Development of a new model system to study microbial colonization on dentures

Disinfection and Isotonic Drinks' Influence on Hardness and Color Stability of Ethylene-Vinyl-Acetate Copolymer Mouthguards Used in Martial Arts: An In Vitro Study

This in vitro study aimed to evaluate the hardness and color change of an ethylene-vinyl-acetate copolymer (EVA) material for mouthguards after exposition to different cleaning agent solutions and isotonic drinks. Four hundred samples were prepared and divided into four equinumerous groups (n = 100), in which there were 25 samples from each color of EVA (red, green, blue and white). The hardness, using the digital durometer, and the color coordinates (CIE L*a*b*), using the digital colorimeter, were measured before the first exposition and after 3 months of exposition to spray disinfection and incubation in the oral cavity temperature, or immersion in isotonic drinks. The values of Shore A hardness (HA) and color change (ΔE-calculated by Euclidean distance) were statistically analyzed using the Kolmogorov-Smirnov test, multiple comparison ANOVA/Kruskal-Wallis and appropriate post-hoc tests. Statistically significant changes in color and hardness between the tested groups were demonstrated after the use of agents predestined for disinfecting the surface of mouthguards on the tested samples. There were no statistically significant differences in color and hardness between the groups immersed in isotonic sport drinks potentially consumed by competitors practicing combat sports using mouthguards. Despite the changes in color and hardness after the use of disinfectants, the deviations were minor and limited to specific colors of the EVA plates. The intake of isotonic drinks practically did not change either the color or the hardness of the samples, regardless of the tested color of the EVA plates.

Mechanical performance of 3-dimensionally printed resins compared with conventional and milled resins for the manufacture of occlusal devices: A systematic review

STATEMENT OF PROBLEM

Digital methods for manufacturing occlusal devices provide advantages over conventional techniques, but information about the mechanical properties of 3-dimensionally (3D) printed resins is scarce.

PURPOSE

The purpose of this systematic review was to evaluate the literature to determine whether 3D-printed resins for occlusal devices present satisfactory mechanical performance when compared with milled and conventional heat polymerized and autopolymerized resins.

MATERIAL AND METHODS

This systematic review followed the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol and was registered in the Open Science Framework. The search strategy was applied without restriction of time and language to Embase, PubMed, Scopus, Science Direct, and Web of Science databases, and to the nonpeer-reviewed literature in ProQuest and Google Scholar. The selection process was conducted independently in 2 stages by 2 reviewers according to the eligibility criteria. The risk of bias was analyzed by using a checklist of important parameters to be considered. The systematic review considered the population, intervention, comparison, outcome, studies (PICOS) format, where population was resins for 3D printing of occlusal devices, intervention was inherent characteristics of the resin, comparison was conventional heat polymerized, autopolymerized, and milled resins, outcome was mechanical performance, and studies were in vitro experimental studies.

RESULTS

A total of 1430 articles were found with the search strategy. After removing 182 duplicates found in Rayyan, the title and abstract of 1248 articles were evaluated, of which 37 articles were screened from the databases, 23 were selected for full reading, and 6 met the eligibility criteria and were included in this review; 1 had a low risk of bias and 5 had a moderate risk. An additional search of the reference list of included articles did not result in the inclusion of any articles. A quantitative meta-analysis could not be performed because of the heterogeneity of the included studies regarding the type of resin used and the method for evaluating mechanical performance.

CONCLUSIONS

Resins for 3D printing had satisfactory mechanical performance for interocclusal devices when compared with conventional heat polymerized and autopolymerized resins, except for hardness. Milled resins were better than 3D-printed resins in hardness, wear resistance, flexural strength, flexural modulus, and fracture resistance when printing angle and thickness were not considered. Further development is needed in terms of printing techniques and chemical composition, as they are important for optimal mechanical properties and clinical performance.

Properties and characteristics of foam denture cleaners as denture adhesive removers

The need for denture adhesives is increasing worldwide, but few denture-care products target denture adhesive users. Foam denture cleaners have been recently marketed to assist brush denture cleaning, but there is a lack of objective evaluation. In this study, we compared the detergency of denture adhesives using six commercial foam-denture cleaners. For removing the adhesives, most of the tested cleaners were effective in immersion experiments, and three cleaners were more effective in the denture cleaning experiment compared to control water. However, only one could effectively remove the slime that is derived from the adhesive and detergency of artificial dirt. The surface roughnesses of the denture base and the relining material revealed that prolonged immersion in some cleaners could be affected. The results suggest that different commercial foam denture cleaners have different detergency levels, and that some cleaners may affect the properties of denture materials upon long-term use.

Investigating the mechanical and optical properties of novel Urethandimethacrylate (UDMA) and Urethanmethacrylate (UMA) based rapid prototyping materials

OBJECTIVE

This study is focused on testing experimental rapid prototyping materials for occlusal splints made from Urethandimethacrylate (UDMA) and Urethanmethacrylate (UMA).

