.

CONCLUSION

The novel PMMA-based bone cement with the addition of 7 wt% HNTs can effectively be used in orthopedic and dental applications, as they have the potential to enhance the compressive and flexural strength and reduce the maximum temperatures.

Surface Coating of Nickel-Titanium (Ni-Ti) Pediatric Rotary File Using Graphene Oxide: A Scanning Electron Microscopy Analysis

BACKGROUND

The effectiveness of endodontic files relies significantly on the characteristics of the outermost layer, which can be greatly improved through suitable surface treatments and appropriate coatings. Graphene-based materials (GBMs) have been utilized to fabricate nanocomposite coatings aimed at improving surface characteristics and mechanical behavior, including resilience, sustainability, oxidation resistance, solidity, and traction.

AIM

This research aims to study the surface topography of a nickel-titanium (Ni-Ti) pediatric rotary file coated with graphene oxide (GO) using a scanning electron microscope (SEM).

METHODS

The study utilized Ni-Ti pediatric rotary instruments that were 16 mm long and had the same ISO tip size of #25. The Ni-Ti pediatric rotary files had a titanium oxide coating that needed to be removed for the application of the GO coating. The GO coating was applied to the files using an electrophoretic deposition (EPD) procedure. Data were gathered to evaluate the surface topography and structural profiles of the GO-coated endodontic files through SEM analysis.

RESULTS

SEM imaging showed that the GO coatings consisted of numerous layers of GO sheets, which were uniformly and thoroughly applied to the endodontic instrument. A substantial portion of the GO layers aligned with neighboring layers along the edges, creating a continuous structure.

CONCLUSION

GO coatings were effectively applied to Ni-Ti endodontic instruments using EPD. The deposition of the GO coating is consistent throughout the surface of the Ni-Ti rotary instrument.

Structure-properties correlation of acrylic resins modified with silver vanadate and graphene

This study aimed to incorporate β-AgVO3 and rGO into self-curing (SC) and heat-curing (HC) acrylic resins and to evaluate their physicochemical, mechanical, and antimicrobial properties while correlating them with the characterized material structure. Acrylic resin samples were prepared at 0 % (control), 0.5 %, 1 %, and 3 % for both nanoparticles. The microstructural characterization was assessed by scanning electron microscopy (SEM) (n = 1) and energy dispersive X-ray spectroscopy (EDS) (n = 1). The physicochemical and mechanical tests included flexural strength (n = 10), Knoop hardness (n = 10), roughness (n = 10), wettability (n = 10), sorption (n = 10), solubility (n = 10), porosity (n = 10), and color evaluation (n = 10). The microbiological evaluation was performed by counting colony-forming units (CFU/mL) and cell viability (n = 8). The results showed that the β-AgVO3 samples showed lower counts of Candida albicans, Pseudomonas aeruginosa, and Streptococcus mutans due to their promising physicochemical properties. The mechanical properties were maintained with the addition of β-AgVO3. The rGO samples showed higher counts of microorganisms due to the increase in physicochemical properties. It can be concluded that the incorporation of β-AgVO3 into acrylic resins could be an alternative to improve the antimicrobial efficacy and performance of the material.

Effect of using different strips on reducing the most common error in panoramic imaging: A randomised controlled trial on palatoglossal air space shadow

INTRODUCTION

Panoramic radiography quality can be impaired by some errors such as positioning errors. Palatoglossal air space shadow error is one of the most common positioning errors and it is due to the tongue not sticking to the roof of the palate. Techniques used to deal with this error might help prevent unnecessary radiation to patients and save them time and money. The study aimed to investigate the effects of using celluloid matrix and edible tapes (fruit leather and chewing gum) on reducing the palatoglossal air space shadow error in panoramic imaging.

METHODS

In our study, 270 patients referred to the Department of Radiology were randomised into three groups: a control group, a celluloid matrix group and an edible tapes group. Before panoramic imaging, all patients were instructed to adhere their tongues to the roof of their mouths, with the distinction that for the celluloid matrix and edible tapes groups, patients were asked to place celluloid tapes, fruit leathers, or chewing gums on their tongues before doing so. The routine imaging process was then performed, and the results were compared across groups to evaluate the incidence of palatoglossal air space shadow error.

RESULTS

The number of error-free images in each fruit leather, chewing gum and celluloid tape group were significantly higher than the control group (all cases P < 0.05). The chances of error-free images in the fruit leather groups were the highest (9.57 times). The age (P = 0.136) and gender (P = 0.272) of patients had no significant effect on the results of interventions.

CONCLUSION

The application of fruit leathers, chewing gums and celluloid tapes reduced the palatoglossal air space shadow error of panoramic imaging.

Clinical Effectiveness of Ion-Releasing Restorations versus Composite Restorations in Dental Restorations: Systematic Review and Meta-Analysis

BACKGROUND

To compare the clinical effectiveness of ion-releasing restorations (IRR) vs. composite resin (CR) in dental restorations.

METHODS

A systematic search was carried out from articles published until January 2024, in the biomedical databases: PubMed, Cochrane Library, Scielo, Scopus, Web of Science and Google Scholar. Randomized clinical trials were included, with a follow-up time greater than or equal to 1 year, without time and language limits and which reported the clinical effect of IRR compared to CR in dental restorations. The RoB 2.0 tool was used to assess the risk of bias of the included studies and the GRADEPro GDT tool was used to assess the quality of evidence and the strength of recommendation of the results.

RESULTS

The search yielded a total of 1109 articles. After excluding those that did not meet the selection criteria, 29 articles remained for the quantitative synthesis. The analysis found no statistically significant difference when comparing the dental restorations with IRRs or CRs.

CONCLUSION

The literature reviewed suggests that there are no differences between the IRRs and CRs in dental restorations.

