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

Biofilm Formation on Denture Base Material Reinforced With a Novel Organic Material

BACKGROUND

Microcrystalline cellulose (MCC) is a novel organic material developed by one of the authors in this study. When MCC was incorporated with conventionally available denture base resin, it demonstrated increased flexural strength and flexural modulus. However, it was speculated that because the material is organic, it can promote the growth of Candida. The purpose of this study is to evaluate the Candida albicans biofilm formation on polymethyl methacrylate (PMMA) denture base resin incorporated with MCC.

MATERIALS AND METHODS

MCC is an organic material extracted from the oil palm empty fruit bunch (OPEFB). The growth of C. albicans and biofilm formation in three test groups were compared by biofilm assay and imaging techniques like microscopy (by safranin staining) and scanning electron microscopy. The three test groups were comprised of MCC-reinforced PMMA containing OPEFB fibers of 50-micrometer thickness at 5% weight reinforcement, conventionally and commercially available heat cure PMMA, and an empty well to assess any discrepancies from the environment.

RESULTS

The test groups showed increased biofilm formation by C. albicans compared to commercially and conventionally available heat cure PMMA. Reinforcement with MCC showed higher biofilm formation of 1.43 times higher compared to conventional PMMA. Biofilms formed by Candida albicans on MCC-reinforced PMMA appeared heterogeneous in structure, comprised of yeast cells and hyphae, surrounded by a higher density of polysaccharide extracellular matrix material compared to that of conventionally available heat cure PMMA.

CONCLUSION

Biofilm formation is increased in denture base resin incorporated with MCC. More investigation is warranted to study the antifungal efficacy of the addition of antifungal agents to the reinforced denture base resin.

Comparative Evaluation of Microbial Adhesion on Provisional Crowns Fabricated With Milled Polymethyl Methacrylate (PMMA) and Conventional Acrylic Resin: A Prospective Clinical Trial

Introduction Provisional prosthetic restorations play a crucial role in dentistry by protecting dentinal tubules, offering thermal insulation, and ensuring a precise fit during dental treatments. Computer-aided design and computer-aided manufacturing (CAD/CAM) have improved polymethyl methacrylate (PMMA), enhancing its mechanical properties such as hardness and resistance compared to traditional methods. However, bacterial accumulation remains a challenge due to inherent surface roughness. This study aims to assess and compare Streptococcus mutans adhesion on milled PMMA and conventional self-cure acrylic resin, providing insights into their microbial interaction dynamics. Materials and methods This study was a prospective trial approved by the Institutional Human Ethical Committee (SRB-IHEC) (registration number: IHEC/SDC/PROSTHO-2104/24/045) and registered in the Clinical Trial Registry, India (registration number: CTRI/2024/05/068196). The study involved 20 patients requiring single crowns in the right and left molar regions. Two groups were established: Group I (the milled PMMA group) and Group II (the conventional PMMA group). Criteria for participant selection and exclusion were set. A total of 120 swab samples from the buccal mucosa and tooth surfaces were collected before tooth preparation (the baseline) at one week and three weeks. Culture for S. mutans was done, and colony-forming units were counted. Data analysis was carried out using IBM SPSS Statistics for Windows, Version 26 (Released 2019; IBM Corp., Armonk, New York, United States). An independent sample t-test was employed to compare the two materials for crowns. To analyze changes over time within each group, a repeated-measures analysis of variance (ANOVA) was conducted. When the ANOVA test indicated significance, Tukey's post-hoc test was utilized for pairwise mean comparison. The level of significance was set at P < 0.05. Results The mean colony-forming units (CFU) counts for the milled PMMA group were 4.46 ± 0.167 CFU at baseline, 4.163 ± 0.058 CFU at one week, and 3.87 ± 0.19 CFU at three weeks. The mean CFU counts for the conventional PMMA group were 4.41 ± 0.13 CFU at baseline, 4.29 ± 0.114 CFU at one week, and 4.16 ± 0.108 CFU at three weeks. At baseline (before cementation), there was no difference between milled PMMA and conventional PMMA (P = 0.578). After one week, a significant difference between milled PMMA and conventional PMMA was observed (P < 0.005). After three weeks, a significant difference between milled PMMA and conventional PMMA persisted (P < 0.005).  Conclusion There was a significant reduction in microbial adhesion in both the milled and conventional PMMA groups. However, milled PMMA demonstrated a greater decrease in microbial adhesion as compared to conventional PMMA.

