Self-cleaning effects of acrylic resin containing fluoridated apatite-coated titanium dioxide

Different Polymers for the Base of Removable Dentures? Part II: A Narrative Review of the Dynamics of Microbial Plaque Formation on Dentures

This review focuses on the current disparities and gaps in research on the characteristics of the oral ecosystem of denture wearers, making a unique contribution to the literature on this topic. We aimed to synthesize the literature on the state of current knowledge concerning the biological behavior of the different polymers used in prosthetics. Whichever polymer is used in the composition of the prosthetic base (poly methyl methacrylate acrylic (PMMA), polyamide (PA), or polyether ether ketone (PEEK)), the simple presence of a removable prosthesis in the oral cavity can disturb the balance of the oral microbiota. This phenomenon is aggravated by poor oral hygiene, resulting in an increased microbial load coupled with the reduced salivation that is associated with older patients. In 15-70% of patients, this imbalance leads to the appearance of inflammation under the prosthesis (denture stomatitis, DS). DS is dependent on the equilibrium-as well as on the reciprocal, fragile, and constantly dynamic conditions-between the host and the microbiome in the oral cavity. Several local and general parameters contribute to this balance. Locally, the formation of microbial plaque on dentures (DMP) depends on the phenomena of adhesion, aggregation, and accumulation of microorganisms. To limit DMP, apart from oral and lifestyle hygiene, the prosthesis must be polished and regularly immersed in a disinfectant bath. It can also be covered with an insulating coating. In the long term, relining and maintenance of the prosthesis must also be established to control microbial proliferation. On the other hand, several general conditions specific to the host (aging; heredity; allergies; diseases such as diabetes mellitus or cardiovascular, respiratory, or digestive diseases; and immunodeficiencies) can make the management of DS difficult. Thus, the second part of this review addresses the complexity of the management of DMP depending on the polymer used. The methodology followed in this review comprised the formulation of a search strategy, definition of the inclusion and exclusion criteria, and selection of studies for analysis. The PubMed database was searched independently for pertinent studies. A total of 213 titles were retrieved from the electronic databases, and after applying the exclusion criteria, we selected 84 articles on the possible microbial interactions between the prosthesis and the oral environment, with a particular emphasis on Candida albicans.

Denture Base Resin Coated with Titanium Dioxide (TiO2): A Systematic Review

Background

The main objective of this systematic review was to evaluate the effect of coating with titanium dioxide nanoparticles (TiO2 nanoparticle) on the surface condition of removable acrylic resin prosthetic base materials.

Methods

Our review is registered in the PROSPERO database under the identification code CRD42023397170. Electronic database searches of PubMed, Scopus and Science Direct including studies from January 2009 to January 2023 were conducted and supplemented with manual searches. Research questions were generated in accordance with the PICO strategy. The modified Consolidated Standards of Reporting Trials (CONSORT) checklist was used to evaluate the quality of the selected studies.

Results

Since the included studies were variable in design, a meta-analysis was not performed. The electronic searches retrieved 29 references that met the eligibility criteria, among which 5 studies matched the inclusion criteria for this review. Significant differences were detected between the TiO2 NP-coated and uncoated groups. The available data indicate that TiO2 NP coating elicits antimicrobial activity and improves the wear resistance of polymethylmethacrylate (PMMA) surfaces. Moreover, the nanoparticles provide high levels of glossiness and decelerate the process of color change of heat-cured acrylic resin, thus increasing the lifespan of dentures.

Conclusion

The collective results clearly indicate that TiO2 nanoparticle coating induces alterations in the surface properties of pure PMMA, enhancing the mechanical, physical and biological characteristics of the denture base material. Further studies are essential to identify the optimal thickness of coating and concentrations of nanoparticles for clinical applications.

Overview of incorporation of inorganic antimicrobial materials in denture base resin: A scoping review

STATEMENT OF PROBLEM

Dental hygiene for institutionalized patients and recurring Candida-associated denture stomatitis remain problematic because of a patient's limited dexterity or inability to eliminate Candida from denture surfaces. Although there has been extensive research into antimicrobial modification of denture base resins with inorganic materials, scoping reviews of the literature to identify knowledge gaps or efficacy of inorganic antimicrobial materials in denture base resins are lacking.

