In vitro evaluation of artificial ageing on surface properties and early Candida albicans adhesion to prosthetic resins

Tendency of microbial adhesion to denture base resins: a systematic review

Objectives

Digital denture fabrication became an alternative method to conventional denture fabrication. However reviewing the antimicrobial performance of newly introduced digital fabrication methods in comparison to the conventional method is neglected. Aim of study: this review was to compare the antiadherence properties of various CAD-CAM subtractive (milled), additive (3D printed) conventional denture base resins. In order to answer the developed PICO question: "Does CAD-CAM milled and 3D printed denture base resins have microbiological antiadherence properties over the conventional ones?" We included comparative studies on digitally fabricated Denture base resins with conventionally fabricated one in term of microbial adhesion.

Methods

All in vitro studies investigated the microbial adherence to CAD-CAM milled and 3D printed denture base resins in comparison to conventional were searched in the PubMed, Web of Sciences, and Scopus databases up to December 2023.

Results

Fifteen studies have been investigated the microbial adhesion to milled and 3D printed denture base resins. CAD-CAM milled resins significantly decreased the microbial adhesion when compared with the conventional resins and 3D printed resins, while the later showed a high tendency for microbial adhesion. The addition of antifungal agents to 3D printed resins significantly reduced C. albicans adhesion. In terms of 3D printing parameters, printing orientation affected adherence while printing technology had no effect on microbial adhesion.

Conclusion

Denture base materials and fabrication methods significantly affect the microbial adhesion. CAD-CAM milled denture base resins demonstrated low microbial adhesion. 3D-printed resins showed high tendency for C. albicans adhesion. The antiadherent properties of 3D-printed resins can be improved by incorporating antifungal agents or changing the printing parameters, but further investigations are required to validate these modifications.

Antibacterial coating of orthodontic elastomeric ligatures with silver and bismuth nanofilms by magnetron sputtering: A feasibility study

OBJECTIVES

Magnetron sputtering was evaluated to equip surfaces of orthodontic elastomeric ligatures with silver and bismuth nanofilms.

MATERIAL AND METHODS

Antibacterial properties were evaluated by the adhesion of Streptococcus mutans. Polyurethane-based elastomeric ligatures were coated with silver and bismuth nanofilms via direct current magnetron sputtering. Surface roughness (Ra ) and surface-free energy (SFE) were assessed. Coated specimens were incubated with S. mutans for 2 h. Adhering bacteria were visualized by Hoechst staining and quantified by an ATP-based luminescence assay. One-way analysis of variance with Tukey post hoc testing and Pearson correlation analysis were performed (p < .05) to relate bacterial adhesion to surface roughness and surface-free energy.

RESULTS

Elastomeric ligatures were successfully coated with silver and bismuth nanofilms. Ra was significantly reduced by silver coating. Silver and bismuth coatings showed significantly higher SFE than controls. Adhesion of S. mutans was significantly decreased by silver coating. No correlation between bacterial adhesion and SFE was found. Correlation between bacterial adhesion and Ra was positive but not statistically significant.

CONCLUSIONS

Magnetron sputtering proved to be a feasible method to equip orthodontic elastomeric ligatures with silver and bismuth nanofilms. Silver coatings of elastomeric ligatures may reduce white spots and carious lesions in orthodontic patients. Future research is required to stabilize coatings.

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.

Biofilm formation of C. albicans on occlusal device materials and antibiofilm effects of chitosan and eugenol

STATEMENT OF PROBLEM

Microbial adhesion on occlusal devices may lead to oral diseases such as candidiasis. Whether chitosan and eugenol provide antibiofilm effects is unclear.

PURPOSE

The purpose of this in vitro study was to evaluate the biofilm formation of C. albicans strains on occlusal device materials and the antibiofilm effects of chitosan and eugenol against C. albicans on these surfaces.