Application of Polyether Ketone in Oral Implantology and Prosthodontics

Polyetheretherketone (PEEK) is a polymer that has a comprehensive range of possible uses in dental treatment. The goal of this study was to compile research findings on the substance of dental claims and highlight the upcoming predictions of PEEK in clinical dentistry. PEEK is a novel polymeric material that is yet in its preliminary stage of evolution. Biomolecules are elastic materials with remarkable mechanical strength, barrier properties, and heat resistance compared to other matrix materials. The efficacy of PEEK in clinical dentistry has been acknowledged. Polyetherketone (PEKK) and PEEK are the most commonly mentioned members of the polyaryletherketone (PAEK) family. PEEK has also found significant use in dentistry, notably in prosthodontics and implant dentistry. It also offers exceptional mechanical qualities, including high strength and toughness, making it ideal for dental implants and prostheses. It can endure the stresses of chewing and grinding, resulting in long-lasting restorations. PEEK's tooth-colored look and ability to simulate natural tooth translucency make it suitable for use in dental prostheses such as crowns and bridges. This makes it a more esthetically acceptable alternative to standard metal-based repairs.

Comparative analysis of cytotoxicity effects of two denture hard lining materials on human gingival fibroblasts: an in vitro study

Background

The objective of this study was to compare the cytotoxicity of TDV and Rebase II denture hard liners on human gingival fibroblasts, aiming to address issues associated with incomplete polymerization and free monomers that affect material properties.

Methods

Seventy-two specimens (24 each of TDV, Rebase II, and controls) were prepared under aseptic conditions according to factory instructions. Cytotoxicity was determined using the MTT test with methyl tetrazolium salt added to the cell culture medium. A two-way ANOVA and a post-hoc Tukey test was used to evaluate the results of incubation before mitochondrial activity was measured using Multiscan spectrophotometry (570 nm).

Results

There were significant differences in cell viability between the groups after 24 hours (P < 0.001), with TDV having higher viability than Rebase II. The difference between Rebase II and TDV, however, was not significant at 48 and 96 hours (P > 0.131). At 24 hours, Rebase II exhibited significantly lower viability than TDV liner, with a significant difference between the two groups (P = 0.001).

Conclusion

Due to the maximum monomer release in the early hours of incubation, the amount of cytotoxicity decreased with increasing incubation time.

Nanochemistry of gold: from surface engineering to dental healthcare applications

Advancements in nanochemistry have led to the development of engineered gold nanostructures (GNSs) with remarkable potential for a variety of dental healthcare applications. These innovative nanomaterials offer unique properties and functionalities that can significantly improve dental diagnostics, treatment, and overall oral healthcare applications. This review provides an overview of the latest advancements in the design, synthesis, and application of GNSs for dental healthcare applications. Engineered GNSs have emerged as versatile tools, demonstrating immense potential across different aspects of dentistry, including enhanced imaging and diagnosis, prevention, bioactive coatings, and targeted treatment of oral diseases. Key highlights encompass the precise control over GNSs' size, crystal structure, shape, and surface functionalization, enabling their integration into sensing, imaging diagnostics, drug delivery systems, and regenerative therapies. GNSs, with their exceptional biocompatibility and antimicrobial properties, have demonstrated efficacy in combating dental caries, periodontitis, peri-implantitis, and oral mucosal diseases. Additionally, they show great promise in the development of advanced sensing techniques for early diagnosis, such as nanobiosensor technology, while their role in targeted drug delivery, photothermal therapy, and immunomodulatory approaches has opened new avenues for oral cancer therapy. Challenges including long-term toxicity, biosafety, immune recognition, and personalized treatment are under rigorous investigation. As research at the intersection of nanotechnology and dentistry continues to thrive, this review highlights the transformative potential of engineered GNSs in revolutionizing dental healthcare, offering accurate, personalized, and minimally invasive solutions to address the oral health challenges of the modern era.

Biomechanical Fatigue Behavior of a Dental Implant Due to Chewing Forces: A Finite Element Analysis

The use of titanium as a biomaterial for the treatment of dental implants has been successful and has become the most viable and common option. However, in the last three decades, new alternatives have emerged, such as polymers that could replace metallic materials. The aim of this research work is to demonstrate the structural effects caused by the fatigue phenomenon and the comparison with polymeric materials that may be biomechanically viable by reducing the stress shielding effect at the bone-implant interface. A numerical simulation was performed using the finite element method. Variables such as Young's modulus, Poisson's coefficient, density, yield strength, ultimate strength, and the S-N curve were included. Prior to the simulation, a representative digital model of both a dental implant and the bone was developed. A maximum load of 550 N was applied, and the analysis was considered linear, homogeneous, and isotropic. The results obtained allowed us to observe the mechanical behavior of the dental implant by means of displacements and von Mises forces. They also show the critical areas where the implant tends to fail due to fatigue. Finally, this type of non-destructive analysis proves to be versatile, avoids experimentation on people and/or animals, and reduces costs, and the iteration is unlimited in evaluating various structural parameters (geometry, materials, properties, etc.).

Emerging polymeric materials for treatment of oral diseases: design strategy towards a unique oral environment

Oral diseases are prevalent but challenging diseases owing to the highly movable and wet, microbial and inflammatory environment. Polymeric materials are regarded as one of the most promising biomaterials due to their good compatibility, facile preparation, and flexible design to obtain multifunctionality. Therefore, a variety of strategies have been employed to develop materials with improved therapeutic efficacy by overcoming physicobiological barriers in oral diseases. In this review, we summarize the design strategies of polymeric biomaterials for the treatment of oral diseases. First, we present the unique oral environment including highly movable and wet, microbial and inflammatory environment, which hinders the effective treatment of oral diseases. Second, a series of strategies for designing polymeric materials towards such a unique oral environment are highlighted. For example, multifunctional polymeric materials are armed with wet-adhesive, antimicrobial, and anti-inflammatory functions through advanced chemistry and nanotechnology to effectively treat oral diseases. These are achieved by designing wet-adhesive polymers modified with hydroxy, amine, quinone, and aldehyde groups to provide strong wet-adhesion through hydrogen and covalent bonding, and electrostatic and hydrophobic interactions, by developing antimicrobial polymers including cationic polymers, antimicrobial peptides, and antibiotic-conjugated polymers, and by synthesizing anti-inflammatory polymers with phenolic hydroxy and cysteine groups that function as immunomodulators and electron donors to reactive oxygen species to reduce inflammation. Third, various delivery systems with strong wet-adhesion and enhanced mucosa and biofilm penetration capabilities, such as nanoparticles, hydrogels, patches, and microneedles, are constructed for delivery of antibiotics, immunomodulators, and antioxidants to achieve therapeutic efficacy. Finally, we provide insights into challenges and future development of polymeric materials for oral diseases with promise for clinical translation.

