Dynamic viscoelastic properties of antimicrobial tissue conditioners containing silver-zeolite

Application of Zeolites and Zeolitic Imidazolate Frameworks in Dentistry-A Narrative Review

Zeolites and zeolitic imidazolate frameworks (ZIFs) are crystalline aluminosilicates with porous structure, which are closely linked with nanomaterials. They are characterized by enhanced ion exchange capacity, physical-chemical stability, thermal stability and biocompatibility, making them a promising material for dental applications. This review aimed to provide an overview of the application of zeolites and ZIFs in dentistry. The common zeolite compounds for dental application include silver zeolite, zinc zeolite, calcium zeolite and strontium zeolite. The common ZIFs for dental application include ZIF-8 and ZIF-67. Zeolites and ZIFs have been employed in various areas of dentistry, such as restorative dentistry, endodontics, prosthodontics, implantology, periodontics, orthodontics and oral surgery. In restorative dentistry, zeolites and ZIFs are used as antimicrobial additives in dental adhesives and restorative materials. In endodontics, zeolites are used in root-end fillings, root canal irritants, root canal sealers and bone matrix scaffolds for peri-apical diseases. In prosthodontics, zeolites can be incorporated into denture bases, tissue conditioners, soft denture liners and dental prostheses. In implantology, zeolites and ZIFs are applied in dental implants, bone graft materials, bone adhesive hydrogels, drug delivery systems and electrospinning. In periodontics, zeolites can be applied as antibacterial agents for deep periodontal pockets, while ZIFs can be embedded in guided tissue regeneration membranes and guided bone regeneration membranes. In orthodontics, zeolites can be applied in orthodontic appliances. Additionally, for oral surgery, zeolites can be used in oral cancer diagnostic marker membranes, maxillofacial prosthesis silicone elastomer and tooth extraction medicines, while ZIFs can be incorporated to osteogenic glue or used as a carrier for antitumour drugs. In summary, zeolites have a broad application in dentistry and are receiving more attention from clinicians and researchers.

Tissue Conditioner Incorporating a Nano-Sized Surface Pre-Reacted Glass-Ionomer (S-PRG) Filler

We aimed to evaluate the properties of a novel tissue conditioner containing a surface pre-reacted glass-ionomer (S-PRG) nanofiller. Tissue conditioners containing 0 (control), 2.5, 5, 10, 20, or 30 wt% S-PRG nanofiller or 10 or 20 wt% S-PRG microfiller were prepared. The S-PRG nanofillers and microfillers were observed using scanning electron microscopy. The ion release, acid buffering capacity, detail reproduction, consistency, Shore A0 hardness, surface roughness, and Candida albicans adhesion of the tissue conditioners were examined. The results indicated that the nanofiller particles were smaller and more homogeneous in size than the microfiller particles. In addition, Al, B, F, and Sr ions eluted from S-PRG were generally found to decrease after 1 day. Acid neutralization was confirmed in a concentration-dependent manner. The mechanical properties of tissue conditioners containing S-PRG nanofiller were clinically acceptable according to ISO standard 10139-1:2018, although the surface roughness increased with increasing filler content. Conditioners with 5-30 wt% nanofiller had a sublethal effect on C. albicans and reduced fungal adhesion in vitro. In summary, tissue conditioner containing at least 5 wt% S-PRG nanofiller can reduce C. albicans adhesion and has potential as an alternative soft lining material.

Controlled release, antimicrobial activity, and oral mucosa irritation of cetylpyridinium chloride-montmorillonite incorporated in a tissue conditioner

This study examined the controlled release of cetylpyridinium chloride (CPC) from a tissue conditioner (TC) containing CPC-montmorillonite (CPC-Mont), the associated antimicrobial activity, and oral mucosa irritation. The CPC release test was performed daily for 28 days in three test solutions: distilled water, 0.2 M NaCl, and 0.2 M HCl. The antimicrobial activities for 7, 14, 21, and 28 days against Candida albicans, Staphylococcus aureus, and Streptococcus mutans were assessed according to the JIS Z 2801/ISO 22196 standard. An oral mucosa irritation test was conducted using cheek pouches in five male hamsters according to the ISO 10993-10:2010 standard. The amount of CPC released each day and the cumulative amount released over 28 days (6.12 mg) were less than the daily safe maximum of sore throat medicines (8 mg). Additionally, TC with CPC-Mont could sustain antimicrobial activity against adherent bacteria for 14 days and has no oral mucosa irritation potential.