PURPOSE

The purpose of this scoping review was to provide a synopsis of the efficacy of the major classes of inorganic antimicrobial materials currently incorporated into denture base resins.

MATERIAL AND METHODS

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension for scoping reviews was applied. Four electronic databases, including Embase, PubMed, Web of Science, and Google Scholar, were accessed for articles in the English language, up to February 2019, without restrictions on the date of publication.

RESULTS

From the 53 articles selected, 25 distinguishable inorganic materials were found and divided into 3 subgroups. Forty-three articles evaluated nanomaterials, where mostly silver ion nanoparticles and/or titanium dioxide nanoparticles were incorporated into denture base resins. Fourteen articles examined antimicrobial drugs and medications, including azole group medications, amphotericin-B, Bactekiller, chlorhexidine, Novaron, and Zeomic. Two articles classified as others explored hydroxyapatite- and fiber-incorporated denture base resins.

CONCLUSIONS

Although nanotechnology and antimicrobial medications or drugs have been successfully used to reduce Candida-associated denture stomatitis, long-term solutions are still lacking, and their disadvantages continue to outweigh their advantages.

Polymeric Denture Base Materials: A Review

An ideal denture base must have good physical and mechanical properties, biocompatibility, and esthetic properties. Various polymeric materials have been used to construct denture bases. Polymethyl methacrylate (PMMA) is the most used biomaterial for dentures fabrication due to its favorable properties, which include ease of processing and pigmenting, sufficient mechanical properties, economy, and low toxicity. This article aimed to comprehensively review the current knowledge about denture base materials (DBMs) types, properties, modifications, applications, and construction methods. We searched for articles about denture base materials in PubMed, Scopus, and Embase. Journals covering topics including dental materials, prosthodontics, and restorative dentistry were also combed through. Denture base material variations, types, qualities, applications, and fabrication research published in English were considered. Although PMMA has several benefits and gained popularity as a denture base material, it has certain limitations and cannot be classified as an ideal biomaterial for fabricating dental prostheses. Accordingly, several studies have been performed to enhance the physical and mechanical properties of PMMA by chemical modifications and mechanical reinforcement using fibers, nanofillers, and hybrid materials. This review aimed to update the current knowledge about DBMs' types, properties, applications, and recent developments. There is a need for specific research to improve their biological properties due to patient and dental staff adverse reactions to possibly harmful substances produced during their manufacturing and use.

BNN/TiO2 nanocomposite system-modified dental flow resins and the mechanism of the enhancement of mechanical and antibacterial properties

Robust and antibacterial dental resins are essential for repairing the shape and function of the teeth. However, an ingenious way to achieve a synergistic enhancement of these two properties is still lacking. In this work, guided by molecular dynamics (MD) calculations, a boron nitride nanosheet (BNN)/titanium dioxide (TiO2) nanocomposite system was synthesized and used to modify the dental flow resin to enhance its mechanical and antimicrobial properties. The mechanical and antimicrobial enhancement mechanisms were further explored. The modified resin demonstrated outstanding performance improvement with 88.23%, 58.47%, 82.01%, and 55.06% improvement in compressive strength (CS), microhardness (MH), flexural strength (FS), and elastic modulus (EM), respectively. Moreover, the modified resin could effectively inhibit the growth of Streptococcus mutans (S. mutans) regardless of aging in water and the inhibition rates were more than 90%. In conclusion, the modified resin is expected to be an ideal restorative material for clinical applications.

PMMA-Based Nanocomposites for Odontology Applications: A State-of-the-Art

Polymethyl methacrylate (PMMA), a well-known polymer of the methacrylate family, is extensively used in biomedicine, particularly in odontological applications including artificial teeth, dentures and denture bases, obturators, provisional or permanent crowns, and so forth. The exceptional PMMA properties, including aesthetics, inexpensiveness, simple manipulation, low density, and adjustable mechanical properties, make it a perfect candidate in the field of dentistry. However, it presents some deficiencies, including weakness regarding hydrolytic degradation, poor fracture toughness, and a lack of antibacterial activity. To further enhance its properties and solve these drawbacks, different approaches can be performed, including the incorporation of nanofillers. In this regard, different types of metallic nanoparticles, metal oxide nanofillers, and carbon-based nanomaterials have been recently integrated into PMMA matrices with the aim to reduce water absorption and improve their performance, namely their thermal and flexural properties. In this review, recent studies regarding the development of PMMA-based nanocomposites for odontology applications are summarized and future perspectives are highlighted.

