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

Mapping the research landscape of nanoparticles and their use in denture base resins: a bibliometric analysis

BACKGROUND

Nanoparticles are increasingly used in dentistry for various applications, including enhancing the mechanical properties of denture base resins. This study aimed to comprehensively review and analyze the research landscape of nanoparticles and their effect on the flexural strength of denture base resins to identify key research areas and trends and to highlight the importance of collaboration between authors and institutions.

METHODS

A Bibliometric Analysis was conducted using the Keywords "Nanoparticle*" AND "Denture*" OR "CAD/CAM." The literature search from the WOS database was restricted to the publication years 2011 to 2022.

RESULTS

Key findings encompass an increase in research publications but a decline in citations. Saudi Arabia, China, and Iraq led this research, with specific institutions excelling. Notable journals with high impact factors were identified. Authorship patterns show variations in citation impact. Additionally, keyword analysis revealed that current research trends offer insights into influential authors and their networks.

CONCLUSIONS

The analysis of nanoparticles and denture base resins reveals a dynamic and evolving landscape that emphasizes the importance of collaboration, staying current with research trends, and conducting high-quality research in this ever-evolving domain.

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

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

Fullerenes on a Nanodiamond Platform Demonstrate Antibacterial Activity with Low Cytotoxicity

Carbon nanoparticles with antimicrobial properties, such as fullerenes, can be distinguished among the promising means of combating pathogens characterized by resistance to commercial antibiotics. However, they have a number of limitations for their use in medicine. In particular, the insolubility of carbon nanoparticles in water leads to a low biocompatibility and especially strong aggregation when transferred to liquid media. To overcome the negative factors and enhance the action of fullerenes in an extended range of applications, for example, in antimicrobial photodynamic therapy, we created new water-soluble complexes containing, in addition to C60 fullerene, purified detonation nanodiamonds (AC960) and/or polyvinylpyrrolidone (PVP). The in vitro antibacterial activity and toxicity to human cells of the three-component complex C60+AC960+PVP were analyzed in comparison with binary C60+PVP and C60+AC960. All complexes showed a low toxicity to cultured human skin fibroblasts and ECV lines, as well as significant antimicrobial activity, which depend on the type of microorganisms exposed, the chemical composition of the complex, its dosage and exposure time. Complex C60+PVP+AC960 at a concentration of 175 µg/mL showed the most stable and pronounced inhibitory microbicidal/microbiostatic effect.

Evaluation of the Effects of Different Polishing Protocols on the Surface Characterizations of 3D-Printed Acrylic Denture Base Resins: An In Vitro Study

Chairside polishing kits are an alternative to laboratory polishing techniques. The effects of using a chairside polishing kit on a three-dimensional (3D)-printed acrylic denture base (ADB) have not been reported previously. Thus, this study aimed to evaluate the effects of different chairside polishing techniques on the surface characterizations of ABD, including surface roughness average (Ra), average maximum profile height (Rz), and scanning electron microscopy (SEM) representations. One hundred and twenty disc-shaped specimens were fabricated from one conventional heat-polymerized (HP) ADB resin and two 3D-printed (Asiga (AS) and NextDent (ND)) ADB resins (n = 40 per material). Each group was further divided based on the polishing protocol (n = 10) as follows: conventional polishing protocol (C), microdont chairside polishing kit (M), shofu chairside polishing kit (S), and an unpolished group (U). The Ra and Rz values were measured using an optical profilometer. Two-way ANOVA and post hoc tests were used for data analysis (α = 0.05) at significant levels. In unpolished groups, there was a statistically significant difference between HP-U vs. AS-U and ND-U groups (p < 0.0001). For Ra, the lowest values were observed in HP-C, AS-S, and ND-C. While the highest values were shown in all unpolished groups. Within the material, there were statistically significant differences between the three polishing protocols (C, M, and S) vs. unpolished (p < 0.0001), while there was no significant between C, M, and S groups (p = 0.05). The Rz values had the same pattern as the Ra values. The two chairside polishing kits were comparable to conventional polishing techniques, and they can be recommended for clinical application.

