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Temizci T, Bozoğulları HN. Effect of thermal cycling on the flexural strength of 3-D printed, CAD/CAM milled and heat-polymerized denture base materials. BMC Oral Health 2024; 24:357. [PMID: 38509542 PMCID: PMC10953149 DOI: 10.1186/s12903-024-04122-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 03/07/2024] [Indexed: 03/22/2024] Open
Abstract
BACKGROUND This study compared the impact of thermal cycling on the flexural strength of denture-base materials produced through conventional and digital methods, using both subtractive and additive approaches. METHODS In total, 60 rectangular specimens were fabricated with specific dimensions for flexural strength tests. The dimensions were set according to the International Organization for Standardization (ISO) guideline 20795-1:2013 as 64 × 10 × 3.3 ± 0.2 mm. Specimens from each material group were divided into two subgroups (thermal cycled or nonthermal cycled, n = 10/group). We used distinct methods to produce three different denture-base materials: Ivobase (IB), which is a computer-aided-design/computer-aided-manufacturing-type milled pre-polymerized polymethyl methacrylate resin disc; Formlabs (FL), a 3D-printed denture-base resin; and Meliodent (MD), a conventional heat-polymerized acrylic. Flexural strength tests were performed on half of the samples without a thermal-cycle procedure, and the other half were tested after a thermal cycle. The data were analyzed using a two-way analysis of variance and a post hoc Tukey test (α = 0.05). RESULTS Based on the results of flexural-strength testing, the ranking was as follows: FL > IB > MD. The effect of thermal aging was statistically significant for the FL and IB bases, but not for the MD base. CONCLUSIONS Digitally produced denture bases exhibited superior flexural strength compared with conventionally manufactured bases. Although thermal cycling reduced flexural strength in all groups, the decrease was not statistically significant in the heat-polymerized acrylic group.
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Affiliation(s)
- Tuğba Temizci
- Department of Prosthodontics, Faculty of Dentistry, Karamanoğlu Mehmetbey University, Karaman, Turkey.
| | - Hatice Nalan Bozoğulları
- Department of Prosthodontics, Faculty of Dentistry, Karamanoğlu Mehmetbey University, Karaman, Turkey
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Cengiz S, Bagis B, Külünk Ş, Velioğlu N, Sağlam G. Comparison of fiber reinforcing methods of composite resin: A flexural strength and stereo microscopy study. Microsc Res Tech 2023; 86:252-257. [PMID: 36408657 DOI: 10.1002/jemt.24266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Revised: 10/19/2022] [Accepted: 11/10/2022] [Indexed: 11/22/2022]
Abstract
This study aimed to compare the effect of fiber reinforcing methods on the flexural strength and failure modes of indirect composite resins. Based on the reinforcement methods, the bar specimens (3 × 3 × 25 mm) were divided into five groups (n = 20). Glass or polyethylene fibers were used for reinforcement of indirect composite resins. Fibers were either light polymerized and mixed with indirect composite resin or mixed with indirect composite resin after resin application and polymerized together. Indirect composite resin without fiber reinforcement was used as control. All five types of specimens were stored in distilled water at 37°C for 24 h. Half of the specimens were additionally thermocycled. Then the specimens were tested in a three-point bending test. Failure types were examined and categorized by using stereo microscope. The data were analyzed using two-way ANOVA and Tukey HSD test. Flexural strength was found to be significantly higher for fiber-reinforced indirect resin composites than control. However, the fiber-reinforced groups did not present any significant difference. Analysis revealed aging does not affect the flexure strength of fiber reinforcement of indirect composite resin. The study concluded that the flexure strength of indirect composite resins was improved with fiber reinforcement. Different fiber reinforcement methods demonstrated similar effects on the flexure strength of indirect composite resin. Reinforcement with glass or polyethylene fibers presented the potential to improve the mechanical properties of indirect composite resins. RESEARCH HIGHLIGHTS: Flexural strength of indirect composite resins are affected by the reinforcement of composites with glass or polyethylene fibers. Aging with thermocycling has no effect on the flexural strength of the indirect composite resins, however can cause catastrophic failures in material.