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.

Silver-hydroxyapatite nanocomposites prepared by three sequential reaction steps in one pot and their bioactivities in vitro

Hydroxyapatite (HA) combined with antimicrobial agents for biomedical application can effectively avoid the bacteria infection, while HA have the good performance. In this study, we prepared silver-hydroxyapatite (Ag-HA) nanocomposites using a one-pot method consisting of three sequential steps of wet chemical precipitation, ion exchange, and a silver mirror reaction. The HA nanoparticles used as the precursor for Ag ion doping were first synthesised by wet chemical precipitation. Next, Ag⁺ absorbed on HA surface through ion exchange reaction. Glucose was then added to initiate the silver mirror reaction, which made the Ag⁺ ions reduce to Ag⁰ and Ag nanoparticles in situ formed on HA nanoparticles. Subsequently, Ag-HA nanocomposites with different Ag content were prepared. X-ray diffraction, SEM, EDX mapping and TEM imaging confirmed that spherical Ag nanoparticles ~20-40 nm in diameter were adhered to the surface of HA nano-rods (0.4-0.8 μm in length and 15-40 nm in diameter). The Ag content (1.9-15.2 wt%) in the Ag-HA nanocomposites was adjusted by varying the feeding Ag/Ca molar ratio (2.0-20%). The cell viability evaluation in vitro proved that Ag-HA nanocomposites had low cytotoxicity to L929 normal cells. Meanwhile, the antibacterial examinations in vitro demonstrated that Ag-HA nanocomposites had obvious antibacterial effects on Gram-positive bacteria, Gram-negative bacteria, and fungus. The antibacterial results were dose-dependent on the accumulation of silver content. The Ag-HA nanocomposites loaded PMMA resins also demonstrated a potential antibacterial activity against S. mutans. This paper presents a convenient and bio-friendly approach for preparing Ag-HA nanocomposites with adjustable Ag content, which are a promising material for biomedical applications.

Prosthodontic Applications of Polymethyl Methacrylate (PMMA): An Update

A wide range of polymers are commonly used for various applications in prosthodontics. Polymethyl methacrylate (PMMA) is commonly used for prosthetic dental applications, including the fabrication of artificial teeth, denture bases, dentures, obturators, orthodontic retainers, temporary or provisional crowns, and for the repair of dental prostheses. Additional dental applications of PMMA include occlusal splints, printed or milled casts, dies for treatment planning, and the embedding of tooth specimens for research purposes. The unique properties of PMMA, such as its low density, aesthetics, cost-effectiveness, ease of manipulation, and tailorable physical and mechanical properties, make it a suitable and popular biomaterial for these dental applications. To further improve the properties (thermal properties, water sorption, solubility, impact strength, flexural strength) of PMMA, several chemical modifications and mechanical reinforcement techniques using various types of fibers, nanoparticles, and nanotubes have been reported recently. The present article comprehensively reviews various aspects and properties of PMMA biomaterials, mainly for prosthodontic applications. In addition, recent updates and modifications to enhance the physical and mechanical properties of PMMA are also discussed.

Incorporation of antimicrobial agents in denture base resin: A systematic review

STATEMENT OF PROBLEM

Denture base resins (DBRs), such as polymethyl methacrylate, are commonly used in the fabrication of removable dentures because of their physical, mechanical, and esthetic properties. However, the denture base acts as a substrate for microorganism adherence and biofilm formation, which may lead to denture stomatitis and be further complicated by fungal infections, of especial importance with geriatric and immunosuppressed patients. Therefore, methods to enhance the antimicrobial property of DBRs will be beneficial.

PURPOSE

The purpose of this systematic review was to evaluate the literature on the antimicrobial activity of DBRs incorporating antimicrobial agents or materials.