Elimination of Pathogen Biofilms via Postbiotics from Lactic Acid Bacteria: A Promising Method in Food and Biomedicine

Pathogenic biofilms provide a naturally favorable barrier for microbial growth and are closely related to the virulence of pathogens. Postbiotics from lactic acid bacteria (LAB) are secondary metabolites and cellular components obtained by inactivation of fermentation broth; they have a certain inhibitory effect on all stages of pathogen biofilms. Postbiotics from LAB have drawn attention because of their high stability, safety dose parameters, and long storage period, which give them a broad application prospect in the fields of food and medicine. The mechanisms of eliminating pathogen biofilms via postbiotics from LAB mainly affect the surface adhesion, self-aggregation, virulence, and QS of pathogens influencing interspecific and intraspecific communication. However, there are some factors (preparation process and lack of target) which can limit the antibiofilm impact of postbiotics. Therefore, by using a delivery carrier and optimizing process parameters, the effect of interfering factors can be eliminated. This review summarizes the concept and characteristics of postbiotics from LAB, focusing on their preparation technology and antibiofilm effect, and the applications and limitations of postbiotics in food processing and clinical treatment are also discussed.

Application of an Antibacterial Coating Layer via Amine-Terminated Hyperbranched Zirconium-Polysiloxane for Stainless Steel Orthodontic Brackets

The massive growth of various microorganisms on the orthodontic bracket can form plaques and cause diseases. A novel amine-terminated hyperbranched zirconium-polysiloxane (HPZP) antimicrobial coating was developed for an orthodontic stainless steel tank (SST). After synthesizing HPZP and HPZP-Ag coatings, their structures were characterized by nuclear magnetic resonance spectroscopy, scanning electron microscopy, thickness measurement, contact angle detection, mechanical stability testing, and corrosion testing. The cell toxicity of the two coatings to human gingival fibroblasts (hGFs) and human oral keratinocytes (hOKs) was detected by cell counting kit eight assays, and SST, HPZP@SST, and HPZP-Ag@SST were cocultured with Staphylococcus aureus, Escherichia coli, and Streptococcus mutans for 24 hr to detect the antibacterial properties of the coatings, respectively. The results show that the coatings are about 10 μm, and the water contact angle of HPZP coating is significantly higher than that of HPZP-Ag coating (P < 0.01). Both coatings can be uniformly and densely distributed on SST and have good mechanical stability and corrosion resistance. The cell counting test showed that HPZP coating and HPZP-Ag coating were less toxic to cells compared with SST, and the toxicity of HPZP-Ag coating was greater than that of HPZP coating, with the cell survival rate greater than 80% after 72 hr cocultured with hGFs and hOKs. The antibacterial test showed that the number of bacteria on the surface of different materials was ranked from small to large: HPZP@SST < HPZP-Ag@SST < SST and 800 μg/mL HPZP@SST showed a better bactericidal ability than 400 μg/mL after cocultured with S. aureus, E. coli, and S. mutans, respectively (all P < 0.05). The results showed that HPZP coating had a better effect than HPZP-Ag coating, with effective antibacterial and biocompatible properties, which had the potential to be applied in orthodontic process management.

Polymethylmethacrylate-hydroxyapatite antibacterial and antifungal activity against oral bacteria: An in vitro study

Objective

Reconstruction of alveolar bone defects resulting from aging, trauma, ablative surgery or pathology, remains a significant clinical challenge. The objective of this study was to investigate the antibacterial and antifungal activities of mixed polymethylmethacrylate-hydroxyapatite (PMMA-HA) against oral microorganisms. Our findings could provide valuable insights into the prospective application of PMMA-HA as a synthetic bone graft material to manage alveolar bone defects via tissue engineering.

Methods

HA powder was obtained from the Center for Ceramics in Indonesia and PMMA granules were obtained from HiMedia Laboratories; these were prepared in 20:80, 30:70, and 40:60 ratios. The antibacterial diffusion method was then performed against Staphylococcusaureus, Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, and Fusobacterium nucleatum, while the antifungal diffusion method was used to test against Candida albicans. Standardized protocols were used for microbial culturing and inhibition zones were measured with digital calipers. Statistical analyses included one-way ANOVA and Kruskal-Wallis tests, supplemented by post-hoc Tukey HSD tests.

Results

A PMMA-HA scaffold with a 20:80 ratio demonstrated the highest antibacterial activity against S. aureus, A. actinomycetemcomitans, P. gingivalis, and F. nucleatum. This was followed by the 30:70 and 40:60 ratios in terms of antibacterial activity. Statistical significance was achieved with p < 0.05 in comparison to controls. However, none of the PMMA-HA ratios showed antifungal activity against C. albicans.

Conclusion

PMMA-HA scaffolds have significant activity against bacteria, but not against fungi.

Evaluation of flexural strength, impact strength, and surface microhardness of self-cured acrylic resin reinforced with silver-doped carbon nanotubes

BACKGROUND

Poly-methyl methacrylate (PMMA) is a type of polymer mostly used to make denture bases. Self-cured acrylic resin (PMMA) can be used to repair a fractured acrylic denture base; however, even after repair, this area remains vulnerable. Carbon nanotubes (CNTs) could be used as a filler for polymer reinforcement. Furthermore, silver nanoparticles are efficient agents for the prevention of dental biofilm and improving their mechanical properties. The doping of CNTs with silver nanoparticles may lead to a synergistic interaction that is predicted to enhance the mechanical characteristics of the fillers.

OBJECTIVES

The aim of the study was to assess the influnce of manual incorporation of 0.5% weight percent (%wt.) of silver doped carbon nanotubes (Ag-doped CNTs) into commercial self-cured PMMA on its flexural strength, impact strength, and surface microhardness.

METHODS

In this investigation, a total of 60 specimens comprised of acrylic resin were employed. They are divided into two main groups: (a) the control group, which was made by using liquid monomer and commercial self-cured PMMA powder; and (b) the modified group, prepared by hand mixing the purchased silver-doped CNTs powder (0.5% wt.) to self-cured PMMA powder (99.5%wt.), and then the blended powder was incorporated into the liquid monomer. Flexural strength, flexural modulus, impact strength, and surface microhardness were evaluated. Independent sample t-tests were used to statistically analyze the data and compare the mean values of flexural strength, flexural modulus, impact strength, and surface microhardness (p-value ≤ 0.05).