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Affiliation(s)
- Seda Cengiz
- Department of Prosthodontics, Faculty of Dentistry, Zonguldak Bülent Ecevit University, Zonguldak, Turkey
| | - Bora Bagis
- Department of Prosthodontics, Faculty of Dentistry, İstanbul Health and Technology University, Istanbul, Turkey
| | - Şafak Külünk
- Department of Prosthodontics, Faculty of Dentistry, 19 Mayıs University, Samsun, Turkey
| | - Neslin Velioğlu
- Navadent Oral and Dental Health Policlinic, Zonguldak, Turkey
| | - Gaye Sağlam
- Department of Prosthodontics, Faculty of Dentistry, Zonguldak Bülent Ecevit University, Zonguldak, Turkey
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Szabelski J, Karpiński R, Krakowski P, Jojczuk M, Jonak J, Nogalski A. Analysis of the Effect of Component Ratio Imbalances on Selected Mechanical Properties of Seasoned, Medium Viscosity Bone Cements. MATERIALS (BASEL, SWITZERLAND) 2022; 15:5577. [PMID: 36013714 PMCID: PMC9416016 DOI: 10.3390/ma15165577] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 08/05/2022] [Accepted: 08/11/2022] [Indexed: 06/15/2023]
Abstract
The paper presents the results of experimental strength tests of specimens made of two commercially available bone cements subjected to compression, that is a typical variant of load of this material during use in the human body, after it has been used for implantation of prostheses or supplementation of bone defects. One of the factors analysed in detail was the duration of cement seasoning in Ringer's solution that simulates the aggressive environment of the human body and material degradation caused by it. The study also focused on the parameters of quantitative deviation from the recommended proportions of liquid (MMA monomer, accelerator and stabiliser) and powder (PMMA prepolymer and initiator) components, i.e., unintentional inaccuracy of component proportioning at the stage of cement mass preparation. Statistical analysis has shown the influence of these factors on the decrease in compressive strength of the cements studied, which may be of significant importance in operational practice.
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Affiliation(s)
- Jakub Szabelski
- Department of Computerization and Production Robotization, Faculty of Mechanical Engineering, Lublin University of Technology, Nadbystrzycka 36, 20-618 Lublin, Poland
| | - Robert Karpiński
- Department of Machine Design and Mechatronics, Faculty of Mechanical Engineering, Lublin University of Technology, Nadbystrzycka 36, 20-618 Lublin, Poland
| | - Przemysław Krakowski
- Chair and Department of Trauma Surgery and Emergency Medicine, Medical University of Lublin, Staszica 11, 20-081 Lublin, Poland
- Orthopaedic Department, Łęczna Hospital, Krasnystawska 52, 21-010 Leczna, Poland
| | - Mariusz Jojczuk
- Chair and Department of Trauma Surgery and Emergency Medicine, Medical University of Lublin, Staszica 11, 20-081 Lublin, Poland
| | - Józef Jonak
- Department of Machine Design and Mechatronics, Faculty of Mechanical Engineering, Lublin University of Technology, Nadbystrzycka 36, 20-618 Lublin, Poland
| | - Adam Nogalski
- Chair and Department of Trauma Surgery and Emergency Medicine, Medical University of Lublin, Staszica 11, 20-081 Lublin, Poland
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Leite A, Viotto H, Nunes T, Pasquini D, Pero A. Cellulose nanocrystals into Poly(ethyl methacrylate) used for dental application. POLIMEROS 2022. [DOI: 10.1590/0104-1428.20210066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Andressa Leite
- Universidade Estadual Paulista “Júlio de Mesquita Filho”, Brasil
| | - Hamille Viotto
- Universidade Estadual Paulista “Júlio de Mesquita Filho”, Brasil
| | - Thais Nunes
- Universidade Estadual Paulista “Júlio de Mesquita Filho”, Brasil
| | | | - Ana Pero
- Universidade Estadual Paulista “Júlio de Mesquita Filho”, Brasil
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Postpolymerization of a 3D-printed denture base polymer: Impact of post-curing methods on surface characteristics, flexural strength, and cytotoxicity. J Dent 2021; 115:103856. [PMID: 34695506 DOI: 10.1016/j.jdent.2021.103856] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 09/30/2021] [Accepted: 10/20/2021] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE This study investigated the influence of postpolymerization of a three-dimensional (3D) printed denture base polymer. The effect of post-curing methods on surface characteristics, flexural strength, and cytotoxicity was evaluated. METHODS A total of 172 specimens were additively manufactured using one denture base material (V-Print dentbase, VOCO) and further post-cured by different light-curing devices, including Otoflash G171 (OF), Labolight DUO (LL), PCU LED (PCU), and LC-3DPrintbox (PB), respectively. Polymethyl methacrylate resin (PalaExpress Ultra) was used as a reference (REF). Afterward, surface