Nanomaterials in Dentistry: State of the Art and Future Challenges

Nanomaterials are commonly considered as those materials in which the shape and molecular composition at a nanometer scale can be controlled. Subsequently, they present extraordinary properties that are being useful for the development of new and improved applications in many fields, including medicine. In dentistry, several research efforts are being conducted, especially during the last decade, for the improvement of the properties of materials used in dentistry. The objective of the present article is to offer the audience a complete and comprehensive review of the main applications that have been developed in dentistry, by the use of these materials, during the last two decades. It was shown how these materials are improving the treatments in mainly all the important areas of dentistry, such as endodontics, periodontics, implants, tissue engineering and restorative dentistry. The scope of the present review is, subsequently, to revise the main applications regarding nano-shaped materials in dentistry, including nanorods, nanofibers, nanotubes, nanospheres/nanoparticles, and zeolites and other orders porous materials. The results of the bibliographic analysis show that the most explored nanomaterials in dentistry are graphene and carbon nanotubes, and their derivatives. A detailed analysis and a comparative study of their applications show that, although they are quite similar, graphene-based materials seem to be more promising for most of the applications of interest in dentistry. The bibliographic study also demonstrated the potential of zeolite-based materials, although the low number of studies on their applications shows that they have not been totally explored, as well as other porous nanomaterials that have found important applications in medicine, such as metal organic frameworks, have not been explored. Subsequently, it is expected that the research effort will concentrate on graphene and zeolite-based materials in the coming years. Thus, the present review paper presents a detailed bibliographic study, with more than 200 references, in order to briefly describe the main achievements that have been described in dentistry using nanomaterials, compare and analyze them in a critical way, with the aim of predicting the future challenges.

Zeolite in tissue engineering: Opportunities and challenges

Tissue engineering and regenerative medicine follow a multidisciplinary attitude to the expansion and application of new materials for the treatment of different tissue defects. Typically, proper tissue regeneration is accomplished through concurrent biocompatibility and positive cellular activity. This can be resulted by the smart selection of platforms among bewildering arrays of structural possibilities with various porosity properties (ie, pore size, pore connectivity, etc). Among diverse porous structures, zeolite is known as a microporous tectosilicate that can potentially provide a biological microenvironment in tissue engineering applications. In addition, zeolite has been particularly appeared promising in wound dressing and bone‐ and tooth‐oriented scaffolds. The wide range of composition and hierarchical pore structure renders the zeolitic materials a unique character, particularly, for tissue engineering purposes. Despite such unique features, research on zeolitic platforms for tissue engineering has not been classically presented. In this review, we overview, classify, and categorize zeolitic platforms employed in biological and tissue engineering applications.

Knowledge and attitude about relining of complete dentures in clinical practice: A cross-sectional study

Background

Residual ridge resorption is crucial sequelae of tooth loss. Complete dentures are the most common way of rehabilitating edentulous patients. However, with continuing residual ridge resorption, dentures tend to become loose and unstable causing discomfort, chewing disability, and speech problems. Denture relining is an economical means of improving a denture's stability and retention. An understanding of the clinical indications and limitations of these materials and procedures is crucial for clinical success.

Aim and Objective

The purpose of this survey was to assess knowledge, attitude, and practice in relining dentures among dental practitioners.

Materials and Methods

The cross-sectional survey was conducted using a validated questionnaire on 200 (n = 200) dental practitioners in Nagpur city, Maharashtra. Data analysis was done using proportion test with SPSS EPI INFO software.