MATERIAL AND METHODS

A total of 88 specimens (5×10×2 mm) were produced from occlusal device materials with 4 production techniques: vacuum-formed thermoplastic (Group V), head-press (Group H), computer-aided design and computer-aided manufacture (CAD-CAM) (Group C), and 3-dimensionally (3D) printed (Group D) (n=22). After various finishing procedures, the surface properties of the specimens were evaluated by using surface free energy (SFE), surface roughness (SR) measurements, and elemental and topographic analysis. Biofilm formation of C. albicans strain and the antibiofilm effects of chitosan and eugenol against biofilm formation on these surfaces were also examined with a crystal violet assay. The distribution's normality was statistically analyzed with the Kolmogorov-Smirnov test. One-way and two-way analysis of variance with post hoc Tukey tests were used for statistical evaluations (α=.05).

RESULTS

Surface roughness values in Groups D and H were significantly higher than in other groups (P<.05). While the highest surface free energy values (except γp) were in Group V, Group C had the highest γp. The lowest biofilm value appeared in Group H. Chitosan exhibited an antibiofilm effect in all groups except Group H, while eugenol was effective in all groups.

CONCLUSIONS

The production method affected the susceptibility of occlusal device materials to the adhesion of C. albicans. Eugenol was an effective antibiofilm agent for device materials.

Could Helium Plasma Treatment be a Novel Approach to Prevent the Biofilm Formation of Candida albicans?

There is no definitive method to prevent Candida albicans (C. albicans) biofilm formation on polymethyl methacrylate (PMMA) surfaces. The objective of this study was to evaluate the effect of Helium plasma treatment (before the application of removable dentures to the patient) to prevent or reduce C. albicans ATCC 10,231 the anti-adherent activity, viability, and biofilm formation on PMMA surfaces. One hundred disc-shaped PMMA samples (2 mm × 10 mm) were prepared. The samples were randomly divided into 5 surface groups and treated with different concentrations of Helium plasma: G I: Control group (untreated), G II: 80% Helium plasma-treated group, G III: 85% Helium plasma-treated group, G IV: 90% Helium plasma-treated group, G V: 100% Helium plasma-treated group. C. albicans viability and biofilm formations were evaluated using 2 methods: MTT (3-(4,5-dimethyl thiazolyl-2)-2, 5-diphenyltetrazolium bromide) assays and Crystal Violet (CV) staining. The surface morphology and C. albicans biofilm images were observed with scanning electron microscopy. The Helium plasma-treated PMMA groups (G II, G III, G IV, G V) observed a significant reduction in C. albicans cell viability and biofilm formation compared with the control group. Treating PMMA surfaces with different concentrations of Helium plasma prevents C. albicans viability and biofilm formation. This study suggests that Helium plasma treatment might be an effective strategy in modifying PMMA surfaces to prevent denture stomatitis formation.

Bacterial Adhesion on Dental Polymers as a Function of Manufacturing Techniques

The microbiological behavior of dental polymer materials is crucial to secure the clinical success of dental restorations. Here, the manufacturing process and the machining can play a decisive role. This study investigated the bacterial adhesion on dental polymers as a function of manufacturing techniques (additive/subtractive) and different polishing protocols. Specimens were made from polyaryletherketone (PEEK, PEKK, and AKP), resin-based CAD/CAM materials (composite and PMMA), and printed methacrylate (MA)-based materials. Surface roughness (R_z; R_a) was determined using a laser scanning microscope, and SFE/contact angles were measured using the sessile drop method. After salivary pellicle formation, in vitro biofilm formation was initiated by exposing the specimens to suspensions of Streptococcus mutans (S. mutans) and Streptococcus sanguinis (S. sanguinis). Adherent bacteria were quantified using a fluorometric assay. One-way ANOVA analysis found significant influences (p < 0.001) for the individual parameters (treatment and material) and their combinations for both types of bacteria. Stronger polishing led to significantly (p < 0.001) less adhesion of S. sanguinis (Pearson correlation PC = -0.240) and S. mutans (PC = -0.206). A highly significant (p = 0.010, PC = 0.135) correlation between S. sanguinis adhesion and R_z was identified. Post hoc analysis revealed significant higher bacterial adhesion for vertically printed MA specimens compared to horizontally printed specimens. Furthermore, significant higher adhesion of S. sanguinis on pressed PEEK was revealed comparing to the other manufacturing methods (milling, injection molding, and 3D printing). The milled PAEK samples showed similar bacterial adhesion. In general, the resin-based materials, composites, and PAEKs showed different bacterial adhesion. Fabrication methods were shown to play a critical role; the pressed PEEK showed the highest initial accumulations. Horizontal DLP fabrication reduced bacterial adhesion. Roughness < 10 µm or polishing appear to be essential for reducing bacterial adhesion.