The Contribution of BaTiO3 to the Stability Improvement of Ethylene-Propylene-Diene Rubber: Part I-Pristine Filler

This study presents the functional effects of BaTiO₃ powder loaded in ethylene-propylene-diene rubber (EPDM) in three concentrations: 0, 1, and 2.5 phr. The characterization of mechanical properties, oxidation strength, and biological vulnerability is achieved on these materials subjected to an accelerated degradation stimulated by their γ-irradiation at 50 and 100 kGy. The thermal performances of these materials are improved when the content of filler becomes higher. The results obtained by chemiluminescence, FTIR-ATR, and mechanical testing indicate that the loading of 2.5 phr is the most proper composition that resists for a long time after it is γ-irradiated at a high dose. If the oxidation starts at 176 °C in the pristine polymer, it becomes significant at 188 and 210 °C in the case of composites containing 1 and 2.5 phr of filler, respectively. The radiation treatment induces a significant stability improvement measured by the enlargement of temperature range by more than 1.5 times, which explains the durability growth for the radiation-processed studied composites. The extension of the stability period is also based on the interaction between degrading polymer substrate and particle surface in the composite richest in titanate fraction when the exposure is 100 kGy was analyzed. The mechanical testing as well as the FTIR investigation clearly delimits the positive effects of carbon black on the functionality of EPDM/BaTiO₃ composites. The contribution of carbon black is a defining feature of the studied composites based on the nucleation of the host matrix by which the polymer properties are effectively ameliorated.

Antibiofilm Activity of 3D-Printed Nanocomposite Resin: Impact of ZrO2 Nanoparticles

Poly(methyl methacrylate) (PMMA) is a commonly used material, as it is biocompatible and relatively cheap. However, its mechanical properties and weak antibiofilm activity are major concerns. With the development of new technology, 3D-printed resins are emerging as replacements for PMMA. Few studies have investigated the antibiofilm activity of 3D-printed resins. Therefore, this study aimed to investigate the antibiofilm activity and surface roughness of a 3D-printed denture base resin modified with different concentrations of zirconium dioxide nanoparticles (ZrO₂ NPs). A total of 60 resin disc specimens (15 × 2 mm) were fabricated and divided into six groups (n = 10). The groups comprised a heat-polymerized resin (PMMA) group, an unmodified 3D-printed resin (NextDent) group, and four 3D-printed resin groups that were modified with ZrO₂ NPs at various concentrations (0.5 wt%, 1 wt%, 3 wt%, and 5 wt%). All specimens were polished using a conventional method and then placed in a thermocycler machine for 5000 cycles. Surface roughness (Ra, µm) was measured using a non-contact profilometer. The adhesion of Candida albicans (C. albicans) was measured using a fungal adhesion assay that consisted of a colony forming unit assay and a cell proliferation assay. The data were analyzed using Shapiro-Wilk and Kruskal-Wallis tests. A Mann-Whitney U test was used for pairwise comparison, and p-values of less than 0.05 were considered statistically significant. The lowest Ra value (0.88 ± 0.087 µm) was recorded for the PMMA group. In comparison to the PMMA group, the 3% ZrO₂ NPs 3D-printed group showed a significant increase in Ra (p < 0.025). For the 3D-printed resins, significant differences were found between the groups with 0% vs. 3% ZrO₂ NPs and 3% vs. 5% ZrO₂ NPs (p < 0.025). The highest Ra value (0.96 ± 0.06 µm) was recorded for the 3% ZrO₂ NPs group, and the lowest Ra values (0.91 ± 0.03 µm) were recorded for the 0.5% and 5% ZrO₂ NPs groups. In terms of antifungal activity, the cell proliferation assay showed a significant decrease in the C. albicans count for the 0.5% ZrO₂ NPs group when compared with PMMA and all other groups of 3D-printed resins. The group with the lowest concentration of ZrO₂ NPs (0.5%) showed the lowest level of C. albicans adhesion of all the tested groups and showed the lowest Candida count (0.29 ± 0.03). The addition of ZrO₂ NPs in low concentrations did not affect the surface roughness of the 3D-printed resins. These 3D-printed resins with low concentrations of nanocomposites could be used as possible materials for the prevention and treatment of denture stomatitis, due to their antibiofilm activities.

Prospects on Tuning Bioactive and Antimicrobial Denture Base Resin Materials: A Narrative Review

Denture base resin (DBR) materials are used in dentistry in constructing removable dentures and implant-supported prostheses. A plethora of evidence has demonstrated that DBR materials are associated with a high risk of denture stomatitis, a clinical complication where the soft oral tissues underneath the resin-based material are inflamed. The prevalence of denture stomatitis among denture wearers is high worldwide. Plaque accumulation and the infiltration of oral microbes into DBRs are among the main risk factors for denture stomatitis. The attachment of fungal species, mainly Candida albicans, to DBRs can irritate the underneath soft tissues, leading to the onset of the disease. As a result, several attempts were achieved to functionalize antimicrobial compounds and particles into DBRs to prevent microbial attachment. This review article explored the advanced approaches in designing bioactive and antimicrobial DBR materials. It was reported that using monomer mixtures, quaternary ammonium compounds (QACs), and organic and inorganic particles can suppress the growth of denture stomatitis-related pathogens. This paper also highlighted the importance of characterizing bioactive DBRs to be mechanically and physically sustainable. Future directions may implement a clinical translational model to attempt these materials inside the oral cavity.