Assessing the suitability of fused deposition modeling to produce acrylic removable denture bases

OBJECTIVE

To study the feasibility of using poly methyl methacrylate (PMMA) filament and fused deposition modeling (FDM) to manufacture denture bases via the development of a study that considers both conventional and additive-based manufacturing techniques.

MATERIALS AND METHODS

Five sample groups were compared: heat and cold cured acrylic resins, CAD/CAM milled PMMA, 3D-printed PMMA (via FDM), and 3D-printed methacrylate resin (via stereolithography, SLA). All groups were subjected to mechanical testing (flexural strength, impact strength, and hardness), water sorption and solubility tests, a tooth bonding test, microbiological assessment, and accuracy of fit measurements. The performance of sample groups was referred to ISO 20795-1 and ISO/TS 19736. The data was analyzed using one-way ANOVA.

RESULTS

Samples manufactured using FDM performed within ISO specifications for mechanical testing, water sorption, and solubility tests. However, the FDM group failed to achieve the ISO requirements for the tooth bonding test. FDM samples presented a rough surface finish which could ultimately encourage an undesirable high level of microbial adhesion. For accuracy of fit, FDM samples showed a lower degree of accuracy than existing materials.

CONCLUSIONS

Although FDM samples were a cost-effective option and were able to be quickly manufactured in a reproducible manner, the results demonstrated that current recommended testing regimes for conventionally manufactured denture-based polymers are not directly applicable to additive-manufactured denture base polymers. Therefore, new standards should be developed to ensure the correct implementation of additive manufacturing techniques within denture-based fabrication workflow.

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.

In Vitro Evaluation of Candida albicans Adhesion and Related Surface Properties of CAD/CAM Denture Base Resins

OBJECTIVE

 The aim of this study was to evaluate the surface roughness, contact angle, and adhesion of Candida albicans to computer-aided designing/computer-aided manufacturing (CAD/CAM) and heat-polymerized (HP) denture base materials.

MATERIALS AND METHODS

 Specimens were allocated to six groups based on the composition of studied denture base materials, HP acrylic resin, milled resins (AvaDent and IvoCad), and 3D-printed resins (ASIGA, FormLabs, and NextDent). Ten specimens per group were used for each test (n = 10/test). Surface roughness and contact angles were analyzed using profilometer and goniometer, respectively. Adhesion of C. albicans was counted using colony-forming unit (CFU/mL). Means and standard deviations were calculated, and then one-way analysis of variance (ANOVA), followed by Tukey's post hoc test. Correlation of Candida adhesion and surface parameters was determined by using Pearson's correlation analysis.

RESULTS

 No statistically significant difference was noted in surface roughness between HP, milled, and 3D-printed denture base resins except NextDent, which showed significantly higher roughness in comparison to all other resins (p = 0.001). In terms of contact angle, milled resins had the lowest value, followed by HP, ASIGA, and FormLabs, whereas NextDent showed the highest contact angle (p = 0.001). C. albicans adhesion showed no significant difference between all denture base resins. A positive and significant correlation was found between C. albicans adhesion and contact angle (p = 0.003), while no correlation was reported between C. albicans adhesion and surface roughness (p = 0.523).

CONCLUSION

 Adhesion of C. albicans was similar in all tested specimens. Surface roughness showed no significant difference between all groups except NextDent, which had the highest value. Milled denture base resins had the lowest contact angle among all groups.