Evaluation of the color stability of 3D printed resin according to the oxygen inhibition effect and temperature difference in the post-polymerization process

The aim of this study was to determine the color stability of 3D printed resin according to the post-curing conditions (polymerization conditions and temperature). Specimens were post-polymerized under different conditions of oxygen inhibition, such as on glycerin immersion (GLY), medium-low vacuum environment (VA), and oxygen contact (CON, the control group), and temperature (35 °C, 60 °C, and 80 °C). The degree of conversion (DC), water sorption (Wsp) and solubility (Wsl), surface roughness (Ra) were measured. Additionally, surface free energy (SFE), pH values of colorants were measured. Grape juice (grape), coffee, and curry were used as the colorants, and distilled water (DW) was used as a control. And the color value was measured before and after immersion using a spectrophotometer. Then, Calculated the color change. For statistical methods, The Shapiro-Wilk test performed to check for normality revealed that the data presented a normal distribution (p>0.05). ΔE values were analyzed using three-way ANOVA. DC, Wsp, Wsl, SFE, and Ra were analyzed using two-way ANOVA. To confirm the linear correlation, Pearson's correlation coefficient was determined. The threshold for significance (p) was set at 0.05 (95% confidence interval) for all tests. DC was the highest at 80 °C in the GLY group (95.08 ± 4.88%). And Wsl decreased with increasing temperature, and was lowest at 80 °C in the GLY group (0.46 ± 0.30 um/mm3). After the colorants were immersed for 30 days, as the temperature increased, ΔE decreased in the GLY group but not in the VA and CON groups, and was the lowest at 80 °C in the GLY group: (DW, 0.95 ± 0.45 [mean± SD]; grape, 6.45± 0.69; coffee, 4.50± 0.56; curry, 9.37± 1.40). There was also a significant inverse relation between DC and ΔE. A significant inverse relation was found between Wsl and DC, and a significant positive correlation was found between Wsl and ΔE. Wsp, SFE, and Ra did not affect color stability. In the post-polymerization process, increasing the temperature and GLY were effective in reducing ΔE, which was lowest at 80 °C in the GLY group. It was also observed that a complex mechanism between the DC, Wsl of 3D printed resin affects ΔE of the resin.

In vitro study of surface properties and microbial adhesion of various dental polymers fabricated by different manufacturing techniques after thermocycling

OBJECTIVES

The study aims to investigate surface properties and microbial adhesion of various dental polymers fabricated by different manufacturing techniques before and after thermocycling.

MATERIALS AND METHODS

The following six materials were used to fabricate disk-shaped specimens: conventional denture polymer (Vertex Acrylic Resin, VAR), CAD/CAM denture polymer (Organic PMMA eco Pink, OP), conventional temporary polymer (Protemp™ 4, PT), CAD/CAM temporary polymer (Die Material, DM), conventional denture framework polymer (BioHPP, PB), and CAD/CAM denture framework polymer (breCAM.BioHPP, CB). The specimens were tested before and after thermocycling (5000 and 10,000 cycles, 5 °C/55 °C). Surface roughness (SR), hydrophobicity, and surface topography were determined by profilometry, water contact angle, and scanning electron microscopy (SEM). Then specimens were incubated with Staphylococcus aureus, Streptococcus mutans, and Candida albicans for 24 h, respectively. Microbial adhesion was assessed using colony-forming unit counts, XTT assay, and SEM.

RESULTS

SR and hydrophobicity of VAR group were higher than that of OP group. S. aureus and C. albicans adhesion on VAR and PT groups were higher than that on OP and DM groups, respectively. There was no difference in surface properties and microbial adhesion between PB and CB groups. After thermocycling, SR (expect OP group) of all materials increased and hydrophobicity decreased, and the amount and activity of S. aureus and C. albicans adhesion also increased. The adhesion of S. aureus and C. albicans showed a moderate positive correlation with SR, independent of hydrophobicity.