Antibacterial Effect of Zirconia Nanoparticles on Polyethyl Methacrylate Resin for Provisional Crowns

Objective

Mid-to-long term use of provisional crowns in the oral cavity is associated with bacterial adhesion and biofilm formation, thus necessitating provisional crowns exhibiting antibacterial properties to prevent the occurrence of gingivitis and periodontal disease. This study aimed to evaluate the antibacterial effect of zirconia nanoparticle-containing polyethyl methacrylate (PEMA) resin for provisional restorations.

Methods

Zirconia nanoparticles were added to the monomer of PEMA resin for provisional restorations, and the mixture was stirred for 2 h using a magnetic stirrer. Disk-shaped specimens were prepared by mixing the polymer with the nanoparticle solution. The control group contained pure PEMA resin samples, and the experimental groups Group Z2, Group Z4, and Group Z8 included PEMA resin specimens containing 2, 4, and 8% w/v zirconia nanoparticles, respectively. After analyzing the sample surfaces, the antibacterial effect of the specimens was evaluated using Streptococcus mutans. Statistical analysis was performed using Tukey's test and Mann-Whitney U-test, according to the normality result in the Shapiro-Wilk test.

Results

FE-SEM and EDX analyses revealed the successful addition of zirconia nanoparticles. Results showed no significant difference in the measured values for surface roughness and contact angle between the experimental and control groups; however, adhesion and biofilm thickness of S. mutans were significantly decreased in Group Z2, Group Z4, and Group Z8 compared to the control group (P < 0.05, P < 0.01, P < 0.01, respectively).

Conclusion

The addition of zirconia nanoparticles can lower the incidence of adhesion and biofilm thickness of S. mutans on PEMA resin used for provisional crowns. Thus, incorporating zirconia nanoparticles in repair materials for provisional crowns and PEMA resin can produce an antibacterial effect and prevent gingivitis, periodontal disease, and dental caries.

Zinc-modified phosphate-based glass micro-filler improves Candida albicans resistance of auto-polymerized acrylic resin without altering mechanical performance

Colonization of auto-polymerized acrylic resin by pathogenic Candida albicans is a common problem for denture users. In this study, zinc-modified phosphate-based glass was introduced into an auto-polymerized acrylic resin at concentrations of 3, 5, and 7 wt.%. The mechanical or physical properties (flexural strength, elastic modulus, microhardness, and contact angle), surface morphology of the resultant materials, and the antimicrobial effect on C. albicans were investigated. There were no statistical differences in the mechanical properties between the control and the zinc-modified phosphate-based glass samples (p > 0.05); however, the number of C. albicans colony-forming units was significantly lower in the control group (p < 0.05). Scanning electron microscopy revealed that C. albicans tended not to adhere to the zinc-modified-phosphate-based glass samples. Thus, the zinc-modified materials retained the advantageous mechanical properties of unaltered acrylic resins, while simultaneously exhibiting a strong antimicrobial effect in vitro.

The Inflammation Level and a Microbiological Analysis of the Anophthalmic Cavities of Unilateral Ocular Prosthesis Users: A Blind, Randomized Observational Study

Irritation and biofilm adhesion are complaints associated with ocular prosthesis use. This study aimed to evaluate the effects of prosthesis repolishing on several conditions of anophthalmic volunteers. Participants were divided into two groups: intervention (IG, n = 10) and nonintervention (NIG, n = 6) groups. The anophthalmic cavity, contralateral eye, and prosthesis surface were evaluated at initial, day 15, and day 30 after repolishing. Microbiological analysis (colony-forming units), exfoliative cytology (conjunctiva inflammatory cells), sensory analysis (quantitative mechanical sensory test), tear production (Schirmer’s test), and conjunctival inflammation (clinical evaluation) were performed. Nonparametric tests were used to compare groups in the initial period and to analyze periods for the IG (p < 0.05). More microorganisms were formed in the anophthalmic socket and prosthesis than in the contralateral eye in the initial period. For IG, the anophthalmic cavity exhibited more microorganisms and inflammatory clinical signs in the initial period than at 15 and 30 after repolishing. The prosthesis showed greater accumulations of total bacteria and Candida albicans in the initial period than at 15 and 30 days after repolishing. The anophthalmic cavity had more palpebral inflammation than the contralateral eye. In conclusion, repolishing reduced the number of microorganisms and inflammatory signs over time.