Navigating the future: Microfluidics charting new routes in drug delivery

Microfluidics has emerged as a transformative force in the field of drug delivery, offering innovative avenues to produce a diverse range of nano drug delivery systems. Thanks to its precise manipulation of small fluid volumes and its exceptional command over the physicochemical characteristics of nanoparticles, this technology is notably able to enhance the pharmacokinetics of drugs. It has initiated a revolutionary phase in the domain of drug delivery, presenting a multitude of compelling advantages when it comes to developing nanocarriers tailored for the delivery of poorly soluble medications. These advantages represent a substantial departure from conventional drug delivery methodologies, marking a paradigm shift in pharmaceutical research and development. Furthermore, microfluidic platformsmay be strategically devised to facilitate targeted drug delivery with the objective of enhancing the localized bioavailability of pharmaceutical substances. In this paper, we have comprehensively investigated a range of significant microfluidic techniques used in the production of nanoscale drug delivery systems. This comprehensive review can serve as a valuable reference and offer insightful guidance for the development and optimization of numerous microfluidics-fabricated nanocarriers.

Evaluation of surface roughness, wettability and adhesion of multispecies biofilm on 3D-printed resins for the base and teeth of complete dentures

OBJECTIVE

This study evaluated the surface roughness, wettability and adhesion of multispecies biofilms (Candida albicans, Staphylococcus aureus and Streptococcus mutans) on 3D-printed resins for complete denture bases and teeth compared to conventional resins (heat-polymerized acrylic resin; artificial pre-fabricated teeth).

METHODOLOGY

Circular specimens (n=39; 6.0 mm Ø × 2.0 mm) of each group were subjected to roughness (n=30), wettability (n=30) and biofilm adhesion (n=9) tests. Three roughness measurements were taken by laser confocal microscopy and a mean value was calculated. Wettability was evaluated by the contact angle of sessile drop method, considering the mean of the three evaluations per specimen. In parallel, microorganism adhesion to resin surfaces was evaluated using a multispecies biofilm model. Microbial load was evaluated by determining the number of Colony Forming Units (CFU/mL) and by scanning electron microscopy (SEM). Data were subjected to the Wald test in a generalized linear model with multiple comparisons and Bonferroni adjustment, as well as two-way ANOVA (α=5%).

RESULTS

The roughness of the conventional base resin (0.01±0.04) was lower than that of the conventional tooth (0.14±0.04) (p=0.023) and 3D-printed base (0.18±0.08) (p<0.001). For wettability, conventional resin (84.20±5.57) showed a higher contact angle than the 3D-printed resin (60.58±6.18) (p<0.001). Higher microbial loads of S. mutans (p=0.023) and S. aureus (p=0.010) were observed on the surface of the conventional resin (S. mutans: 5.48±1.55; S. aureus: 7.01±0.57) compared to the 3D-printed resin (S. mutans: 4.11±1.96; S. aureus: 6.42±0.78). The adhesion of C. albicans was not affected by surface characteristics. The conventional base resin showed less roughness than the conventional dental resin and the printed base resin.

CONCLUSION

The 3D-printed resins for base and tooth showed less hydrophobicity and less adhesion of S. mutans and S. aureus than conventional resins.

Effects of aging on attachment of Candida albicans to conventional heat-polymerized, CAD-CAM milled, and CAD-CAM 3D-printed acrylic resin bases

PURPOSE

The aim of this study was to assess Candida albicans attachment on conventionally fabricated (polymethylmethacrylate, PMMA), CAD-CAM milled, and 3D-printed acrylic resin bases pre- and post-simulated thermal aging, along with examining material surface changes after aging.