MATERIAL AND METHODS

A search of English peer-reviewed literature up to February 2019 reporting on antimicrobial activity of DBRs with respect to antimicrobial agents or materials, antimicrobial test effects and methods, and conclusion or knowledge gaps was conducted by using Embase, Google Scholar, PubMed, and Web of Science databases. Search terms included denture base resin and antibacterial, denture base resin and antifungal, and denture base resin and antimicrobial. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were applied for subsequent data analysis.

RESULTS

Of 2536 identified articles, 28 met the inclusion criteria for the systematic review. Antimicrobial materials were divided into 3 groups: antimicrobial monomer or copolymer, phytochemical or phytomedical components, and other compounds. Strategies on how to incorporate these substances into DBRs and their impact on the reduction and prevention of the growth of microorganisms were identified.

CONCLUSIONS

Although many efforts have been made to improve the antimicrobial ability of DBRs, this systematic review found that the effectiveness of incorporating of antimicrobial agents into DBRs has not been demonstrated conclusively.

Polymeric and inorganic nanoscopical antimicrobial fillers in dentistry

Failure of dental treatments is mainly due to the biofilm accumulated on the dental materials. Many investigations have been conducted on the advancements of antimicrobial dental materials. Polymeric and inorganic nanoscopical agents are capable of inhibiting microorganism proliferation. Applying them as fillers in dental materials can achieve enhanced microbicidal ability. The present review provides a broad overview on the state-of-the-art research in the field of antimicrobial fillers which have been adopted for incorporation into dental materials over the last 5 years. The antibacterial agents and applications are described, with the aim of providing information for future investigations. STATEMENT OF SIGNIFICANCE: Microbial infection is the primary cause of dental treatment failure. The present review provides an overview on the state-of-art in the field of antimicrobial nanoscopical or polymeric fillers that have been applied in dental materials. Trends in the biotechnological development of these antimicrobial fillers over the last 5 years are reviewed to provide a backdrop for further advancement in this field of research.

Effect of adding TiO2 nanoparticles on the SEM morphology and mechanical properties of conventional heat-cured acrylic resin

Background. The current study evaluated the compressive, flexural and impact strengths of heat-cured acrylic resins reinforced by TiO₂ nanoparticles (NPs).

Methods. TiO₂ NPs were provided and characterized using scanning electron microscopy (SEM) to determine their morphology and crystalline structure. For three mechanical tests, 12 acrylic resin groups (n=9), totaling 108 specimens, were prepared using a special mold for each test, with TiO₂ nanoparticle contents of 0, 0.5, 1 or 2 wt% in different groups. After curing, the compressive, flexural and impact strengths of the specimens were examined according to ISO 1567.

Results. In the SEM and XRD study of TiO2 NPs, anatase was identified as the major crystalline phase followed by rutile (average particle size: 20.4 nm). SEM images showed that the nanocomposite with 1 wt% NPs had a more homogenized blend. 1 wt% TiO₂ nanocomposite exhibited a higher, but non-significant, impact strength compared to the controls. ANOVA showed significant differences in the impact and flexural strengths between nanocomposites with various contents of TiO2 NPs.

Conclusion. The nanocomposite with 1 wt% TiO2 NPs exhibited fewer micro-pores and micro-cracks in the SEM crosssections. A non-significant increase was also observed in the impact strength with TiO₂ NPs at 1 wt%. Further increase in TiO₂ NPs decreased both the impact and flexural strengths. The compressive strength of the heat-cured acrylic resin was not affected by the incorporation of NPs.

The effect of nanodiamonds on candida albicans adhesion and surface characteristics of PMMA denture base material - an in vitro study

Candida albicans is the main causative pathogen of denture stomatitis, which affects many complete denture patients. Objective: To evaluate the effect of different concentrations of nanodiamonds (NDs) added to polymethyl methacrylate (PMMA) denture base material on Candida albicans adhesion as well as on surface roughness and contact angle. Methodology: Acrylic resin specimens sized 10×10×3 mm³ were prepared and divided into four groups (n=30) according to ND concentration (0%, 0.5%, 1%, 1.5% by wt). Surface roughness was measured with a profilometer, and the contact angle with a goniometer. The effect of NDs on Candida albicans adhesion was evaluated using two methods: 1) slide count and 2) direct culture test. Analysis of variance (ANOVA) and Tukey's post hoc test were used in the statistical analyses. Results: Addition of NDs decreased the Candida albicans count significantly more than in the control group (p<0.05), with a lowest of 1% NDs. Addition of NDs also significantly decreased the surface roughness (p<0.05), but the contact angle remained the same. Incorporation of NDs into the PMMA denture base material effectively reduced Candida albicans adhesion and decreased surface roughness. Conclusion: PMMA/NDs composites could be valuable in the prevention of denture stomatitis, which is considered one of the most common clinical problems among removable denture wearers.