Effect of surface prereacted glass ionomer nanofillers on fluoride release, flexural strength, and surface characteristics of polymethylmethacrylate resin

OBJECTIVE

Dentures should have proper fluoride release and physical properties. We evaluated how surface prereacted glass ionomer (S-PRG) nanofillers influenced fluoride release, flexural strength, and surface characteristics of polymethylmethacrylate (PMMA) resin.

MATERIALS AND METHODS

PMMA resin disc (n = 14) and rectangular (n = 5) specimens containing 0, 20 wt% microparticles, and 20 wt% nanoparticles of S-PRG were prepared. Six-disc specimens were examined for surface roughness; eight-disc specimens were immersed in 5 ml of deionized water for 24 h before analyzing the fluoride levels on days 1-3, 12, and 15. They were recharged with 1000 ppm fluoride solution for 24 h and stored in deionized water for five cycles. Fluoride release was examined. The flexural strength of the rectangular specimens was determined using a three-point bending test. Data were analyzed by two-way repeated-measures ANOVA.

RESULTS

S-PRG nanofiller had the highest fluoride exchange rate and did not significantly change the surface roughness compared with the microparticle and control groups; however, the nanofillers agglomerated and reduced the flexural strength to below 65 MPa.

CONCLUSIONS

Incorporating 20 wt% nanofillers into resin enhanced the fluoride exchange property greater than microfillers at the same content, but diminished the mechanical properties of the resin.

CLINICAL SIGNIFICANCE

Incorporating 20 wt% S-PRG nanofillers in resin denture base can improve the fluoride releasing property without affecting the surface roughness.

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.

Flexural Properties, Impact Strength, and Hardness of Nanodiamond-Modified PMMA Denture Base Resin

Purpose. Investigate the effect of low nanodiamond (ND) addition and autoclave polymerization on the flexural strength, impact strength, and hardness of polymethylmethacrylate (PMMA) denture base. Methods. A total of 240 heat polymerized PMMA were fabricated with low ND concentrations of 0.1%, 0.25%, and 0.5%, and unmodified as control. The specimens were divided equally into group I: conventionally polymerized PMMA by water bath and group II: polymerized by the autoclave. The impact strength, flexural strength, and elastic modulus were tested using the Charpy-type impact-testing machine and three-point bending test, respectively. A scanning electron microscope (SEM) was used to analyze the fractured surfaces. Surface hardness was measured by a hardness tester with a Vickers diamond. The bonding and interaction between the PMMA and ND particles were analyzed by the Fourier-transform infrared (FTIR) spectroscope. ANOVA and post hoc Tukey test were used for data analysis (α = 0.05). Results. ND addition significantly increased the flexural strength of groups I and II ( $p<0.001$ , $p=0.003$ ); it was highest (128.8 MPa) at 0.25% ND concentration for group I and at 0.1% for group II. Elastic modulus increased at 0.1% ND for both groups ( $p=0.004$ , $p=0.373$ ), but the increase was statistically significant for group I only. Impact strength showed no significant change with the addition of ND in groups I and II ( $p=0.227$ , $p=0.273$ ), as well as surface hardness in group I ( $p=0.143$ ). Hardness decreased significantly with 0.25%ND in group II. Conclusion. The addition of ND at low concentration increased the elastic modulus and flexural strength of conventionally and autoclave polymerized denture base resin. Autoclave polymerization significantly increased the flexural strength, impact strength, and hardness of unmodified PMMA and hardness of 0.5% ND group.

The denture microbiome in health and disease: an exploration of a unique community

The United Nations suggests the global population of denture wearers (an artificial device that acts as a replacement for teeth) is likely to rise significantly by the year 2050. Dentures become colonized by microbial biofilms, the composition of which is influenced by complex factors such as patient’s age and health, and the nature of the denture material. Since colonization (and subsequent biofilm formation) by some micro‐organisms can significantly impact the health of the denture wearer, the study of denture microbiology has long been of interest to researchers. The specific local and systemic health risks of denture plaque are different from those of dental plaque, particularly with respect to the presence of the opportunist pathogen Candida albicans and various other nonoral opportunists. Here, we reflect on advancements in our understanding of the relationship between micro‐organisms, dentures, and the host, and highlight how our growing knowledge of the microbiome, biofilms, and novel antimicrobial technologies may better inform diagnosis, treatment, and prevention of denture‐associated infections, thereby enhancing the quality and longevity of denture wearers.