MATERIALS AND METHODS

Forty-six samples (10 mm × 10 mm × 2 mm) for each of four material groups (conventional heat-polymerized PMMA, CAD-CAM milled acrylic resin base, CAD-CAM 3D-printed methacrylate resin base, CAD-CAM 3D-printed urethane methacrylate resin base) were subjected to 0, 1, or 2 years of simulated thermal aging. Microscopic images were taken before and after aging, and C. albicans attachment was quantified using cell proliferation assay (XTT). Statistical analysis employed analysis of variance (α = 0.05).

RESULTS

Two-way factorial analysis showed no significant differences based on acrylic resin type or thermal aging (p = 0.344 and p = 0.091 respectively). However, C. albicans attachment significantly differed between 0- and 2-year thermally aged groups (p = 0.004), mainly due to elevated initial attachments on CAD-CAM milled acrylic resin base and CAD-CAM 3D-printed urethane methacrylate resin base.

CONCLUSIONS

Regardless of the fabrication technique and material combination, no significant differences were found in C. albicans adhesion pre- or post- thermal aging. Milled and 3D-printed bases compared favorably with heat- polymerized PMMA in their affinity for C. albicans attachment and surface characteristics after aging. These findings indicate that the risk of patients developing denture stomatitis might not be linked to the type of acrylic resin or fabrication method used.

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.

Adhesion of Candida Albicans to digital versus conventional acrylic resins: a systematic review and meta-analysis

BACKGROUND

The present systematic review and meta-analysis investigated the available evidence about the adherence of Candida Albicans to the digitally-fabricated acrylic resins (both milled and 3D-printed) compared to the conventional heat-polymerized acrylic resins.

METHODS

This study followed the guidelines of the Preferred Reporting Items for Systematic Review and Meta-analyses (PRISMA). A comprehensive search of online databases/search tools (Web of Science, Scopus, PubMed, Ovid, and Google Scholar) was conducted for all relevant studies published up until May 29, 2023. Only in-vitro studies comparing the adherence of Candida albicans to the digital and conventional acrylic resins were included. The quantitative analyses were performed using RevMan v5.3 software.

RESULTS

Fourteen studies were included, 11 of which were meta-analyzed based on Colony Forming Unit (CFU) and Optical Density (OD) outcome measures. The pooled data revealed significantly lower candida colonization on the milled digitally-fabricated compared to the heat-polymerized conventionally-fabricated acrylic resin materials (MD = - 0.36; 95%CI = - 0.69, - 0.03; P = 0.03 and MD = - 0.04; 95%CI = - 0.06, - 0.01; P = 0.0008; as measured by CFU and OD respectively). However, no differences were found in the adhesion of Candida albicans between the 3D-printed digitally-fabricated compared to the heat-polymerized conventionally-fabricated acrylic resin materials (CFU: P = 0.11, and OD: P = 0.20).

CONCLUSION

The available evidence suggests that candida is less likely to adhere to the milled digitally-fabricated acrylic resins compared to the conventional ones.

The Effect of Aging on Artificial Saliva at Different pH Values on the Color Stability of New Generation Denture Base Materials

STATEMENT OF PROBLEM

New-generation denture base materials are used successfully in denture fabrication; however, the effect of saliva pH change on the color stability of materials is unknown.

PURPOSE

The purpose of this in vitro study is to evaluate the color stability of new-generation denture base materials after immersion in artificial saliva with different pH values (3,7,14).

MATERIAL AND METHODS

Disc-shaped samples (Ø 10 mm x 2 mm) were prepared from three different denture base materials (1 pre-polymerized polymethylmethacrylate [PMMA], 1 graphene-reinforced PMMA, and heat-cure polymethyl methacrylate resin) (n=10). After polishing, color coordinates were measured using a PCE-CSM 5 colorimeter programmed in the CIE system (L* a* b*). The samples were kept in artificial saliva at different pH values and 37°C for 21 days. At the end of 21 days, color coordinates were measured again. The suitability of the measurements for a normal distribution was examined with the Kolmogro-Smirnov test. Whether color measurements obtained at different pH levels differed according to groups was examined with the Kruskal-Wallis test. The correlation between the CIEDE2000 and CIELab color difference formulas was examined by correlation analysis.