RESULTS

The flexural strength of the modified groups with Ag-doped CNTs (132.4 MPa) was significantly greater than that of the unmodified (control) groups (63.2 MPa). Moreover, the flexural modulus of the modified groups with Ag-doped CNTs (3.067 GPa) was significantly greater than that of the control groups (1.47 GPa). Furthermore, the impact strength of the modified groups with Ag-doped CNTs (11.2 kJ/mm2) was significantly greater than that of the control groups (2.3 kJ/mm2). Furthermore, the microhardness of the modified groups with Ag-doped CNTs (29.7 VHN) was significantly greater than that of the control groups (16.4 VHN), (p-value = 0.0001).

CONCLUSION

The incorporation of 0.5% wt. silver doped CNTs fillers to the self-cured acrylic resin enhanced its flexural strength, flexural modulus, impact strength, and surface microhardness.

Influence of Novel SrTiO3/MnO2 Hybrid Nanoparticles on Poly(methyl methacrylate) Thermal and Mechanical Behavior

While dental poly methyl methacrylate(PMMA) possesses distinctive qualities such as ease of fabrication, cost-effectiveness, and favorable physical and mechanical properties, these attributes alone are inadequate to impart the necessary impact strength and hardness. Consequently, pure PMMA is less suitable for dental applications. This research focused on the incorporation of Strontium titanate (SrTiO3-STO) and hybrid filler STO/Manganese oxide (MnO2) to improve impact resistance and hardness. The potential of STO in reinforcing PMMA is poorly investigated, while hybrid filler STO/MnO2 has not been presented yet. Differential scanning calorimetry is conducted in order to investigate the agglomeration influence on the PMMA glass transition temperature (Tg), as well as the leaching of residual monomer and volatile additives that could pose a threat to human health. It has been determined that agglomeration with 1 wt% loading had no influence on Tg, while the first scan revealed differences in evaporation of small molecules, in favor of composite PMMA-STO/MnO2, which showed the trapping potential of volatiles. Investigations of mechanical properties have revealed the significant influence of hybrid STO/MnO2 filler on microhardness and total absorbed impact energy, which were increased by 89.9% and 145.4%, respectively. Results presented in this study revealed the reinforcing potential of hybrid nanoparticles that could find application in other polymers as well.

Graphene loaded into dental polymers as reinforcement of mechanical properties: A systematic review

Graphene compounds are incorporated into polymers in order to improve their mechanical properties and in dentistry this modification favors the clinical performance of these materials. The aim of this review was to evaluate graphene compounds, their concentrations, and their effect on mechanical properties as flexural, tensile, and compressive strength and hardness of polymethylmethacrylate (PMMA) and polyether-ether-ketone (PEEK) for dental application. The search was carried out in two steps in PubMed/Medline, Embase, Scopus, and Web of Science databases. The eligibility criteria included studies that incorporated pure graphene compounds into dental polymers and evaluated their mechanical properties. Were found 4984 results, of which 11 articles were included in this review. Graphene compounds: graphene oxide (GO), reduced graphene oxide (rGO), and graphene nanoplatelets (GNP) were incorporated into PMMA and PEEK, in concentrations ranging from 0.1 to 10 wt%. Concentrations lower than 0.75 wt% of GO in PMMA and 1 wt% of GNP in PEEK resulted in increased flexural, tensile, compression strength, and hardness of these polymers. It was concluded that the incorporation of graphene compounds in low concentrations increases dental polymers' mechanical properties.

Recent Advances in 3D Printing of Polymers for Application in Prosthodontics

Contemporary mass media frequently depict 3D printing as a technology with widespread utilization in the creation of dental prosthetics. This paper endeavors to provide an evidence-based assessment of the current scope of 3D printing's integration within dental laboratories and practices. Its primary objective is to offer a systematic evaluation of the existing applications of 3D-printing technology within the realm of dental prosthetic restorations. Furthermore, this article delves into potential prospects, while also critically examining the sustained relevance of conventional dental laboratory services and manufacturing procedures. The central focus of this article is to expound upon the extent to which 3D printing is presently harnessed for crafting dental prosthetic appliances. By presenting verifiable data and factual insights, this article aspires to elucidate the actual implementation of 3D printing in prosthetic dentistry and its seamless integration into dental practices. The aim of this narrative review is twofold: firstly, to provide an informed and unbiased evaluation of the role that 3D printing currently plays within dental laboratories and practices; and secondly, to instigate contemplation on the transformative potential of this technology, both in terms of its contemporary impact and its future implications, while maintaining a balanced consideration of traditional dental approaches.

Phosphorus and Silicon-Based Macromolecules as Degradable Biomedical Polymers

Synthetic polymers are indispensable in biomedical applications because they can be fabricated with consistent and reproducible properties, facile scalability, and customizable functionality to perform diverse tasks. However, currently available synthetic polymers have limitations, most notably when timely biodegradation is required. Despite there being, in principle, an entire periodic table to choose from, with the obvious exception of silicones, nearly all known synthetic polymers are combinations of carbon, nitrogen, and oxygen in the main chain. Expanding this to main-group heteroatoms can open the way to novel material properties. Herein the authors report on research to incorporate the chemically versatile and abundant silicon and phosphorus into polymers to induce cleavability into the polymer main chain. Less stable polymers, which degrade in a timely manner in mild biological environments, have considerable potential in biomedical applications. Herein the basic chemistry behind these materials is described and some recent studies into their medical applications are highlighted.

Evaluation of compressive strength, surface microhardness, solubility and antimicrobial effect of glass ionomer dental cement reinforced with silver doped carbon nanotube fillers

BACKGROUND

Conventional glass ionomer cements (GICs) are currently the most widely used dental cements due to their chemical bonding into tooth structure, release of fluoride, and ease of manipulation and usage. One of their drawbacks is their low mechanical properties and high solubility. Carbon nanotubes (CNTs) could be utilized in dentistry due to their several potential applications. CNTs can be used as fillers to reinforce polymers or other materials. Additionally, silver (Ag) nanoparticles are highly effective at preventing dental biofilm and enhancing mechanical properties.