CONCLUSIONS

CAD/CAM denture polymers and temporary polymers showed less S. aureus and C. albicans adhesion when compared to conventional ones, which were mainly affected by surface roughness, independent of hydrophobicity. Thermocycling could increase surface roughness, decrease hydrophobicity, and affect microbial adhesion of the materials.

CLINICAL SIGNIFICANCE

CAD/CAM dental polymers may be a better choice for the manufacture of temporary restorations and dentures to reduce microbial adhesion.

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.

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

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

Influence of the Surface Energy of Different Brands of Polymethyl Methacrylate on the Adherence of Candida albicans: An In Vitro Study

Objective:

The objective of this study was to evaluate the influence of the surface energy of different brands of polymethyl methacrylate (PMMA) on the adherence of Candida albicans ATCC 10231 in an in vitro study.

Materials and Methods:

The study had an in vitro, longitudinal, and comparative experimental design. The following groups were made: (1) Vitacryl versus controls (water, dimethyl sulfoxide, glycerol, diethylene glycol, and formamide); (2) Triplex versus the same controls; (3) Vitacryl versus Triplex (surface energy); and (4) Vitacryl versus Triplex (adhesion per cell/field). Adhesion was measured in the area of each field magnified 10 × 10, and with an increase in magnification to 40 × 10, very dense colonies of 0.152 mm² were observed.

Results:

The surface energy of Vitacryl and Triplex was 40.3 ± 0.3 and 39.5 ± 0.3N/m, respectively, showing statistically significant differences (P < 0.001). On the contrary, in relation to the adhesion per cell/field of C. albicans, Vitacryl presented 15.7 ± 1.1, whereas Triplex had 16.7 ± 2.3, with no significant differences (P = 0.058).

Conclusion:

In relation to the adhesion per cell/field of C. albicans, there was no evidence of significant differences between Vitacryl and Triplex.

In vitro Candida albicans biofilm formation on different titanium surface topographies

Objectives

To investigate if differences in titanium implant surface topography influence Candida albicans biofilm formation.

Materials and Methods

Titanium discs were prepared and characterized using a profilometer: Group A (R_a 0.15 µm, smooth), Group B (R_a 0.64 µm, minimally rough) and Group C (R_a 1.3 µm, moderately rough). Contact angle and surface free energy (SFE) were determined for each group. Non-preconditioned titanium discs were incubated with C. albicans for 24 h. In additional experiments, the titanium discs were initially coated with human saliva, bovine serum albumin or phosphate-buffered saline for 2 h before incubation with C. albicans for 24 h. The amount of fungal biofilm formation was quantified using a colorimetric assay.

Results

C. albicans biofilm formation was significantly lower (p < 0.05) on the minimally rough titanium surface compared to smooth and moderately rough surfaces. The titanium surface displaying the lowest SFE (Group B) was associated with significantly lower (p < 0.05) C. albicans biofilm formation than the other two groups. Salivary coating resulted in greater adherence of C. albicans with increased surface roughness.

Conclusions

The minimally rough titanium discs displayed lowest SFE compared to smooth and moderately rough surfaces and showed the least C. albicans biofilm formation. This study demonstrated that C. albicans biofilm formation increased in a SFE-dependent manner. These findings suggest that SFE might be a more explanatory factor for C. albicans biofilm formation on titanium surfaces than roughness. The presence of a pellicle coating may negate the impact of SFE on C. albicans biofilm formation on titanium surfaces.

The antimicrobial and cytotoxic effects of a copper-loaded zinc oxide phosphate cement

Objectives

Evidence about modifications of dental luting materials to minimize biological failure at the “marginal gap” between teeth and fixed prosthodontics is scarce. We compared a copper-modified (Co-ZOP) and a conventional zinc oxide phosphate cement (ZOP) in terms of antimicrobial and cytotoxic potentials in vitro and in vivo.