RESULTS

The highest color difference occurred in heat-cure samples at pH 3 (p<0.001). The color difference at different pH values was least observed in pre-polymerized PMMA samples. Significant color differences occurred in the graphene-reinforced pre-polymerized PMMA group at pH 7 (p<0.001).

CONCLUSIONS

It was observed that color differences occurred in all groups. Dentures made of new-generation CAD/CAM PMMA, which are less exposed to color differences, can be recommended for elderly patients with systemic diseases who are frequently exposed to pH changes in the oral cavity.

CLINICAL IMPLICATIONS

Color differences on denture surfaces over time negatively affect aesthetics. Since pH changes cause changes on the prosthesis surface, it may be recommended for these patients to fabricate dentures from new-generation CAD/CAM PMMA resins, which are less deformable.

Effect of thermocycling on surface topography and fracture toughness of milled and additively manufactured denture base materials: an in-vitro study

BACKGROUND

Studies investigating thermocycling effect on surface topography and fracture toughness of resins used in digitally manufactured denture bases are few. The study aimed to assess the impact of thermocycling on surface topography and fracture toughness of materials used for digitally manufactured denture bases.

METHODS

Water sorption, solubility, hardness, surface roughness, and fracture toughness of both three-dimensional (3D)-printed and computer-aided design, computer-aided manufacturing (CAD-CAM) milled specimens (n = 50) were assessed both prior to and following 2000 thermocycles, simulating 2 years of clinical aging. Surface hardness (n = 10) was measured using a Vickers hardness testing machine, surface roughness (n = 10) was determined by a contact profilometer, and fracture toughness (n = 20) was measured using the 3-point bend test, then studying the fractured surfaces was done via a scanning electron microscope (SEM). Prior to and following thermocycling, water sorption and solubility (n = 10) were assessed. Normally distributed data was tested using two-way repeated ANOVA and two-way ANOVA, while Mann Whitney U test and the Wilcoxon signed ranks test were used to analyze data that was not normally distributed (α < 0.05).

RESULTS

Following thermocycling, Vickers hardness and fracture toughness of both groups declined, with a significant reduction in values of the 3D-printed resin (P < .001). The 3D-printed denture base resins had a rougher surface following thermocycling with a significant difference (P < .001). The sorption and solubility of water of both materials were not affected by thermocycling.

CONCLUSIONS

Before and after thermocycling, milled specimens had lower surface roughness and a greater degree of hardness and fracture toughness than 3D-printed specimens. Thermocycling lowered hardness and fracture toughness, and increased surface roughness in both groups, but had no effect on water sorption and solubility.

Assessing the effect of Artemisia sieberi extracts on surface roughness and candida growth of digitally processed denture acrylic materials

BACKGROUND

Denture stomatitis, frequently encountered, is generally addressed symptomatically, with limited exploration of preventive approaches involving antifungal medicinal plants.

OBJECTIVE

This study assessed the impact of Artemisia sieberi extracts on the candida growth of conventional and digitally processed acrylic materials.

METHOD

Thirty acrylic resin discs (3 mm thickness × 10 mm diameter) were prepared by conventional or CAD/CAM technology (milling and 3D printing). The resin discs were exposed to simulated brushing, thermocycling, and immersion in Artemisia sieberi extract for 8 hours. The surface roughness of the discs was assessed at baseline and after immersion in Artemisia sieberi extract. Candida growth was quantified through colony-forming units (CFU/mL). Data was analyzed using SPSS v.22 (α⩽ 0.05).