Results

Although all 200 practitioners were aware of the relining procedure and were routinely carrying out the procedure in their dental clinics, 50% of the practitioners were unaware of the correct relining step by step procedure and were also not sure about the antimicrobial properties of the relining material available in the market.

Conclusion

Awareness and scientific knowledge about the relining materials and procedure should be enhanced within general dental practitioners through CDE program and workshops. Steps should be taken to include relining procedure as a part of undergraduate clinical curriculum as well as internship program.

Effect of Incorporation of Antifungal Agents on the Ultimate Tensile Strength of Temporary Soft Denture Liners

PURPOSE

To investigate the ultimate tensile strength of temporary soft denture liners modified by minimum inhibitory concentrations (MICs) of antifungal agents for Candida albicans biofilm (SC5314) determined in previous microbiological research.

MATERIALS AND METHODS

Dumbbell-shaped specimens (n = 7) with a central cross-sectional area of 6 × 3 × 33 mm were produced by Softone and Trusoft, without (control) or with incorporation of drugs in powder form at MICs for C. albicans biofilm (per g of material powder): nystatin (0.032 g), chlorhexidine diacetate (0.064 g), ketoconazole (0.128 g), miconazole (0.256 g), and itraconazole (0.256 g). After plasticization, specimens were immersed in distilled water at 37°C for 24 hours, 7 or 14 days, and then tested in tension in a universal testing machine at 40 mm/min. Data of tensile strength (MPa) and elongation percentage (%) were submitted to 3-way ANOVA and Tukey's test (α = 0.05).

RESULTS

At the end of 14 days, the tensile strength for both materials was significantly lower in the groups modified by miconazole and itraconazole compared to the other groups (p < 0.0001), which showed no significant difference between them (p > 0.05). After 7 and 14 days in water, miconazole and itraconazole added into both materials resulted in significantly lower elongation percentages compared to the other antifungal agents and control (p < 0.0001), which were similar to each other (p > 0.05).

CONCLUSIONS

The addition of the nystatin, chlorhexidine, and ketoconazole at MICs for C. albicans biofilm resulted in no harmful effects on the tensile strength and elongation percentage of the temporary soft denture liner materials up to 14 days.

Antimicrobial efficacy and mechanical properties of BAC-modified hard and soft denture liners

This study investigated the antimicrobial efficacy and mechanical strength of hard and soft denture liners modified with benzalkonium chloride (BAC). The specimens (1 mm thickness, 8 mm diameter) were prepared by mixing 0.5, 1, 2 and 5 wt% BAC with soft (Sofreliner Medium, Tokuyama) and hard (Rebase II, Tokuyama) denture liners (n = 5/group). BAC was not added to the controls. Candida albicans ATCC 28366 (A ₅₅₀ = 0.5) and Streptococcus mutans Ingbritt suspensions (A ₅₅₀ = 0.35) were pipetted onto the specimens, and incubated for 4 h. The viable cells were collected, and determined by plate-culturing (CFU). The tests were repeated after the specimens were soaked in distilled water for 7 days. The mechanical strengths were evaluated by tear and 4-point flexural strength tests for soft and hard liners, respectively. The data were analyzed with ANOVA and Tukey's HSD tests at p = 0.05. C. albicans viability was lost in all groups of BAC-modified soft liners (p < 0.001), and S. mutans viability was reduced (p < 0.01), except of soaked BAC 0.5 wt% group (p > 0.05). For the hard liner, BAC 5 wt% killed the C. albicans and S. mutans cells both before and after soaked in water (p < 0.001). BAC 2 wt% showed comparable tear strength with the soft liner control (p > 0.05). BAC did not reduce the flexural strength of the hard liner (p > 0.05), except of BAC 5 wt% group (p < 0.01). BAC can be a promising agent reducing the C. albicans and S. mutans viability on the soft and hard denture liner surfaces.