OBJECTIVES

The aim of the present in vitro study is to evaluate the compressive strength, surface microhardness, solubility, and antimicrobial effect of the conventional GIC reinforced with manual blending of 0.01 wt.% Ag doped CNT fillers.

METHODS

The control group was prepared by mixing dental GIC powder with their liquid. The innovatively reinforced dental GIC group was prepared by incorporating 0.01 wt.% Ag doped CNT fillers into the GIC powder prior to liquid mixing. Chemical characterization was performed by XRF. While, physical characterization was done by measuring film thickness and initial setting time. The compressive strength, surface microhardness, solubility, and antimicrobial effect against Streptococcus mutans bacteria using an agar diffusion test were measured. The data was statistically analyzed using independent sample t-tests to compare mean values of compressive strength, surface microhardness, solubility, and antimicrobial activity (p ≤ 0.05).

RESULTS

The results revealed that innovative reinforced GIC with 0.01 wt.% Ag doped CNT fillers showed higher mean compressive strength, surface microhardness, and antimicrobial effect values than the conventional GIC control group; there was no significant difference between different groups in relation to the solubility test (P ≤ 0.05).

CONCLUSION

The innovatively reinforced GIC with 0.01 wt.% Ag doped CNT fillers had the opportunity to be used as an alternative to conventional GIC dental cements.

Flexural Strength Analysis of Different Complete Denture Resin-Based Materials Obtained by Conventional and Digital Manufacturing

PMMA (Polymethylmethacrylate) is the material of choice to fabricate denture bases. Recently, with the introduction of CAD-CAM and 3D printers in dentistry, new materials have been proposed for complete denture manufacturing.

AIM

This study compared the flexural strength of different resins fabricated using different technologies (conventional, CAD-CAM-milled, and 3D-printed) and polymerization techniques.

METHODS

A total of 11 different resins were tested: six PMMA conventional (Acrypol R, Acrypol LL, Acrypol HI, Acrypol Fast, Acryself and Acryslef P), two milled obtained from UDMA PMMA disks (Ivotion disk and Aadva disk, control groups), two 3D-printed PMMA resins (NextDent Denture 3D+, and SprintRayEU Denture Base), and one 3D-printed composite resin (GC Temp Print). Flexural strength was measured using a universal testing machine. One-way ANOVA and Bonferroni post hoc tests were performed; the p-value was set at 0.05 to consider statistically significant differences among the groups. Spearman test was used to evaluate the correlation between polymerization technique and the flexural strength of 3D-printed resins.

RESULTS

CAD-CAM-milled specimens showed the highest flexural strength (107.87 MPa for UDMA) followed by 3D-printed composite resins (102.96 MPa). Furthermore, 3D-printed resins polymerized for 40 min with the BB cure unit showed no statistically significant differences with conventional resin groups. Moreover, in all the 3D-printed specimens, a high correlation between polymerization technique and flexural strength was found.

CONCLUSIONS

In terms of flexural strength, the polymerization technique is a determinant for both acrylic and composite resins. Temp Print can be a potential alternative to fabricating removable dentures and showed promising results when used in combination with pink color resin powder.

Unveiling the mechanisms behind surface degradation of dental resin composites in simulated oral environments

Dental resin composites are widely used as restorative materials due to their natural aesthetic and versatile properties. However, there has been limited research on the degradation mechanisms of these composites in gastric acid environments, which would be common in patients with gastroesophageal reflux. This study aims to investigate the degradation behavior of dental composites immersed in simulated oral environments, including acid, saliva, and water. Mechanical and morphological properties of the composites, upon immersion in the simulated environments, were thoroughly examined using hardness testing and SEM imaging. Qualitative analyses of the ions leached from the polymer matrix and fillers were conducted using XPS and ICP-MS. In addition, the thermodynamic stability of the inorganic fillers of the composites in aqueous solutions across a wide range of pH values was theoretically studied through construction of Pourbaix diagrams. This study proposed a mechanism for composite leaching involving interactions between the matrix's hydrophilic groups and the aqueous immersion media, leading to swelling and chemical degradation of the composites. Furthermore, it was demonstrated that filler leaching was followed by ion exchange with Ca and P, resulting in the formation of hard calcified layers on the composite surface. The current findings provide valuable insights into the development of new composite materials with improved durability and resistance to degradation, especially for patients suffering from gastroesophageal reflux.

Different Polymers for the Base of Removable Dentures? Part I: A Narrative Review of Mechanical and Physical Properties

Even before considering their introduction into the mouth, the choice of materials for the optimization of the prosthesis depends on specific parameters such as their biocompatibility, solidity, resistance, and longevity. In the first part of this two-part review, we approach the various mechanical characteristics that affect this choice, which are closely related to the manufacturing process. Among the materials currently available, it is mainly polymers that are suitable for this use in this field. Historically, the most widely used polymer has been polymethyl methacrylate (PMMA), but more recently, polyamides (nylon) and polyether ether ketone (PEEK) have provided interesting advantages. The incorporation of certain molecules into these polymers will lead to modifications aimed at improving the mechanical properties of the prosthetic bases. In the second part of the review, the safety aspects of prostheses in the oral ecosystem (fragility of the undercuts of soft/hard tissues, neutral pH of saliva, and stability of the microbiota) are addressed. The microbial colonization of the prosthesis, in relation to the composition of the material used and its surface conditions (roughness, hydrophilicity), is of primary importance. Whatever the material and manufacturing process chosen, the coating or finishes dependent on the surface condition remain essential (polishing, non-stick coating) for limiting microbial colonization. The objective of this narrative review is to compile an inventory of the mechanical and physical properties as well as the clinical conditions likely to guide the choice between polymers for the base of removable prostheses.