Influence of Propolis Extract (Caffeic Acid Phenethyl Ester) Addition on the Candida albicans Adhesion and Surface Properties of Autopolymerized Acrylic Resin

Background. Denture stomatitis has been linked to the adhesion and proliferation of Candida albicans (C. albicans) on denture bases, which is a common and recurrent problem in denture wearers. The current study aimed to evaluate the effect of incorporating caffeic acid phenethyl ester (CAPE) into autopolymerized polymethyl methacrylate (PMMA) acrylic resin on C. albicans adhesion, surface roughness, and hardness as well as the correlation between tested properties. Methods. Autopolymerized acrylic resin discs (N = 100, 50/C. albicans adhesion; 50/C. albicans surface roughness and hardness test) were fabricated in dimensions 15 × 2.5 mm, samples were categorized into 5 groups (n = 10) based on CAPE concentrations; unmodified (control), 2.5, 5, 10 and 15% wt of acrylic powder. Specimens were stored in distilled water for 48 h at 37°C. C. albicans adhesion was evaluated via direct culture method. Profilometer and Vickers hardness tester were used for surface roughness and hardness measurement. Post hoc Tukey’s HSD with ANOVA test was performed to compare the difference of means amongst groups. $P$ values were statistically significant at ≤0.05. Results. The addition of 2.5% of CAPE to PMMA has significantly reduced C. albicans counts in comparison to higher CAPE concentrations ( $p<0.001$ ). As for surface roughness, it was noticed that it increased with increased CAPE concentrations ( $p<0.0001$ ). While surface hardness decreased as CAPE concentrations increased ( $p<0.0001$ ). All tested properties showed a significant difference amongst groups for C. albicans colony count and surface parameters. Conclusion. The addition of 2.5% of CAPE to PMMA acrylic resin significantly decreased C. albicans count compared to higher CAPE concentrations. CAPE can be used as an adjunct in the prevention of DS by incorporating in the PMMA acrylic resin.

How Effective Are Antimicrobial Agents on Preventing the Adhesion of Candida albicans to Denture Base Acrylic Resin Materials? A Systematic Review

Denture stomatitis is a common oral infection caused by Candid albicans. It occurs under removable dentures due to several causative and contributing factors. If not treated, it can lead to fatal systemic candida infections. Different materials and techniques have been used to treat denture stomatitis; however, no single treatment has succeeded. The purpose of this study was to review novel techniques for incorporating antimicrobial and protein repellent agents into denture acrylic resin materials and their effect on the adhesion of Candida albicans to denture base acrylic resin materials to prevent and/or treat denture stomatitis. A systematic review was conducted in which an electronic search was undertaken using different databases and relevant keywords. The literature search revealed numerous studies describing different antifungal materials incorporated into different denture acrylic resin materials. The investigated materials showed significant antimicrobial activity with slight or no effect on the physical and mechanical properties; however, the optical properties were particularly affected with higher concentrations. The incorporation of antimicrobial agents to reduce or prevent Candida albicans biofilm formation on acrylic resin proved to be very effective, and this effect was found to be proportional to the percentage of the material used. The latter should be considered carefully not to alter the physical, mechanical or optical characteristics of the denture base material.

Polymeric Dental Nanomaterials: Antimicrobial Action

This review aims to describe and critically analyze studies published over the past four years on the application of polymeric dental nanomaterials as antimicrobial materials in various fields of dentistry. Nanoparticles are promising antimicrobial additives to restoration materials. According to published data, composites based on silver nanoparticles, zinc(II), titanium(IV), magnesium(II), and copper(II) oxide nanoparticles, chitosan nanoparticles, calcium phosphate or fluoride nanoparticles, and nanodiamonds can be used in dental therapy and endodontics. Composites with nanoparticles of hydroxyapatite and bioactive glass proved to be of low efficiency for application in these fields. The materials applicable in orthodontics include nanodiamonds, silver nanoparticles, titanium(IV) and zinc(II) oxide nanoparticles, bioactive glass, and yttrium(III) fluoride nanoparticles. Composites of silver nanoparticles and zinc(II) oxide nanoparticles are used in periodontics, and nanodiamonds and silver, chitosan, and titanium(IV) oxide nanoparticles are employed in dental implantology and dental prosthetics. Composites based on titanium(IV) oxide can also be utilized in maxillofacial surgery to manufacture prostheses. Composites with copper(II) oxide nanoparticles and halloysite nanotubes are promising materials in the field of denture prosthetics. Composites with calcium(II) fluoride or phosphate nanoparticles can be used in therapeutic dentistry for tooth restoration.