Materials and methods

Specimens of ZOP and Co-ZOP were characterized by the mean arithmetic roughness (Ra) and surface free energy (SFE). Powder components were examined using scanning electron microscopy (SEM). Energy-dispersive X-ray spectroscopy (EDX) showed elemental material compositions. In vitro microbial adhesion was shown using SEM, luminescence, and fluorescence assays. CCK-8 assays of mouse fibroblasts (L929) and human gingival fibroblasts (GF-1) were performed after 6, 24, and 48 h of specimen incubation. In vivo, ZOP and Co-ZOP specimens were applied intraorally for 12 h; biofilm accumulation was shown using SEM.

Results

Ra of ZOP and Co-ZOP showed no significant differences; SFE was significantly higher for Co-ZOP. EDX exhibited minor copper radiation for Co-ZOP, none for ZOP. In vitro fungal adhesion to Co-ZOP was significantly higher than to ZOP; in vitro streptococcal adhesion, cytotoxicity, and in vivo biofilm formation were not significantly different.

Conclusions

Co-ZOP showed low surface allocations of copper with no improved antimicrobial properties compared with conventional ZOP in vitro or in vivo.

Clinical relevance

Antimicrobial effects and low cytotoxicity of biomaterials are important for the clinical outcome. Based on our in vitro and in vivo results, no clinical recommendation can be given for the tested Co-ZOP.

Predictability of Microbial Adhesion to Dental Materials by Roughness Parameters

Microbial adhesion to intraoral biomaterials is associated with surface roughness. For the prevention of oral pathologies, smooth surfaces with little biofilm formation are required. Ideally, appropriate roughness parameters make microbial adhesion predictable. Although a multitude of parameters are available, surface roughness is commonly described by the arithmetical mean roughness value (Ra). The present study investigates whether Ra is the most appropriate roughness parameter in terms of prediction for microbial adhesion to dental biomaterials. After four surface roughness modifications using standardized polishing protocols, zirconia, polymethylmethacrylate, polyetheretherketone, and titanium alloy specimens were characterized by Ra as well as 17 other parameters using confocal microscopy. Specimens of the tested materials were colonized by C. albicans or S. sanguinis for 2 h; the adhesion was measured via luminescence assays and correlated with the roughness parameters. The adhesion of C. albicans showed a tendency to increase with increasing the surface roughness—the adhesion of S. sanguinis showed no such tendency. Although Sa, that is, the arithmetical mean deviation of surface roughness, and Rdc, that is, the profile section height between two material ratios, showed higher correlations with the microbial adhesion than Ra, these differences were not significant. Within the limitations of this in-vitro study, we conclude that Ra is a sufficient roughness parameter in terms of prediction for initial microbial adhesion to dental biomaterials with polished surfaces.

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

PURPOSE

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

MATERIALS AND METHODS

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

RESULTS

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

CONCLUSIONS

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

Bacterial Colonization and Tissue Compatibility of Denture Base Resins

Currently, there is minimal clinical data regarding biofilm composition on the surface of denture bases and the clinical tissue compatibility. Therefore, the aim of this experimental study was to compare the bacterial colonization and the tissue compatibility of a hypoallergenic polyamide with a frequently used PMMA resin tested intraorally in a randomized split-mouth design. Test specimens made of polyamide (n = 10) and PMMA (n = 10) were attached over a molar band appliance in oral cavity of 10 subjects. A cytological smear test was done from palatal mucosa at baseline and after four weeks. The monolayers were inspected for micronuclei. After four weeks in situ, the appliance was removed. The test specimens were immediately cultivated on non-selective and selective nutrient media. All growing colonies were identified using VITEK-MS. The anonymized results were analyzed descriptively. A total of 110 different bacterial species could be isolated, including putative pathogens. An average of 17.8 different bacterial species grew on the PMMA specimens, and 17.3 on the polyamide specimens. The highest number of different bacterial species was n = 24, found on a PMMA specimen. On the two specimens, a similar bacterial distribution was observed. Micronuclei, as a marker for genotoxic potential of dental materials, were not detected. This study indicates that the composition of bacterial biofilm developed on these resins after four weeks is not influenced by the type of resin itself. The two materials showed no cytological differences. This investigation suggests that polyamide and PMMA are suitable for clinical use as denture base material.

Determination of the effective anticandidal concentration of denture cleanser tablets on some denture base resins

Objective

Although the effectiveness of chemical cleansing against Candida albicans biofilm has been shown, the effective concentration of denture cleanser tablets has not been studied. The aim of this study was to assess the effect of three denture materials against Candida albicans biofilm and to determine effective concentrations of denture cleanser tablets.