Role of antifungal medicaments added to tissue conditioners: A systematic review

PURPOSE

The aim of this review is to investigate the current state of knowledge on the incorporation of antifungal agents into the tissue conditioners for the treatment of denture induced stomatitis.

STUDY SELECTION

Studies reporting the incorporation of antifungal/antimicrobial agents in to tissue conditioners were included in the review. In order to search the studies on the topic "incorporation of antifungal agents in tissue conditioners for the treatment of denture induced stomatitis" ISI web of science, PubMed/MEDLINE, and Google-Scholar databases were searched from 1970 up to and including July 2015 using various keywords such as antifungal agents, tissue conditioners, Candida albicans, denture stomatitis, etc.

RESULTS

Various studies reported the efficacy and effectiveness of adding conventional organic antifungal medicines (nystatin, azole group derivatives and chlorhexidine, antimicrobials/antifungals other than organic (silver zeolite, silver nano-particles, photo-catalysts and metallic oxides) and natural and herbal antimicrobials (tea tree oil, lemongrass essential oil and origanum oil) into various tissue conditioners. The review literature reported that incorporation of antifungal agents into tissue conditioners is effective with minimal or no effects on physical and mechanical properties of tissue conditioners.

CONCLUSIONS

Incorporation of different antifungal medicaments to commercially available tissue conditioners can be recommended for the management of denture induced stomatitis.

Peel bond strength of resilient liner modified by the addition of antimicrobial agents to denture base acrylic resin

In order to prolong the clinical longevity of resilient denture relining materials and reduce plaque accumulation, incorporation of antimicrobial agents into these materials has been proposed. However, this addition may affect their properties.

Resilient liners: a review

Resilient liners when used intelligently are an excellent adjunct in removable prosthodontics. However, currently they have to be best considered as temporary expedients because none of the advocated permanent liners have life expectancy comparable to resin denture base. This article reviews the literature regarding their composition, functions, gelation characteristics, bond strength and influence on denture bases. It also presents their drawbacks and attempts made to extend their longevity. A Medline search was completed for the period from 1986 to 2007, along with a manual search, to identify pertinent English peer-reviewed articles and textbooks.

Silver distribution and release from an antimicrobial denture base resin containing silver colloidal nanoparticles

PURPOSE

The aim of this study was to evaluate a denture base resin containing silver colloidal nanoparticles through morphological analysis to check the distribution and dispersion of these particles in the polymer and by testing the silver release in deionized water at different time periods.

MATERIALS AND METHODS

A Lucitone 550 denture resin was used, and silver nanoparticles were synthesized by reduction of silver nitrate with sodium citrate. The acrylic resin was prepared in accordance with the manufacturers' instructions, and silver nanoparticle suspension was added to the acrylic resin monomer in different concentrations (0.05, 0.5, and 5 vol% silver colloidal). Controls devoid of silver nanoparticles were included. The specimens were stored in deionized water at 37°C for 7, 15, 30, 60, and 120 days, and each solution was analyzed using atomic absorption spectroscopy.

RESULTS

Silver was not detected in deionized water regardless of the silver nanoparticles added to the resin and of the storage period. Micrographs showed that with lower concentrations, the distribution of silver nanoparticles was reduced, whereas their dispersion was improved in the polymer. Moreover, after 120 days of storage, nanoparticles were mainly located on the surface of the nanocomposite specimens.

CONCLUSIONS

Incorporation of silver nanoparticles in the acrylic resin was evidenced. Moreover, silver was not detected by the detection limit of the atomic absorption spectrophotometer used in this study, even after 120 days of storage in deionized water. Silver nanoparticles are incorporated in the PMMA denture resin to attain an effective antimicrobial material to help control common infections involving oral mucosal tissues in complete denture wearers.

Effect of the Association of Nystatin with a Tissue Conditioner on its Ultimate Tensile Strength

PURPOSE

This study evaluated the ultimate tensile strength of a tissue conditioner without nystatin incorporation (GI-control group) and the same tissue conditioner modified by the addition of nystatin in two concentrations: GII-500,000 International Units (U) and GIII-1,000,000 U, in which each milligram of the medicament corresponded to 6079 U.