Antifungal Polymeric Materials and Nanocomposites

Rising global populations due to medicinal advancements increases the patient population susceptible to superficial and severe fungal infections. Fungi often implicated in these diseases includes the dermatophytes (Microsporum spp., Epidermophtyon spp., Trichophyton spp.) as well as species of the Candida spp., Aspergillosis spp. and Cryptococcus spp. genera. In addition, increasing global populations leads to increasing agricultural demands. Thus, fungal infections of preharvested crops and stored food by plant pathogens such as Magnaporthe oryzae and Fusarium oxysporum can have detrimental socioeconomic effects due to food insecurity. Current antifungal strategies are based mainly on small molecule antifungal drugs. However, these drugs are limited by poor solubility and bioavailability. Furthermore, antifungal resistance against these drugs are on the rise. Thus, antimicrobial polymers offer an alternative antifungal strategy. Antifungal polymers are characterised by cationic and hydrophobic regions where the cationic regions have been shown to interact with microbial phospholipids and membranes. These polymers can be synthetic or natural and demonstrate distinct antifungal mechanisms ranging from fungal cell membrane permeabilisation, cell membrane depolarisation or cell entry. Although the relative importance of such mechanisms is difficult to decipher. Due to the chemical properties of these polymers, they can be combined with other antimicrobial compounds including existing antifungal drugs, charcoals, lipids and metal ions to elicit synergistic effects. In some cases, antifungal polymers and nanocomposites show better antifungal effects or reduced toxicity compared to the widely used small molecule antifungal drugs. This review provides an overview of antimicrobial polymers and nanocomposites with antifungal activity and the current understanding of their antifungal mechanisms.

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.

Effect of Low Nanodiamond Concentrations and Polymerization Techniques on Physical Properties and Antifungal Activities of Denture Base Resin

Background: Denture base resin has some drawbacks. This study investigated the impact of nanodiamonds (ND) and autoclave polymerization on the surface characteristics, translucency, and Candida albicans adherence in polymethyl methacrylate (PMMA) denture base resin after thermocycling. Methods: Heat-polymerized PMMA discs (15 × 2 mm) with a total sample size n = 160 were studied. Specimens were categorized into two main groups (N = 80): conventional water-bath-polymerized PMMA (CP/PMMA) and autoclave-polymerized PMMA (AP/PMMA). Each group was subdivided according to the ND concentration into four groups (n = 20): unmodified PMMA as a control, and 0.1%, 0.25%, and 0.5% ND–PMMA. Scanning electron microscopy (SEM) was used to inspect the morphology of the ND and the ND–PMMA mixtures before heat polymerization. The specimens were exposed to thermal cycling (5000 cycles at 5 and 55 °C), then surface roughness was measured with a non-contact optical interferometric profilometer, contact angle with an automated goniometer, and translucency using a spectrophotometer. Colony-forming units (CFU) were used to determine the adherence of Candida albicans cells to the specimens. ANOVA and Tukey post hoc tests for pairwise comparison were utilized for the statistical analysis (α = 0.05). Results: Surface roughness was significantly reduced with ND addition to CP/PMMA (p ˂ 0.001), while the reduction was not statistically significant in AP/PMMA (p = 0.831). The addition of ND significantly reduced the contact angle, translucency, and Candida albicans count of CP/PMMA and AP/PMMA (p ˂ 0.001). The incorporation of ND in conjunction with autoclave polymerization of PMMA showed significant reduction in all tested properties (surface roughness, contact angle and Candida albicans adherence) except translucency (p = 0.726). Conclusions: ND addition to PMMA and autoclave polymerization improved the surface properties with respect to antifungal activities, while the translucency was adversely affected.

Polymethylmethacrylate Incorporating Nanodiamonds for Denture Repair: In Vitro Study on the Mechanical Properties

OBJECTIVE

 This study aimed to evaluate the effect of nanodiamond (ND) addition to repair resin with repair gap modifications on the flexural and impact strength of repaired polymethylmethacrylate denture base.