Material and methods

The surface-roughness of Acron-hi™, QC-20™ and Deflex™ (n=45 per resin) resins was standardized by using a profilometer and their contact angle or surface free energy was calculated. C. albicans biofilm was formed on all three resins and were treated with Polident 3 min™, Corega™ and Fittydent™ cleanser solutions at various concentrations and both resin-biofilm and cleanser-biofilm interest were determined by using a MTT protocol according to the European Committee on Antimicrobial Susceptibility Testing's antifungal susceptibility testing (AFST-EUCAST). Scanning electron microscopy was used to compare the efficacy of different resin materials against C. albicans biofilm. Anticandidal activity and surface free energy statistical parameters were calculated by using 3-way and 1-way ANOVA, respectively (p<0.05).

Results

Polident 3 min™ and Corega™ tablets significantly inhibited (p<0.05) the proliferation of C. albicans against all denture resins at 27-37 mg/mL. Scanning electron microscopy results indicated that there was no significant difference among resin specimens regarding biofilm formation on dentures. We failed to find a significant relationship between surface free energy and the anticandidal effect of resin types. However, the polarity value of the resins was statistically associated with their anticandidal activity.

Conclusions

The polarity of the resins, the concentrations of tablets and the chemical content of the cleanser may directly affect C. albicans biofilm formations. Polident 3 min™ and Corega™ tablets should be suggested for patients who use any denture resin types, whereas the Fittydent™ tablet should only be proposed for those who use Deflex™, when two tablets are dropped into 150 mL water.

Dental materials and their performance for the management of screw access channels in implant-supported restorations

Unsuccessfully sealed screw access channels of prosthetic implant abutments may lead to malodor or peri-implant diseases in gingival tissues adjacent to implant-supported restorations. Therefore, 72 sets of screw channel analogs with six different materials incorporated (Polytetrafluoroethylene (PTFE), wax, gutta-percha, cavit, endofrost-pellets and cotton pellets) were exposed (2.5 h, 37°C) to Streptococcus mutans, oralis and Candida albicans suspensions. Bacterial adherence was quantified by using the fluorescence dye, Alamar Blue/resazurin, and an automated multifunctional reader. For quantification of fungal adherence the ATP-based bioluminescence approach was used. High relative fluorescence and luminescence intensities (>10,000), indicating high adhesion of streptococci and fungi were found for cotton and endofrost-pellets and low intensities (<5,000) for wax, gutta-percha, cavit and PTFE. The quantity of bacterial and fungal adhesion differed significantly between the assessed various sealing materials. In conclusion and within the limitations of this study, wax, gutta-percha, cavit and PTFE should be preferred as sealing materials.

Effectiveness of antibacterial copper additives in silicone implants

Staphylococcus epidermidis plays a major role in capsular contractures of silicone breast implants. This in vitro study evaluates the antibacterial effect of copper on S. epidermidis in silicone implants. Specimens of a silicone material used for breast augmentation (Cu0) and specimens coated with different copper concentrations (Cu1, Cu2) were artificially aged. Surface roughness and surface free energy were assessed. The specimens were incubated in an S. epidermidis suspension. We assessed the quantification and the viability of adhering bacteria by live/dead cell labeling with fluorescence microscopy. Additionally, inhibition of bacterial growth was evaluated by agar diffusion, broth culture, and quantitative culture of surface bacteria. No significant differences in surface roughness and surface free energy were found between Cu0, Cu1 and Cu2. Aging did not change surface characteristics and the extent of bacterial adhesion. Fluorescence microscopy showed that the quantity of bacteria on Cu0 was significantly higher than that on Cu1 and Cu2. The ratio of dead to total adhering bacteria was significantly lower on Cu0 than on Cu1 and Cu2, and tended to be higher for Cu2 than for Cu1. Quantitative culture showed equal trends. Copper additives seem to have anti-adherence and bactericidal effects on S. epidermidis in vitro.