METHODS

Materials were mixed from UDMA and UMA in ratios of 1.0:0.0, 0.75:0.25, 0.5:0.5, 0.25:0.75 and 0.0:1.0. Specimens were printed using digital light processing (DLP). After post-processing, the specimens underwent testing on flexural strength, modulus of elasticity, hardness, wear behavior, surface roughness, gloss and color stability. All tests were performed after 24 h (baseline) and 10 days of water storage (aging). Splints underwent cyclic pull-off and insertion testing, which was alongside simulated using finite element analysis.

RESULTS

The mechanical properties were significantly influenced by changes in the UDMA:UMA ratio. Statistical analysis revealed that increased amounts of UMA correlated with a decrease in flexural strength (92.0 to 30.7 MPa), modulus of elasticity (2.4 to 0.6 GPa), hardness (155.1 to 102.0 N/mm²) and wear resistance (-1394.9 to -1742.1 μm). Materials with higher amounts of UMA were also more likely to be influenced by water storage. Specimens with 75% and 100% UMA content were partly not analyzable due to soft consistency. Optical properties showed only minor influence from UMA content and aging. Differences in surface roughness (3.9 to 2.4 μm) and color stability were insignificant. Gloss was partly influenced by the UDMA:UMA ratio and water storage. Mean survival rates for cyclic pull-off and insertion testing ranged from 2537 to 23,857 cycles. A correlation between the amount of UMA and survival rates was observed.

SIGNIFICANCE

The addition of up to 25% UMA showed promising results, complying with clinical standards and delivering acceptable results in the cyclic pull-off and insertion test. Further investigation on increments between 0 and 25% UMA could help to find an optimum.

Effect of Denture Cleansers on Cobalt-Chromium Alloy Surface: A Simulated Period of 5 Years' Use

PURPOSE

To compare the effect of solutions of effervescent tablets (ET), cetylpyridinium chloride (CPC), and experimental solutions of Ricinus communis on the surface of cobalt-chromium (Co-Cr) alloys.

MATERIALS AND METHODS

Fifty-five specimens of Co-Cr were prepared by the lost-wax casting method using circular patterns (∅12 × 3 mm). The specimens were randomly divided into 5 groups: deionized water (control); 2% R. communis; 10% R. communis; ET, and CPC. The surface roughness of specimens (n = 10) was evaluated before immersion (baseline), and at simulated times of ½, 1, 2, 3, 4, and 5 years, by laser confocal microscope (Sa, μm) and profilometer (Ra, μm). The surface topography and chemical composition (n = 1) was qualitatively analyzed with scanning electron microscopy (SEM), and energy dispersive X-ray spectrometry (EDS). Data were subjected to Kruskal-Wallis followed by Dunn tests, and Friedman followed by Wilcoxon tests (α = 0.05).

RESULTS

For Sa, there was no difference for the solution factor. For the time factor a significant difference was found with 2% R. communis solution among baseline and ½, 2, 3, and 5 years (p < 0.001) and with 10% R. communis solution between 1 and 2 years (p = 0.007), with decreasing roughness over time. For Ra, cetylpyridinium chloride exhibited less roughness than 10% R. communis solution in ½ (p = 0.048) and 5 years (p = 0.013). In the SEM and EDS analysis the solutions did not present deleterious effects or changes in the chemical composition on the surfaces.

CONCLUSIONS

Although a significant difference was found for the roughness, the results, below 0.2 μm, are clinically acceptable. Thus, all solutions can be used safely in removable partial denture cleaning for a period of 5 years.

Methodologies for in vitro and in vivo evaluation of efficacy of antifungal and antibiofilm agents and surface coatings against fungal biofilms

Unlike superficial fungal infections of the skin and nails, which are the most common fungal diseases in humans, invasive fungal infections carry high morbidity and mortality, particularly those associated with biofilm formation on indwelling medical devices. Therapeutic management of these complex diseases is often complicated by the rise in resistance to the commonly used antifungal agents. Therefore, the availability of accurate susceptibility testing methods for determining antifungal resistance, as well as discovery of novel antifungal and antibiofilm agents, are key priorities in medical mycology research. To direct advancements in this field, here we present an overview of the methods currently available for determining (i) the susceptibility or resistance of fungal isolates or biofilms to antifungal or antibiofilm compounds and compound combinations; (ii) the in vivo efficacy of antifungal and antibiofilm compounds and compound combinations; and (iii) the in vitro and in vivo performance of anti-infective coatings and materials to prevent fungal biofilm-based infections.

Using Fluorescence Intensity of Enhanced Green Fluorescent Protein to Quantify Pseudomonas aeruginosa

A variety of direct and indirect methods have been used to quantify planktonic and biofilm bacterial cells. Direct counting methods to determine the total number of cells include plate counts, microscopic cell counts, Coulter cell counting, flow cytometry, and fluorescence microscopy. However, indirect methods are often used to supplement direct cell counting, as they are often more convenient, less time-consuming, and require less material, while providing a number that can be related to the direct cell count. Herein, an indirect method is presented that uses fluorescence emission intensity as a proxy marker for studying bacterial accumulation. A clinical strain of Pseudomonas aeruginosa was genetically modified to express a green fluorescent protein (PA14/EGFP). The fluorescence intensity of EGFP in live cells was used as an indirect measure of live cell density, and was compared with the traditional cell counting methods of optical density (OD₆₀₀) and plate counting (colony-forming units (CFUs)). While both OD₆₀₀ and CFUs are well-established methods, the use of fluorescence spectroscopy to quantify bacteria is less common. This study demonstrates that EGFP intensity is a convenient reporter for bacterial quantification. In addition, we demonstrate the potential for fluorescence spectroscopy to be used to measure the quantity of PA14/EGFP biofilms, which have important human health implications due to their antimicrobial resistance. Therefore, fluorescence spectroscopy could serve as an alternative or complementary quick assay to quantify bacteria in planktonic cultures and biofilms.