MATERIALS AND METHODS

 Heat-polymerized acrylic resin specimens (N = 100/test) were prepared and sectioned to half creating two repair gaps: 2.5- and 0 mm with 45 degrees beveling. They were further divided into subgroups (n = 20) according to ND concentration (control, 0.25%ND, and 0.50%ND), thermocycling (500 cycles) was done to half the specimens in each subgroup. Flexural strength was tested using 3-point bending test and impact strength was tested by Charpy's impact test. Analysis of variance and post-hoc Tukey's tests were performed for data analysis (α = 0.05). Scanning electron microscope was employed for fracture surface analysis and ND distribution.

RESULTS

 Before and after thermocycling, the addition of ND significantly increased the flexural strength and elastic modulus in comparison to control group (p ˂ 0.001), while 0 mm repair gap showed insignificant difference between ND-reinforced groups (p ˃ 0.05). Regarding impact strength, ND addition increased the impact strength with 0 mm gap in comparison to control and 2.5 mm with ND (p˂0.001), while later groups showed no significant in between (p ˃ 0.05). Comparing thermocycling effect per respective concentration and repair gap, thermocycling adversely affected all tested properties except elastic modulus with 0 mm-0.25 and 0 mm-0.5% and impact strength with 2.5 mm, 2.5 mm-0.25%, 2.5 mm- 0.5% (p ˃ 0.05).

CONCLUSION

 ND addition combined with decreased repair gap improved the flexural strength, elastic modulus, and impact strength of repaired denture resin, while thermocycling has a negative effect on denture repair strength.

Evaluating Polishability of Zirconia Impregnated PMMA Nanocomposite for Denture Base Application

Artificial biomaterials are being developed for use in denture base with symmetrical properties to restore the aesthetics and functionalities. The rough surface of denture base resin promotes the adhesion of microorganisms and plaque accumulation. This study aimed to explore the consequences of polishing times on the surface roughness of high-impact (HI) heat-polymerized PMMA denture base acrylic resin reinforced with zirconia nanoparticles (nanocomposite). Thirty specimens (25 ± 0.50 mm in diameter and 2 ± 0.10 mm thickness) were fabricated from HI PMMA by adding zirconia nanoparticles at different concentrations of (0 wt.%, 1.5 wt.%, 3 wt.%, 5 wt.%, 7 wt.%, and 10 wt.%). Specimens were divided into six groups (n = 5) and surface roughness (Ra) was measured before and after polishing with a standard protocol for one and two minutes. The addition of zirconia in PMMA at low concentrations (1.5 wt.%, 3 wt.%, and 5 wt.%) did not negatively affect the surface finish of the denture base composites following conventional polishing and remained below the clinically acceptable limit (0.2 µm). After one minute of polishing, only the 10 wt.% zirconia (0.17 ± 0.03 µm) demonstrated a substantial rise in median surface roughness, in comparison with the control group (0.11 ± 0.01 µm). It is concluded that the group containing 3 wt.% (0.10 ± 0.01 µm) of zirconia is the optimum concentration to obtain the best symmetrical surface finish after two minutes of polishing.

The in-vitro effects of white henna addition on the Candida albicans adhesion and physical properties of denture base resin

Purpose:

This in-vitro study evaluated and compared the effect of white henna (WH) and natural henna (NH) addition on Candida albicans adhesion and physical properties of the denture base material.

Materials and methods:

A total of 243 acrylic resin specimens (9 per group) were divided as follows: 81 for flexural strength, 81 for Candida albicans adherence test, and 81 for surface roughness, translucency, and hardness. Heat-polymerized acrylic resin specimens were prepared by adding 0.5, 1.0, 1.5, or 2.0 wt% of WH or NH. Candida albicans adhesion was determined using direct culture and slide count methods. Flexural strength, surface roughness, hardness, and translucency were measured using the three-point bending test, profilometer, Vickers hardness test, and spectrophotometer, respectively. ANOVA and post hoc Tukey’s tests were performed for data analysis.

Results:

Addition of 0.5% WH, 1% WH, and 0.5% NH to denture base resin significantly decreased Candida albicans adhesion (p<0.05). WH and NH significantly decreased the flexural strength and translucency, except 0.5% WH, and significantly increased surface roughness, except 0.5% WH and 0.5% NH. WH addition showed nonsignificant differences in the hardness, while NH addition significantly decreased hardness (p<0.05).

Conclusion:

Addition of WH and NH decreased C. albicans adhesion to PMMA denture base resin. However, flexural strength, translucency, and surface roughness were adversely affected, particularly at higher concentrations. Hardness was reduced with NH only.