RESULTS

Irrespective of the material type, the post-immersion surface roughness was significantly higher compared to pre-immersion values (p< 0.05). Candida growth was significantly higher in conventional acrylic materials than digitally fabricated acrylics (p< 0.05). At × 3, Ra and CFU were found to be moderately positive and non-significantly correlated (R= 0.664, p= 0.149). At × 4, Ra and CFU were found to be weak positive and non-significantly correlated (R= 0.344, p= 0.503).

CONCLUSION

Artemisia sieberi extracts had a notable impact on digitally fabricated denture acrylics, reducing candida albicans growth compared to conventional heat-cured acrylic. This suggests a potential role for these extracts in improving denture hygiene and preventing denture stomatitis, particularly in the context of digitally fabricated dentures.

Microbiological evaluation of conjunctival anopthalmic flora after using digital 3D-printed ocular prosthesis compared to conventional one: a randomized clinical trial

BACKGROUND

This study aims to assess the influence of using 3D-printed acrylic resin versus conventional Poly-methyl methacrylate (PMMA) for fabricating ocular prostheses on the biofilm and microbial flora of anophthalmic socket.

METHODS

A randomized controlled trial was designed as a parallel group study. Participants were allocated randomly into two groups: the control group, which received conventionally fabricated ocular prostheses (CG, n = 11), and the test group, which received digitally 3D-printed ocular prostheses (DG, n = 11). Microbiological analysis was conducted before prosthesis insertion and three months after using the ocular prosthesis. Swab samples were inoculated on blood agar, MacConkey's agar, and Sabouraud's dextrose agar (SDA) for isolating Gram-positive, Gram-negative, and fungal organisms, respectively. Subsequently, the plates were incubated at 37 degrees Celsius for 48 h. Additionally, a validated questionnaire was used for subjective clinical evaluation, including parameters such as comfort level, socket discharge, lacrimation, and frequency of lubrication for each ocular prosthesis patient in both groups.

RESULTS

Test group (DG, n = 11) exhibited a positive, though statistically insignificant, difference (p > 0.001) in microbial growth when compared to the control group (CG, n = 11). A statistically significant difference was observed in comfort levels between the two groups, with more comfort level within group II (test group) patients. While parameters such as discharge amount, discharge location, lacrimation and lubrication frequency displayed statistically insignificant differences between the two groups, all parameters showed improved results after three months of prosthesis use.

CONCLUSIONS

The choice of ocular prosthesis fabrication technique did not yield a statistically significant difference in anophthalmic flora. However, the 3D-printed acrylic resin, as an artificial eye material, displayed potential advantages in reducing the colonization of opportunistic pathogens. All subjective clinical evaluation parameters exhibited enhanced outcomes after three months of prosthesis use, emphasizing the need for an adaptation period during which patients complains are alleviated. In comparison with PMMA, 3D-printed acrylic resin showcased a certain degree of anti-colonization ability against pathogenic bacteria, along with a significant level of patient comfort, suggesting its potential as a promising material for ocular prostheses.

TRIAL REGISTRATION

This parallel double-blinded RCT has been registered at ClinicalTrials.gov with identification number: NCT05584865, 18/10/2022.

The effect of zinc oxide (ZnO) nanoparticle concentration on the adhesion of mucin and Streptococcus mutans to heat-cured acrylic resin

Incorporating zinc oxide (ZnO) nanoparticles as antibacterial fillers in heat-cured acrylic resin could decrease mucin and Streptococcus mutans (S. mutans) adhesion, reducing the incidence of dental caries in the baseplates of orthodontic patients. Here, ZnO nanoparticles were modified using 3-(trimethoxysilyl)propyl methacrylate with various concentrations, added to acrylic resin powder, homogenized, mixed with acrylic resin liquid, and processed. The composite systems interfered well with mucin and S. mutans adhesion. The lowest mean of the amount of mucin adhered was on heat-cured acrylic resin with 7.5% ZnO nanoparticles, with a standard deviation of 18.07±0.80 mg/mL. The ZnO nanoparticles with a concentration of 7.5% showed an 87.09±0.88% S. mutans adhesion in control groups with no additives. These composite systems were proven to have better physicochemical characteristics and antibacterial abilities. Combining ZnO nanoparticles with heat-cured acrylic resin has great potential for self-cleaning baseplates of orthodontic patients in the future.