topography was observed using scanning electron microscopy, and surface roughness was measured (n = 6). Furthermore, flexural strength was tested (n = 20). Cytotoxicity was evaluated by the extract and direct contact tests. The data were analyzed using the Kolmogorov-Smirnov test and one-way ANOVA followed by Tukey's multiple comparisons and Kruskal-Wallis tests (p < 0.05). RESULTS The different post-curing methods applied did not significantly influence surface topography and roughness (Ra). Meanwhile, specimens post-cured by PCU (162.3 ± 44.16 MPa) and PB (171.2 ± 34.41 MPa) showed significantly higher flexural strength than those post-cured by OF (131.3 ± 32.87 MPa) and REF (131.2 ± 19.19 MPa), respectively. Additionally, various post-curing methods effectively decreased the cytotoxic effects of 3D-printed denture base polymer. CONCLUSIONS Different post-curing methods did not significantly alter the Ra values of the 3D-printed denture base material. However, flexural strength was significantly affected by the postpolymerization methods, which might be attributed to the different wavelengths of post-curing devices. In addition, various postpolymerization methods reduced the cytotoxic effects of the 3D-printed denture base polymer. CLINICAL SIGNIFICANCE Flexural strength of additively manufactured denture bases depends on the postpolymerization strategy. Therefore, an appropriate post-curing method is required to optimize the flexural strength of 3D-printed denture materials.
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Wekwejt M, Chen S, Kaczmarek-Szczepańska B, Nadolska M, Łukowicz K, Pałubicka A, Michno A, Osyczka AM, Michálek M, Zieliński A. Nanosilver-loaded PMMA bone cement doped with different bioactive glasses - evaluation of cytocompatibility, antibacterial activity, and mechanical properties. Biomater Sci 2021; 9:3112-3126. [PMID: 33704333 DOI: 10.1039/d1bm00079a] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Nanosilver-loaded PMMA bone cement (BC-AgNp) is a novel cement developed as a replacement for conventional cements. Despite its favorable properties and antibacterial activity, BC-AgNp still lacks biodegradability and bioactivity. Hence, we investigated doping with bioactive glasses (BGs) to create a new bioactive BC characterized by time-varying porosity and gradual release of AgNp. The BC Cemex was used as the base material and modified simultaneously with the AgNp and BGs: melted 45S5 and 13-93B3 glasses with various particle sizes and sol-gel derived SiO2/CaO microparticles. The effect of BG addition was examined by microscopic analysis, an assessment of setting parameters, wettability, FTIR and UV-VIS spectroscopy, mechanical testing, and hemo- and cytocompatibility and antibacterial efficiency studies. The results show that it is possible to incorporate various BGs into BC-AgNp, which leads to different properties depending on the type and size of BGs. The smaller particles of melted BGs showed higher porosity and better antibacterial properties with the moderate deterioration of mechanical properties. The sol-gel derived BGs, however, displayed a tendency for agglomeration and random distribution in BC-AgNp. The BGs with greater solubility more efficiently improve the antibacterial properties of BC-AgNp. Besides, the unreacted MMA monomer release could negatively influence the cellular response. Despite that, cements doped with different BGs are suitable for medical applications.
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Affiliation(s)
- M Wekwejt
- Department of Biomaterials Technology, Faculty of Mechanical Engineering and Ship Technology, Gdańsk University of Technology, Gdańsk, Poland.
| | - S Chen
- Centre for Functional and Surface Functionalized Glass, TnU AD, Trenčín, Slovakia
| | - B Kaczmarek-Szczepańska
- Department of Chemistry of Biomaterials and Cosmetics, Faculty of Chemistry, Nicolaus Copernicus University in Toruń, Toruń, Poland
| | - M Nadolska
- Faculty of Applied Physics and Mathematics, Gdańsk University of Technology, Gdańsk, Poland
| | - K Łukowicz
- Department of Biology and Cell Imaging, Institute of Zoology and Biomedical Research, Faculty of Biology, Jagiellonian University, Kraków, Poland
| | - A Pałubicka
- Department of Laboratory Diagnostics and Microbiology with Blood Bank, Specialist Hospital in Kościerzyna, Kościerzyna, Poland
| | - A Michno
- Chair of Clinical Biochemistry, Department of Laboratory Medicine, Medical University of Gdańsk, Gdańsk, Poland
| | - A M Osyczka
- Department of Biology and Cell Imaging, Institute of Zoology and Biomedical Research, Faculty of Biology, Jagiellonian University, Kraków, Poland
| | - M Michálek
- Centre for Functional and Surface Functionalized Glass, TnU AD, Trenčín, Slovakia
| | - A Zieliński
- Department of Biomaterials Technology, Faculty of Mechanical Engineering and Ship Technology, Gdańsk University of Technology, Gdańsk, Poland.