Investigation of mechanical properties of modern dental composites after artificial aging for one year

This in vitro study investigated the aging behavior of dental composites with regard to surface roughness (SR), Vickers hardness (VH) and flexural strength (FS), and the study elucidated the impact of artificial aging parameters. One hundred and sixty-five rectangular specimens were prepared from five composites (Filtek Supreme XT, Filtek Silorane, CeramX, Quixfil, experimental ormocer) and subjected to various artificial aging protocols (storage in distilled water/ethanol/artificial saliva for 7, 90 and 365 days; thermal cycling, 2 x 3000 cycles 5/55 degrees C). SR, VH and FS were determined at baseline and after each aging treatment. Means and standard deviations were calculated; statistical analysis was performed using three-way ANOVA and the Tukey-Kramer multiple comparison test (alpha=.05). The results showed a significant influence in the composite and aging duration on mechanical parameters; the aging medium did not have a significant influence on VH and FS, but there was a significant influence on SR. The highest overall VH was found for theexperimental ormocer; Filtek Silorane yielded the lowest values. For FS, the significantly highest values were found for Filtek Silorane, and the lowest values were found for the experimental ormocer. Prolonged aging periods (90 or 365 days) or thermal cycling led to significant decreases in both VH and FS and significant increases in SR. The findings of the current study indicate that composites differ significantly for SR and its mechanical properties with regard to FS and VH, as well as in aging behavior. Generally, artificial aging leads to a significant decrease in mechanical properties, which underlines the relevance of continuous improvement of dental composites.

Adhesion of Candida albicans to various dental implant surfaces and the influence of salivary pellicle proteins

Dental implants may be considered a potential reservoir for (re)infection with oral Candida albicans. Our aim was to evaluate initial fungal adhesion to three differentially textured titanium and one zirconia implant surface, and to correlate these findings to differences in specific surface characteristics (surface roughness (R(a)) and surface free energy (SFE)). Additionally, we investigated the influence of salivary protein films and two pellicle proteins (mucin and albumin). Implant surfaces were characterized by perthometer (R(a)) and goniometer (SFE) measurements. Implant specimens were rinsed with human whole saliva, mucin, albumin, or phosphate buffered saline and incubated in C. albicans suspension for 2.5h. Adherent fungi were quantified by means of a bioluminometric assay. The lowest amount of fungal cells was found on sand-blasted titanium, whereas zirconia implants did not show any reduced potential to adhere C. albicans. The influence of the implant SFE on fungal biofilm formation appears to be more important than the influence of R(a). The protein mucin enhanced C. albicans accumulation. In contrast, albumin is unlikely to be involved in the adhesion process of C. albicans.

Influence of artificial ageing on surface properties and Streptococcus mutans adhesion to dental composite materials

The aim of this in vitro study was to investigate the influence of artificial ageing on the surface properties and early Streptococcus mutans adhesion to current dental composites for the direct restoration of class II defects. Three hundred and thirty specimens each were prepared from five dental composites, and were randomly allotted to various artificial ageing protocols (storage in distilled water/ethanol/artificial saliva for 7/90/365 days; thermal cycling, 6,000 cycles 5/55 degrees C). Prior and after each treatment, surface roughness (R(a)) and hydrophobicity were determined, and S. mutans adhesion (ATCC 25175; 2.5 h, 37 degrees C) was simulated with and without prior exposition to human whole saliva (2 h, 37 degrees C). Adherence of S. mutans was determined fluorometrically. Means and standard deviations were calculated, and analyzed using three-way ANOVA and post-hoc analysis (alpha = 0.05). For both R(a) and S. mutans adherence to uncoated and saliva-coated specimens, significant influences of the composite material, the ageing medium and the ageing duration have been observed; for surface hydrophobicity, significant influences of the composite material and the ageing duration were found. For uncoated specimens, significant increases in S. mutans adhesion were observed with prolonged artificial ageing, whereas significant decreases in S. mutans adhesion were found for the saliva-coated specimens. The data indicate influences of the artificial ageing method on surface parameters such as R(a) and hydrophobicity as well as microbial adhesion. The results underline the relevance of saliva coating on the outcome of studies simulating microbial adhesion, and highlight differences in the susceptibility of dental composites for the adhesion of oral bacteria.