Effect of Hygiene Protocols on the Mechanical and Physical Properties of Two 3D-Printed Denture Resins Characterized by Extrinsic Pigmentation as Well as the Mixed Biofilm Formed on the Surface

To assess the effect of hygiene protocols and time on the physical-mechanical properties and colony-forming units (CFU) of Candida albicans, Staphylococcus aureus, and Streptococcus mutans on 3D-printed denture resins (SmartPrint and Yller) with extrinsic pigmentation compared to conventional resin (CR). The protocols were evaluated: brushing (B), brushing and immersion in water (W), 0.25% sodium hypochlorite (SH), and 0.15% triclosan (T), simulating 0, 1, 3, and 5 years. The data were analyzed by ANOVA with repeated measurements, ANOVA (Three-way) and Tukey's post-test, generalized linear model with Bonferroni adjustment, and ANOVA (Two-way) and Tukey's post-test (α = 0.05). The protocols influenced color (p = 0.036) and Knoop hardness (p < 0.001). Surface roughness was influenced by protocols/resin (p < 0.001) and time/resin (p = 0.001), and flexural strength by time/protocols (p = 0.014). C. albicans showed interactions with all factors (p = 0.033). Staphylococcus aureus was affected by protocols (p < 0.001). Streptococcus mutans exhibited no count for SH and T (p < 0.001). Yller resin showed more color changes. The 3D-printed resins displayed lower microhardness, increased roughness, and decreased flexural strength compared to CR with all protocols in a simulated period of 5 years. The indication of printed resins should be restricted to less than 3 years.

Effect of DMPEI coating against biofilm formation on PVC catheter surface

Urinary tract infections (UTIs) are a significant cause of morbidity in healthcare systems and are prominently associated with applying urethral catheters, particularly in surgeries. Polyvinyl chloride (PVC) is extensively utilized in the fabrication of catheters. Biofilms, complex polymeric constructions, provide a protective milieu for cell multiplication and the enhancement of antibiotic resistance. Strategies to counteract biofilm development on medical apparatuses' surfaces incorporate antimicrobial agents such as N,N-dodecyl, and methyl polyethylenimine (DMPEI). This research endeavored to characterize the morphology of PVC and PVC-DMPEI surfaces utilizing Scanning Electron Microscopy (SEM) and Atomic Force Microscopy (AFM) and to gauge hydrophobicity through contact angle measurements. Employing Escherichia coli, Staphylococcus aureus, and Candida albicans in adhesion assays enabled the assessment of DMPEI's efficacy in preventing microbial adherence to PVC. Butanol successfully solubilized 2 mg.mL-1 DMPEI without altering the PVC structure. SEM results substantiated the formation of a DMPEI layer on the PVC surface, which led to decreased surface roughness, as validated by AFM, and increased hydrophilicity, as demonstrated by contact angle evaluations. E. coli, S. aureus, and C. albicans exhibited significant adhesion reduction, 89.3%, 94.3%, and 86.6% on PVC-DMPEI surfaces. SEM visualizations confirmed reduced cellular colonization on PVC-DMPEI and highlighted considerable morphological modifications in E. coli. Consequently, DMPEI films effectively minimize the adhesion of E. coli, S. aureus, and C. albicans on PVC surfaces. DMPEI, with its potential as a protective coating for innovative medical devices, promises to inhibit biofilm adherence effectively.

Effect of different disinfection protocols on the surface properties of CAD-CAM denture base materials

STATEMENT OF PROBLEM

Which disinfection protocol provides optimal water contact angle and microhardness for computer-aided design and computer-aided manufacturing (CAD-CAM) polymethyl methacrylate (PMMA) materials is unclear.