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Comparison of Fracture Resistance in Thermal and Self-Curing Acrylic Resins-An In Vitro Study. Polymers (Basel) 2021; 13:polym13081234. [PMID: 33920377 PMCID: PMC8069947 DOI: 10.3390/polym13081234] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 04/08/2021] [Accepted: 04/09/2021] [Indexed: 02/03/2023] Open
Abstract
Thermal and self-curing acrylic resins are frequently and versatilely used in dental medicine since they are biocompatible, have no flavor or odor, have satisfactory thermal qualities and polishing capacity, and are easy and fast. Thus, given their widespread use, their fracture resistance behavior is especially important. In this research work, we comparatively analyzed the fracture resistance capacity of thermo and self-curing acrylic resins in vitro. Materials and Methods: Five prosthesis bases were created for each of the following acrylic resins: Lucitone®, ProBase®, and Megacryl®, which were submitted to different forces through the use of the CS® Dental Testing Machine, usually mobilized in the context of fatigue tests. To this end, a point was defined in the center of the anterior edge of the aforementioned acrylic resin bases, for which the peak tended until a fracture occurred. Thermosetting resins were, on average, more resistant to fracture than self-curable resins, although the difference was not statistically significant. The thermosetting resins of the Lucitone® and Probase® brands demonstrated behavior that was more resistant to fracture than the self-curing homologues, although the difference was not statistically significant. Thermosetting resins tended to be, on average, more resistant to fracture and exhibited the maximum values for impact strength, compressive strength, tensile strength, hardness, and dimensional accuracy than self-curing resins, regardless of brand.
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Repairability of a 3D printed denture base polymer: Effects of surface treatment and artificial aging on the shear bond strength. J Mech Behav Biomed Mater 2020; 114:104227. [PMID: 33279875 DOI: 10.1016/j.jmbbm.2020.104227] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 11/19/2020] [Accepted: 11/24/2020] [Indexed: 02/08/2023]
Abstract
OBJECTIVES The present study aimed to evaluate the repairability of a 3D printed denture base material. The effects of surface treatments and artificial aging on the shear bond strength (SBS) were investigated. METHODS A total of 224 specimens were printed by digital light processing technology (Rapid Shape D30II) using a 3D printing denture base material (FREEPRINT denture). To evaluate the repairability, the SBS and failure modes were measured after surface treatment and artificial aging. Specifically, half of the specimens were further performed with thermocycling (5-55 °C, 5000 cycles) for artificial aging. The aged and non-aged specimens were further divided into four subgroups (n = 28) to simulate a denture base repair with one of the following treatments: control (without surface treatment), monomer (applying methylmethacrylate for 120 s), P600 (grinding with P600 silicon carbide paper) and sandblasting (blasted with 125 μm aluminum oxide with 2 bar), respectively. Surface roughness was measured (n = 6) and surface topography was observed by scanning electron microscopy (n = 2). A test rod was built on the sample surface using the same 3D printing material. Afterward, all specimens further underwent thermocycling (5-55 °C, 10,000 cycles). RESULTS For non-aged groups, no significant differences in SBS could be found (p < 0.05), and bondings failed cohesively in the denture base material. Regarding the aged control and monomer group, adhesive failures at the interface were primarily observed, and SBS values were statistically lower than those of the other groups (p < 0.05). CONCLUSIONS The 3D printed denture base material exhibited favorable repairability. For the realignment surface, the SBS at the bonding interface is satisfying and additional surface treatments could be not necessary. In contrast, the aged surface could significantly decrease the SBS; hence subtractive surface treatments are highly recommended.
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Zafar MS. Prosthodontic Applications of Polymethyl Methacrylate (PMMA): An Update. Polymers (Basel) 2020; 12:E2299. [PMID: 33049984 PMCID: PMC7599472 DOI: 10.3390/polym12102299] [Citation(s) in RCA: 196] [Impact Index Per Article: 49.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Revised: 10/01/2020] [Accepted: 10/02/2020] [Indexed: 12/16/2022] Open
Abstract
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.