Candida albicans biofilm heterogeneity does not influence denture stomatitis but strongly influences denture cleansing capacity

Approximately 20  % of the UK population wear some form of denture prosthesis, resulting in denture stomatitis in half of these individuals. Candida albicans is primarily attributed as the causative agent, due to its biofilm -forming ability. Recently, there has been increasing evidence of C. albicans biofilm heterogeneity and the negative impact it can have clinically; however, this phenomenon has yet to be studied in relation to denture isolates. The aims of this study were to evaluate C. albicans biofilm formation of clinical denture isolates in a denture environment and to assess antimicrobial activity of common denture cleansers against these tenacious communities. C. albicans isolated from dentures of healthy and diseased individuals was quantified using real-time PCR and biofilm biomass assessed using crystal violet. Biofilm development on the denture substratum poly(methyl methacrylate), Molloplast B and Ufi-gel was determined. Biofilm formation was assessed using metabolic and biomass stains, following treatment with denture hygiene products. Although C. albicans was detected in greater quantities in diseased individuals, it was not associated with increased biofilm biomass. Denture substrata were shown to influence biofilm biomass, with poly(methyl methacrylate) providing the most suitable environment for C. albicans to reside. Of all denture hygiene products tested, Milton had the most effective antimicrobial activity, reducing biofilm biomass and viability the greatest. Overall, our results highlight the complex nature of denture- related disease, and disease development cannot always be attributed to a sole cause. It is the distinct combination of various factors that ultimately determines the pathogenic outcome.

Material compatibility and antimicrobial activity of consumer products commonly used to clean dentures

STATEMENT OF PROBLEM

Regular denture cleaning is essential to good oral health, but only limited evidence is available regarding the effects of common cleaning routines.

PURPOSE

The purpose of this in vitro study was to determine the compatibility of denture materials with and the antimicrobial effects of typical cleaning regimens.

MATERIAL AND METHODS

The evaluated treatments were derived from a study of dental professional recommendations and consumer habits, including denture cleanser tablets, toothpaste, mouthwash, isopropyl alcohol (IPA), household bleach, soap, and vinegar. The material integrity of denture materials, including polymethyl methacrylate (PMMA) and metals, was evaluated by scanning electron microscopy and profilometry after treatment with laboratory regimens simulating 2 years of typical consumer use. Treatments were also evaluated in a microbial kill time assay against a range of oral microorganisms with typical treatment regimens.

RESULTS

Alcohol-based mouthwash and IPA damaged the surface of PMMA, and brushing with toothpaste caused scratching and surface material loss. Bleach caused limited damage to PMMA, but corroded CoCr alloy (pitting) and solder (layer formation). Denture tablets caused little damage to any materials apart from the layer formation on silver solder. Vinegar and soap were compatible with all materials. In antimicrobial assays, bleach gave excellent results, and IPA and mouthwash required concentrated dilutions to be effective. Cleanser tablets were effective at 5 minutes treatment time against all organisms. Toothpaste was effective against bacteria but not Candida albicans. Vinegar, soaps, salt, and sodium bicarbonate were microbially ineffective.

CONCLUSIONS

Bleach was highly antimicrobial but incompatible with metal dental prosthesis components. IPA and mouthwash were antimicrobial but damaged PMMA. Specialist denture cleanser tablets gave a good combination of microbial efficacy and reasonable material compatibility.

Biofilm formation and Candida albicans morphology on the surface of denture base materials

Fungal biofilms may contribute to the occurrence of denture stomatitis. The objective of the study was to investigate the biofilm formation and morphology of Candida albicans in biofilms on the surface of denture base materials. Specimens were prepared from different denture base materials. After determination of surface properties and salivary pellicle formation, mono- and multispecies biofilm formation including Candida albicans ATCC 10231 was initiated. Relative amounts of adherent cells were determined after 20, 44, 68 and 188 h; C. albicans morphology was analysed employing selective fluorescence microscopic analysis. Significant differences were identified in the relative amount of cells adherent to the denture base materials. Highest blastospore/hyphae index suggesting an increased percentage of hyphae was observed in mono- and multispecies biofilms on the soft denture liner, which did not necessarily respond to the highest relative amount of adherent cells. For both biofilm models, lowest relative amount of adherent cells was identified on the methacrylate-based denture base material, which did not necessarily relate to a significantly lower blastospore/hyphae index. The results indicate that there are significant differences in both biofilm formation as well as the morphology of C. albicans cells in biofilms on the surface of different denture base materials.