In Vitro Assessment of Artificial Aging on the Antifungal Activity of PMMA Denture Base Material Modified with ZrO2 Nanoparticles

The antifungal effect of zirconium dioxide nanoparticles (ZrO₂NPs) incorporated into denture base material has been inadequately investigated; additionally, to the authors' knowledge, no studies have assessed the influence of artificial aging on the antifungal activity of these particles. Methodology. Heat-polymerized acrylic resin disks were fabricated and divided into four groups (0%, 1%, 2.5%, and 5% ZrO₂NPs by weight). Antifungal activity was assessed using the direct culture and disk diffusion methods. Surface roughness and contact angles were measured using a profilometer and a goniometer, respectively. The artificial aging procedure was performed by repeating all tests at 7, 14, and 30 days following 2 rounds of thermocycling. Data were analyzed using ANOVA and Tukey's post-hoc test (p < 0.05). Results. The addition of ZrO₂NPs significantly decreased the adhesion of Candida albicans with and without artificial aging procedures (p < 0.001), while the disk diffusion methods did not reveal inhibition zones. ZrO₂NP-modified specimens displayed significantly higher surface roughness compared to specimens in the control group (p < 0.05) and showed the same behaviors with artificial aging procedures. The contact angle was significantly decreased in all modified groups in comparison to the control group (p < 0.05). Conclusion. The addition of ZrO₂NPs to polymethylmethacrylate denture base material reduced the adhesion of Candida albicans with a long-term antifungal effect. With the addition of ZrO₂NPs, contact angles were decreased and surface roughness was increased; 1% was the most appropriate concentration. Clinical significance. The addition of ZrO₂NPs to denture base material confers a long-term antifungal effect and could be used as a possible method for preventing and treating denture stomatitis.

Positive Effects of Saliva on Oral Candidiasis: Basic Research on the Analysis of Salivary Properties

The major causes of oral candidiasis include decreased salivary flow rate and the use of ill-fitting dentures. However, the relationships among prosthetic treatment, saliva, and Candida albicans have not been elucidated. This study aimed to examine the effects of prosthetic treatment and changes in saliva (mainly the salivary flow rate) on oral candidiasis symptoms. Participants requiring prosthetic treatment underwent testing for C. albicans, salivary flow rate, intraoral symptoms, and bite force at the initial visit and four months after treatment to evaluate pretreatment and post-treatment changes. The relationships among C. albicans, salivary flow rate, dentures, and intraoral symptoms were analyzed using multiple regression analysis. Denture treatment improved activity against C. albicans as well as the salivary flow rate, intraoral symptoms, and masticatory function. Multiple regression analysis revealed that changes in the stimulated salivary flow rate due to prosthetic treatment significantly improved C. albicans detection (p = 0.011), intraoral symptoms (p = 0.037), and bite force (p = 0.031). This study showed that prosthetic treatment improved salivary flow and intraoral symptoms and confirmed the influence of stimulated salivary flow rate changes.

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.

Investigation of Impact Strength, Water Sorption and Cytotoxicity of Denture Base Resin Reinforced with Polypropylene Fiber: In Vitro Study

Aim:

Polymethyl methacrylate is the common material used as a denture base. Ease of application, stability in the oral environment are its advantages; however, its mechanical properties should be enhanced. This study aimed to evaluate the effect of different ratios of polypropylene fiber (PPF) in addition to denture base materials on impact strength, water sorption, and cytotoxicity.

Materials and Methods:

Heat-cure acrylic resin specimens were prepared according to the manufacturer’s instruction by adding PPFs of 6 mm length in different ratios (1, 3, 5, 10, and 20 wt%). In order to determine the impact strength, specimens were subjected to a Charpy impact test machine after being kept in distilled water at 37°C for 48 h. A span of 40 mm was adjusted and a 0.5 J pendulum was used. The fractured surface of specimens was also analyzed using a scanning electron microscope. In addition, mouse fibroblast cells and agar diffusion tests were used for cytotoxicity determination. The results were analyzed using the Kruskal–Wallis and the Mann–Whitney U tests for determining impact strength, and Kruskal–Wallis and Tukey’s range tests were performed for determining water sorption values ( P = 0.05).

Results:

5 wt% PPF group exhibited the highest water sorption and impact strength values, and the difference was statistically significant ( P < .05). On the other hand, no cytotoxic effects were determined in PPF added groups. Furthermore, increased fiber concentration caused less water sorption.

Conclusion:

Addition of PPFs in acrylic resin increased the impact strength and decreased water sorption without any cytotoxic effects.