Comparison of Mechanical Properties of Three Tissue Conditioners: An Evaluation In Vitro Study

Introduction: Tissue conditioners have been widely used in various clinical applications in dentistry, such as treating inflamed alveolar ridges, temporarily relining partial and complete dentures, and the acquisition of functional impressions for denture fabrication. This study aimed to investigate the mechanical properties of the most prevalent tissue conditioner materials on the market, including Tissue Conditioners (TC), Visco Gel (VG), and FITT (F). Materials and Methods: The three tissue conditioners, TC, VG, and F, were assessed based on the parameters mentioned above. The following tests were performed based on the ISO 10139-1 and ISO 10139-2 requirements: Shore A hardness, denture plate adhesion, sorption, water solubility, and contraction after 1 and 3 days in water. Additional tests are described in the literature, such as ethanol content and gelling time. The tests were carried out by storing the materials in water at 37 °C for 7 days. Results: The gel times of all tested materials exceeded 5 min (TC = 300 [s], VG = 350 [s]). In vitro, phthalate-free materials exhibited higher dissolution in water after 14 days (VG = -260.78 ± 11.31 µg/mm2) compared to F (-76.12 ± 7.11 µg/mm2) and experienced faster hardening when stored in distilled water (F = 33.4 ± 0.30 Sh. A, VG = 59.2 ± 0.60 Sh. A). They also showed greater contractions. The connection of all materials to the prosthesis plate was consistent at 0.11 MPa. The highest counterbalance after 3 days was observed in TC = 3.53 ± 1.12%. Conclusions: Materials containing plasticizers that are not phthalates have worse mechanical properties than products containing these substances. Since phthalates are not allowed to be used indefinitely in medical devices, additional research is necessary, especially in vivo, to develop safe materials with superior functional properties to newer-generation alternatives. In vitro results often do not agree fully with those of in vivo outcomes.

Colour Parameters and Changes of Tea-Stained Resin Composite Exposed to Whitening Pen (In Vitro Study)

BACKGROUND

One of the crucial factors influencing the longevity of anterior aesthetic dental restorations is the colour stability of resin composites. Bleaching and whitening have become popular methods for enhancing dental aesthetics. Home whitening techniques, such as special pens, are widely available commercially. This in vitro study aimed to determine the efficiency of a whitening pen in removing tea stains from resin composite by measuring colour differences (ΔE₀₀). Additionally, the study aimed to evaluate the variations in colour parameters measured by extra-oral and intra-oral spectrophotometers.

METHODS

A total of 45 disc-shaped resin composite specimens were randomly divided into three groups; Group 1: stored in artificial saliva (control), Group 2: stored in artificial saliva followed by a whitening pen application, and Group 3: stored in tea followed by a whitening pen application. Colour measurements were taken three times for each specimen using two spectrophotometers (extra-oral and intra-oral devices); T1: before storage (baseline), T2: after storage in artificial saliva or tea for 6 days; and T3: after one week of whitening pen application in groups 2 and 3. The data were statistically analyzed using one-way ANOVA followed by the Tukey post hoc test (p ≤ 0.05). The independent sample t-test was also employed. The equation of CIEDE2000 (ΔE₀₀) was used to calculate the colour difference between the dry, as-prepared specimens (baseline), and those after storage or bleaching. The colour changes exceeding the acceptability threshold (∆E₀₀ = 1.8) were considered unacceptable.

RESULTS

After whitening, the colour of the specimens stored in brewed tea (Group 3) remained unacceptable, as indicated by both the extra-oral and intra-oral spectrophotometers (ΔE₀₀ = 4 and 2.9, respectively). Groups 1 and 2 exhibited lower ΔE₀₀ values than Group 3 (p = 0.01 *). No significant difference was observed between Group 1 (stored in artificial saliva) and Group 2 (stored in artificial saliva and then bleached) (p = 0.3). Significant differences were consistently observed between the data obtained from the extra-oral spectrophotometer and the intra-oral one.

CONCLUSIONS

The whitening pen proved ineffective in removing tea stains from resin composites. Although significant differences were found between the values obtained by the two spectrophotometers (extra-oral and intra-oral), both devices confirmed the unacceptable colour of the tea-stained resin composites after whitening.

Effect of Adding Silver-Doped Carbon Nanotube Fillers to Heat-Cured Acrylic Denture Base on Impact Strength, Microhardness, and Antimicrobial Activity: A Preliminary Study

Poly (methyl methacrylate) (PMMA), is an acrylic polymer substance that is mostly used for denture base applications. The purpose of this laboratory study was to investigate the effect of adding 0.05 wt.% Ag-doped carbon nanotubes (CNT) to PMMA-based (PMMA and MMA) denture base material on the impact strength, microhardness, and antimicrobial activity. A total of 60 heat-cured acrylic resin specimens were prepared. The specimens were randomly divided into two main groups (n = 30/group), according to the powder used: (a) control group, using heat-cured PMMA; (b) treatment group, using a powder prepared by blending 0.05 wt.% silver-doped CNT nanoparticles with heat-cured PMMA. The impact strength, microhardness and anticandidal activity for each group were assessed via the Charpy, Vickers and agar diffusion tests, respectively (n = 10/test for each subgroup). Data were analyzed using independent-sample t-tests (p ≤ 0.05). The results of the impact strength test revealed that the treated heat-cured PMMA-MMA with Ag-doped CNT (2.2 kJ/mm²) was significantly higher than that of the control heat-cured PMMA (1.6 kJ/mm²). Similarly, the Vickers microhardness of the treatment group (52.7 VHN) was significantly higher than that of the control group (19.4 VHN). Regarding the agar diffusion test, after 24 h of incubation, the treated heat-cured PMMA with the Ag-doped CNT exhibited significantly higher anticandidal activity than that of the control group. Therefore, Ag-doped carbon nanotubes could be considered as promising fillers for the dental heat-cured acrylic resin to improve the resistance of the resultant denture against sudden fractures, scratching, and candida invasion.

Evaluation of photodynamic therapy on nanoparticles and films loaded-nanoparticles based on chitosan/alginate for curcumin delivery in oral biofilms

Nanoparticles and nanoparticle-loaded films based on chitosan/sodium alginate with curcumin (CUR) are promising strategies to improve the efficacy of antimicrobial photodynamic therapy (aPDT) for the treatment of oral biofilms. This work aimed to develop and evaluate the nanoparticles based on chitosan and sodium alginate encapsulated with CUR dispersed in polymeric films associated with aPDT in oral biofilms. The NPs were obtained by polyelectrolytic complexation, and the films were prepared by solvent evaporation. The photodynamic effect was evaluated by counting Colony Forming Units (CFU/mL). Both systems showed adequate characterization parameters for CUR release. Nanoparticles controlled the release of CUR for a longer period than the nanoparticle-loaded films in simulated saliva media. Control and CUR-loaded nanoparticles showed a significant reduction of 3 log10 CFU/mL against S. mutans biofilms, compared to treatment without light. However, biofilms of S. mutans showed no photoinactivation effect using films loaded with nanoparticles even in the presence of light. These results demonstrate the potential of chitosan/sodium alginate nanoparticles associated with aPDT as carriers for the oral delivery of CUR, offering new possibilities to improve the treatment of dental caries and infections. This work will contribute to advances in the search for innovative delivery systems in dentistry.