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Affiliation(s)
- Muhammad Sohail Zafar
- Department of Restorative Dentistry, College of Dentistry, Taibah University, Al Madinah, Al Munawwarah 41311, Saudi Arabia
- Department of Dental Materials, Islamic International Dental College, Riphah International University, Islamabad 44000, Pakistan
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Wekwejt M, Michalska-Sionkowska M, Bartmański M, Nadolska M, Łukowicz K, Pałubicka A, Osyczka AM, Zieliński A. Influence of several biodegradable components added to pure and nanosilver-doped PMMA bone cements on its biological and mechanical properties. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2020; 117:111286. [PMID: 32919647 DOI: 10.1016/j.msec.2020.111286] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 07/09/2020] [Accepted: 07/21/2020] [Indexed: 01/11/2023]
Abstract
Acrylic bone cements (BC) are wildly used in medicine. Despite favorable mechanical properties, processability and inject capability, BC lack bioactivity. To overcome this, we investigated the effects of selected biodegradable additives to create a partially-degradable BC and also we evaluated its combination with nanosilver (AgNp). We hypothesized that using above strategies it would be possible to obtain bioactive BC. The Cemex was used as the base material, modified at 2.5, 5 or 10 wt% with either cellulose, chitosan, magnesium, polydioxanone or tricalcium-phosphate. The resulted modified BC was examined for surface morphology, wettability, porosity, mechanical and nanomechanical properties and cytocompatibility. The composite BC doped with AgNp was also examined for its release and antibacterial properties. The results showed that it is possible to create modified cement and all studied modifiers increased its porosity. Applying the additives slightly decreased BC wettability and mechanical properties, but the positive effect of the additives was observed in nanomechanical research. The relatively poor cytocompatibility of modified BC was attributed to the unreacted monomer release, except for polydioxanone modification which increased cells viability. Furthermore, all additives facilitated AgNp release and increased BC antibacterial effectiveness. Our present studies suggest the optimal content of biodegradable component for BC is 5 wt%. At this content, an improvement in BC porosity is achieved without significant deterioration of BC physical and mechanical properties. Polydioxanone and cellulose seem to be the most promising additives that improve porosity and antibacterial properties of antibiotic or nanosilver-loaded BC. Partially-degradable BC may be a good strategy to improve their antibacterial effectiveness, but some caution is still required regarding their cytocompatibility. STATEMENT OF SIGNIFICANCE: The lack of bone cement bioactivity is the main limitation of its effectiveness in medicine. To overcome this, we have created composite cements with partially-degradable properties. We also modified these cements with nanosilver to provide antibacterial properties. We examined five various additives at three different contents to modify a selected bone cement. Our results broaden the knowledge about potential modifiers and properties of composite cements. We selected the optimal content and the most promising additives, and showed that the combination of these additives with nanosilver would increase cements` antibacterial effectiveness. Such modified cements may be a new solution for medical applications.
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Affiliation(s)
- M Wekwejt
- Biomaterials Division, Department of Materials Engineering and Bonding, Gdańsk University of Technology, Gdańsk, Poland.
| | - M Michalska-Sionkowska
- Faculty of Biological and Veterinary Sciences, Department of Environmental Microbiology and Biotechnology, Nicolaus Copernicus University in Toruń, Toruń, Poland
| | - M Bartmański
- Biomaterials Division, Department of Materials Engineering and Bonding, Gdańsk University of Technology, Gdańsk, Poland
| | - M Nadolska
- Faculty of Applied Physics and Mathematics, Gdańsk University of Technology, Gdańsk, Poland
| | - K Łukowicz
- Institute of Zoology and Biomedical Research, Department of Biology and Cell Imaging, Faculty of Biology, Jagiellonian University, Kraków, Poland
| | - A Pałubicka
- Department of Surgical Oncologic, Medical University of Gdańsk, Gdańsk, Poland; Department of Laboratory Diagnostics and Microbiology with Blood Bank, Specialist Hospital in Kościerzyna, Kościerzyna, Poland
| | - A M Osyczka
- Institute of Zoology and Biomedical Research, Department of Biology and Cell Imaging, Faculty of Biology, Jagiellonian University, Kraków, Poland
| | - A Zieliński
- Biomaterials Division, Department of Materials Engineering and Bonding, Gdańsk University of Technology, Gdańsk, Poland
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