MATERIALS AND METHODS

Dumbbell-shaped specimens (N= 7) with a central cross-sectional area of 33 x 6 x 3 mm were produced for the three experimental groups. After polymerization following manufacturer's instructions, specimens were immersed in distilled water at 37 degrees C for either 24 hours or 7 days and then tested in tension in the MTS 810 at 40 mm/minute. Data were analyzed by two-way ANOVA followed by Tukey's test, at 95% level of confidence.

RESULTS

The means (force-grams (gf) +/- standard deviation) of the ultimate tensile strength were: GI-634.29 +/- 122.80; GII-561.92 +/- 133.56; and GIII-547.30 +/- 73.47 for 24-hour storage, and GI-536.68 +/- 54.71; GII-467.50 +/- 143.51; and GIII-500.62 +/- 159.76 for 7-day storage. There were no statistically significant differences among the three experimental groups (p > 0.05). The ultimate tensile strength means of all experimental groups after 7 days were significantly lower than those observed after 24 hours (p= 0.04).

CONCLUSIONS

The results of this study suggest that the addition of nystatin into the tissue conditioner investigated in concentrations below 1,000,000 U did not affect its ultimate tensile strength.

Silver Bromide Nanoparticle/Polymer Composites: Dual Action Tunable Antimicrobial Materials

We present a simple method of fabricating highly potent dual action antibacterial composites consisting of a cationic polymer matrix and embedded silver bromide nanoparticles. A simple and novel technique of on-site precipitation of AgBr was used to synthesize the polymer/nanoparticle composites. The synthesized composites have potent antibacterial activity toward both gram-positive and gram-negative bacteria. The materials form good coatings on surfaces and kill both airborne and waterborne bacteria. Surfaces coated with these composites resist biofilm formation. These composites are different from other silver-containing antibacterial materials both in the ease of synthesis and in the use of a silver salt nanoparticle instead of elemental silver or complex silver compounds. We also demonstrate the ability to tune the release of biocidal Ag(+) ions from these composites by controlling the size of the embedded AgBr nanoparticles. These composites are potentially useful as antimicrobial coatings in a wide variety of biomedical and general use applications.

The effect of two different coatings on the surface integrity and softness of a tissue conditioner

STATEMENT OF PROBLEM

When they are used to treat inflamed, irritated, or distorted tissues or in implant therapy, tissue conditioners are required to function over relatively long time periods. Most presently available materials have a short life span (3 to 4 days).

PURPOSE

This study evaluated the effects of 2 different coatings on the surface integrity and softness of a tissue conditioner over a 4-week period.

MATERIAL AND METHODS

Ten subjects with a complete maxillary denture and a functioning mandibular dentition were included in the study. Each maxillary denture had 3 troughs filled with a tissue conditioner (Coe Comfort). One trough was coated with Monopoly and one with Permaseal; the third trough was left uncoated (control). The specimens were tested at insertion and at 1 week, 2 weeks, and 4 weeks post-insertion for softness with a durometer and for surface integrity with a scanning electron microscope. Statistical differences were determined with analysis of variance (P<.05).

RESULTS

At the end of 4 weeks, the mean and standard deviation of softness on the ASTM scale was 85.1 (4.2) for the control, 81.6 (3.9) for Monopoly, and 77.9 (5.0) for Permaseal. The difference between the control and Permaseal was significant (P<.0042). Qualitatively, SEM analysis indicated that the control deteriorated by the end of the first week, whereas both Monopoly and Permaseal coatings remained intact for up to 2 weeks. All groups showed some conditioner deterioration by 4 weeks. The tissues under the denture-bearing areas remained healthy during the study period.

CONCLUSION

Within the limitations of this study, the application of Permaseal or Monopoly coatings significantly reduced the loss of tissue conditioner softness. Permaseal-coated conditioner remained the softest over the length of the study.