Effect of different root canal irrigants on push-out bond strength of two novel root-end filling materials

BACKGROUND

The aim of this in vitro study was to evaluate push-out bond strength of different root-end filling materials using various irrigant solutions.

METHODS

A push-out bond strength test was performed to evaluate the bond strength of two experimental root-end filling materials: namely, nano-hybrid mineral trioxide aggregate (MTA) and polymethyl methacrylate (PMMA) cement filled with 20% weight nano hydroxyapatite (nHA) fillers compared to conventional MTA. The irrigant solutions employed were sodium hypochlorite (NaOCl) in concentrations 1%, 2.5% and 5.25% and 2% chlorhexidine gluconate (CHX) followed by application of 17% ethylene diamine tetra-acetic acid (EDTA). A freshly extracted sixty single-rooted human maxillary central incisors were used. The crowns were removed, the canal apex was widened to simulate immature teeth. Each type of irrigation protocols was performed. After application and setting of the root-end filling materials, a slice of one mm thickness was cut transversely from the apical end of each root. Specimens were stored for 1 month in artificial saliva and were subjected to a push-out test to evaluate the shear bond strength. Data were analyzed using two-way ANOVA and Tukey test.

RESULTS

The experimental nano-hybrid MTA showed the highest significant push-out bond strength values when irrigated by NaOCl at several concentrations (1%, 2.5% and 5.25%) (P< 0.05). Meanwhile, irrigation with 2% CHX resulted in highest bond strength values in nano-hybrid white MTA (18 MPa) and PMMA filled with 20% weight nHA (17.4 MPa) with nonsignificant difference between them (p = 0.25). In each root-end filling material, irrigation with 2% CHX led to the highest significant bond strength, followed by NaOCl 1%, while the least significant bond strength was produced after irrigation with NaOCl 2.5% and 5.25% (P< 0.05).

CONCLUSION

Considering the limitations of this study, it may be concluded that the application of 2% CXH and 17% EDTA provides superior push-out bond strength to root canal dentin compared with irrigation with NaOCl irrigants and 17% EDTA, experimental nano-hybrid MTA root-end filling material provides enhanced shear bond strength than conventional micron-sized MTA root-end filling material.

Enhanced effect of a novel bioactive glass-ceramic for dental application

OBJECTIVES

Dental caries is the most common chronic disease in humans, caused by the acid produced by the microflora in the mouth that dissolves the enamel minerals. Bioactive glass (BAG) has been used in various clinical applications due to its unique bioactive properties, such as bone graft substitutes and dental restorative composites. In this study, we introduce a novel bioactive glass-ceramic (NBGC) prepared through a sol-gel process under a water-free condition.

MATERIALS AND METHODS

The anti-demineralization and remineralization effects of NBGC were evaluated by comparing the measurements of bovine enamel surface morphology, surface roughness, surface micro-hardness, enamel elements, and mineral content before and after related treatments with a commercial BAG. The antibacterial effect was characterized by minimal inhibitory concentration (MIC) and minimal bactericidal concentration (MBC).

RESULTS

Results showed that NBGC had greater acid resistance and remineralization potential compared to commercial BAG. The fast formation of a hydroxy carbonate apatite (HCA) layer suggests efficient bioactivity.

CLINICAL RELEVANCE

In addition to its antibacterial properties, NBGC shows promise as an ingredient in oral care products that can prevent demineralization and restore enamel.

POSS and SSQ Materials in Dental Applications: Recent Advances and Future Outlooks

Recently, silsesquioxanes (SSQ) and polyhedral oligomeric silsesquioxanes (POSS) have gained much interest in the area of biomaterials, mainly due to their intrinsic properties such as biocompatibility, complete non-toxicity, the ability to self-assemble and to form a porous structure, facilitating cell proliferation, creating a superhydrophobic surface, osteoinductivity, and ability to bind hydroxyapatite. All the above has resulted in new developments in medicine. However, the application of POSS-containing materials in dentistry is still at initial stage and deserves a systematic description to ensure future development. Significant problems, such as reduction of polymerization shrinkage, water absorption, hydrolysis rate, poor adhesion and strength, unsatisfactory biocompatibility, and corrosion resistance of dental alloys, can be addressed by the design of multifunctional POSS-containing materials. Because of the presence of silsesquioxanes, it is possible to obtain smart materials that allow the stimulation of phosphates deposition and repairing of micro-cracks in dental fillings. Hybrid composites result in materials exhibiting shape memory, as well as antibacterial, self-cleaning, and self-healing properties. Moreover, introducing POSS into polymer matrix allows for materials for bone reconstruction, and wound healing. This review covers the recent developments in the field of POSS application in dental materials and gives the future perspectives within a promising field of biomedical material science and chemical engineering.

Evaluation of Mechanical Properties of 3D-Printed Polymeric Materials for Possible Application in Mouthguards

Custom mouthguards are used in various sports disciplines as a protection for teeth, temporomandibular joints, and soft tissues of the oral cavity from impact forces. The purpose of this research was to evaluate the mechanical properties of flexible polymeric 3D-printable materials and to select a material with the most favourable physical properties for making intraoral protectors. Four 3D-printable polymeric materials were selected for the evaluation: IMPRIMO LC IBT (Scheu-Dental, Iserlohn, Germany), Keyortho IBT (EnvisionTEC, Gladbeck, Germany), IBT (Formlabs, Somerville, MA, USA), and Ortho IBT (NextDent, Utrecht, Netherlands). A total of 176 samples (44 from each material) was 3D-printed using the stereolitography (SLA) technique. Tensile strength, flexural strength, notch-toughness, Shore hardness, sorption, and solubility tests were conducted. The materials were compared using a series of analyses of variance (one-way ANOVA) with Bonferroni post hoc tests. Statistical analyses were performed with the use of IBM SPSS Statistics 28.0.0 software (IBM, New York, NY, USA). Each material was assigned a score from 1 to 4 depending on the individual test results, and tests were given indexes according to the significance of the parameter in the mouthguard protective function. The number of points obtained by each material in each test was then multiplied by the test index, and the results were tabulated. The material with the highest result among the ones studied-most suitable for the application in mouthguard fabrication-was Keyortho IBT from EnvisionTEC.