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

This paper reviews acrylic denture base resin enhancement during the past few decades. Specific attention is given to the effect of fiber, filler, and nanofiller addition on poly(methyl methacrylate) (PMMA) properties. The review is based on scientific reviews, papers, and abstracts, as well as studies concerning the effect of additives, fibers, fillers, and reinforcement materials on PMMA, published between 1974 and 2016. Many studies have reported improvement of PMMA denture base material with the addition of fillers, fibers, nanofiller, and hybrid reinforcement. However, most of the studies were limited to in vitro investigations without bioactivity and clinical implications. Considering the findings of the review, there is no ideal denture base material, but the properties of PMMA could be improved with some modifications, especially with silanized nanoparticle addition and a hybrid reinforcement system.

Inhibition of denture plaque by TiO2 coating on denture base resins in the mouth

STATEMENT OF PROBLEM

Information is lacking about antiadhesion effect of titanium dioxide (TiO₂) coating on denture base resins in the mouth.

PURPOSE

The purpose of this clinical study was to investigate the antiadhesion effect of TiO₂ coating on denture base resins.

MATERIAL AND METHODS

Ten healthy dentate participants (mean 27 ±2 years of age) participated in this study. Disks and palatal appliances were made with denture base resin. They were divided into 2 groups: a TiO₂-coated group and an uncoated group. A primer and a top coat containing TiO₂ were applied to the surfaces of the resin by means of an air spray. In the denture plaque staining test, resin disks were fixed to the retainer, placed in each participant's mouth for 3 days, and stained with a dental plaque-disclosing solution. The staining rate was calculated. The resin disks and palatal appliances were used to measure the total number of microbes. The resin specimens were placed in each participant's mouth for either 3 or 7 days and swabbed to count the total number of microbes. The chewing gum adherence test was performed both subjectively and objectively. Subjectively, each participant wearing a palatal appliance rated adherence using a visual analog scale. The objective test was performed with a chewing gum adhesion test. The staining rate, the total number of microbes, and the visual analog scale values were statistically analyzed using the Wilcoxon signed rank test, and the adhesive force was statistically analyzed using a Student t test.

RESULTS

In the denture plaque staining test, the measurement of microbes, and the resin chewing gum adherence test results, significant differences were observed between the TiO₂-coated groups and the uncoated groups.

CONCLUSIONS

TiO₂ coating of the denture base acrylic resin inhibited the adhesion of microbes, denture plaque, and highly adhesive food.

Biocompatibility of a titanium dioxide-coating method for denture base acrylic resin

OBJECTIVES

Ease of denture cleaning is of paramount importance in geriatric patients and those with limited dexterity. We have previously investigated methods of coating dentures with titanium dioxide (TiO₂ ) and reported the effects (self-cleaning and antibacterial) of such treatments in in vitro studies. This study was to verify the biocompatibility of a TiO₂ -coated acrylic resin produced by the new coating method with spray-coating technique.

METHODS

Specimens were prepared from denture base acrylic resin and polished up to grit #1000. The TiO₂ -coating agent was sprayed onto the specimens using an airbrush gun. Specimens were then divided into 'polymethyl methacrylate (PMMA)', 'primer-coated PMMA' and 'TiO₂ -coated PMMA' groups to be evaluated for biological safety using a hamster oral mucosa irritation test, a guinea pig skin sensitisation test and a rabbit intracutaneous test. The biological reaction was scored.

RESULTS

Reaction scores were considerably <1.0, the acceptable limit set by the ISO, in all three tests. Indeed, in most samples, there was no deleterious effect at all.

CONCLUSION

These results tested on animals demonstrate that denture base resin coated with TiO₂ by this method does not cause irritation or sensitisation of the oral mucosa, skin or intracutaneous tissue and is therefore good biocompatibility for use in close proximity to oral mucosa and skin.