Effect of Different Mouthwashes on the Surface Microhardness and Color Stability of Dental Nanohybrid Resin Composite

BACKGROUND

Surface microhardness and color stability of dental restorative material should be sustained throughout its functional lifetime to maintain the esthetic quality of the restoration. However, the frequent application of mouthwash may affect their surface microhardness and color stability. The aim of this study was to evaluate the effects of different types of mouthwashes with different contents on surface microhardness and color stability of dental nanohybrid resin-based composite.

METHODS

Disc specimens of nanohybrid resin composite (Luna Nano-Hybrid Composite) were prepared according to manufacturing instructions; specimens were incubated for 24 h in three types of mouthwash (Chlorohexidine, Listerine Green Tea, and Colgate Optic White Whitening Mouthwash). Artificial saliva was used as a control group. Surface microhardness was evaluated using Vickers microhardness device. Color stability after and before immersion in the different mouthwashes was evaluated using extra-oral spectrophotometer; the values of color change (ΔE₀₀) were subsequently calculated. Data were analyzed using one-way ANOVA and post hoc test (p ≤ 0.05).

RESULTS

There was no significant difference between microhardness of resin composite immersed in artificial saliva, CHX, and Green Tea mouthwashes (78.5, 78.4, and 73.5, respectively) (p ≥ 0.1), while the bleaching mouthwash led to the lowest microhardness of resin composite, with significant difference compared to the three previous immersion media (p = 0.002). Moreover, there were significant differences in the color changes (ΔE₀₀) of resin composite exposed to the various immersion media (p = 0.0001).

CONCLUSIONS

The bleaching mouthwash led to a significant reduction in nanohybrid resin composite's microhardness compared to the chlorohexidine and Green Tea containing mouthwashes. The resin composite's color change was accepted in bleaching mouthwash but unaccepted in chlorohexidine and Green Tea containing mouthwashes.

Global research on dental polymers and their application: A bibliometric analysis and knowledge mapping

Purpose

The main objective of the current study was to evaluate the top-cited articles, countries, journals, authors, and papers published related to dental polymers and their application. Research articles published from 1962 to 2021 on dental polymers and their application were identified using the Scopus database.

Methodology

Bibliographical data related to the abstract, citations, keywords, and other relevant information was extracted using different combinations of keywords. Further evaluation and visualization of the selected data were performed with the help of various tools, including MS Excel, Microsoft Word, Google open refine, Biblioshiny, BibExcel, and VOS viewer. An initial search revealed 351 documents, of which 327 were chosen for further analysis.

Results

A substantial increase in the number of publications related to this domain was observed. The United States was the most prolific country, while the Aristotle University of Thessaloniki from Greece was identified as the leading institute.

Conclusion

This bibliometric analysis can guide researchers, funding agencies, industry, and institutions.

Antimicrobial Effects of Gum Arabic-Silver Nanoparticles against Oral Pathogens

Dental caries is considered one of the most prevalent oral diseases worldwide, with a high rate of morbidity among populations. It is a chronic infectious disease with a multifactorial etiology that leads to the destruction of the dental tissues. Due to their antimicrobial, anti-inflammatory, antifungal, and antioxidant properties; silver nanoparticles (AgNPs) are incorporated in dental products to help prevent infectious oral diseases. In this study, the antimicrobial effects of AgNPs synthesized using Gum Arabic extracts (GAE) were examined. The GA-AgNPs were synthesized and characterized using ultraviolet-visible (UV-Vis) spectrophotometer, dynamic light scattering (DLS), transmission electron microscopy (TEM), and Fourier transform infrared (FTIR) spectroscopy. The antimicrobial activity of the GA-AgNPs was evaluated on Streptococcus sanguinis (S. sanguinis), Streptococcus mutans (S. mutans), Lactobacillus acidophilus (L. acidophilus), and Candida albicans (C. albicans) using agar disc diffusion and microdilution assays. The antibiofilm of GA-AgNPs was evaluated on the surface of human tooth enamel that had been exposed to S. mutans with and without the GA-AgNPs using scanning electron microscopy (SEM). GA-AgNPs were spherical in shape with a particle size distribution between 4 and 26 nm. The GA-AgNPs exhibited antimicrobial activity against all the tested oral microbes, with GA-AgNPs_0.4g having higher antimicrobial activity. The GA-AgNPs_0.4g inhibited S. mutans adhesion and biofilm formation on the surface of the tooth enamel. Therefore, this study supports the prospective implementation of the plant extract-mediated AgNPs in dental healthcare.

Evaluation of stress and strain on mandible caused using “All-on-Four” system from PEEK in hybrid prosthesis: finite-element analysis

Hybrid prostheses have recently been used as suitable treatment alternatives for edentulous individuals to restore the mastication mechanism. These prostheses utilize “All on four” concept, in which four implants are inserted into the jaw bone, and supported by a bar. Titanium is usually used in the fabrication of “All on four” parts due to its good mechanical properties. However, it has many drawbacks including esthetic impairment, casting issues, hypersensitivity reactions, stress shielding, and incompatibility with imaging techniques. These drawbacks have prompted researchers to find alternative materials (e.g., polymers). Recently, the new polymeric material PEEK has a major role in dentistry, due to its biocompatibility, shock-absorbing ability, and good mechanical properties. This work used the finite-element method to conduct stress–strain analysis on mandible rehabilitated with a hybrid prosthesis, using PEEK in the fabrication of “All on four” parts instead of titanium, using different densities of spongy bone. As the density of spongy bone is expected to influence the choice of “All on four” fabrication material. A 300 N vertical force was applied unilaterally, bilaterally, and anteriorly to stimulate the different mastication mechanisms. The results illustrated that PEEK material reduced the stresses and strains on bone tissues and increased the mucosal stress, compared to titanium. Consequently, this material was recommended to be used in the fabrication of “All on four” parts, especially in the low-density model. However, further research on PEEK implants and abutments is required in near future.