PURPOSE

The purpose of this in vitro study was to evaluate the effect of different disinfection protocols (1% sodium hypochlorite, denture cleanser gel, and effervescent tablet) on the water contact angle and microhardness of different CAD-CAM PMMA denture base materials by comparing them with a heat-polymerized PMMA.

MATERIAL AND METHODS

Disk-shaped specimens (Ø10×2 mm) were fabricated from 3 different CAD-CAM PMMAs-AvaDent (AV), Merz M-PM (M-PM), and Polident (Poli)-and a heat-polymerized PMMA (Vynacron) (CV) (n=21). Three disinfection protocols (1% sodium hypochlorite [HC], denture cleanser gel [GEL], an effervescent tablet [TAB]) were applied to simulate 180 days of cleansing. The water contact angle and microhardness of specimens were measured before and after disinfection and compared by using a 2-way ANOVA (α=.05).

RESULTS

For water contact angle, material (P=.010) and disinfection protocol (P=.002) had a significant effect. The material (P<.001), disinfection protocol (P=.001), and their interaction (P<.001) significantly affected the microhardness after disinfection. When the condition after disinfection was compared with that before disinfection, the water contact angle increased significantly in all material-disinfection protocol pairs (P≤.025), and microhardness increased significantly in all material-disinfection protocol pairs (P≤.040), except for GEL- (P=.689) or TAB-applied (P=.307) AV, HC-applied M-PM (P=.219), and TAB-applied Poli (P=.159).

CONCLUSIONS

The material and disinfection protocol affected the water contact angle of all tested PMMAs after disinfection, resulting in more hydrophobic surfaces for heat-polymerized or CAD-CAM PMMAs. The microhardness of heat-polymerized PMMA was less than that of all CAD-CAM PMMAs after disinfection, regardless of the protocol.

Comparative Evaluation of the Digital Workflow and Conventional Method in Manufacturing Complete Removal Prostheses

The aging population in developed countries has increased the number of edentulous patients and, therefore, the need for prosthetic rehabilitation to improve their quality of life. Complete dentures are the main treatment option in these cases. The use of CAD/CAM (Computer Aided Design/Computer Aided Manufacturing) in dentistry has improved clinical protocols and outcomes, achieving a reduction in work time and economic costs for the patients. The main objective of this review was to compare the characteristics of conventional and digital dentures, attempting to determine whether the use of new technologies represents an improvement in the properties of removable complete dentures. A bibliographic review was carried out in the PubMed/MEDLINE, Cochrane Library, Scielo, and Embase databases. With the initial search, 157 articles were obtained. After applying the inclusion and exclusion criteria, 64 publications were selected for this bibliographic review. The different conclusions of the studies consulted were compared regarding fit and retention, fracture resistance, surface roughness, biocompatibility, and aesthetics, taking into account the different methods of prostheses fabrication. In general, digital prostheses have shown better mechanical properties and, consequently, better biocompatibility and aesthetics than conventional prostheses. However, the obtained results were very heterogeneous, preventing a supported conclusion.

Effects of layer thickness and build angle on the microbial adhesion of denture base polymers manufactured by digital light processing

PURPOSE

To investigate the effects of printing-layer thickness and build angle on the surface characteristics and microbial adhesion of denture base polymers manufactured by digital light processing (DLP).

METHODS

Specimens were additively manufactured using DLP. The specimens were printed with different printing-layer thicknesses (25, 50, and 100 μm) and build angles (0°, 45°, and 90°). Scanning electron microscopy was used to observe the surface topography, and the arithmetical mean heights (Sa) were measured. Moreover, the initial Candida albicans (C. albicans) adhesion to the specimens was evaluated using an adhesion test. Finally, two-way ANOVA and Tukey's multiple comparison tests were conducted.

RESULTS

The results regarding the Sa values exhibited a statistically significant interaction (F (4, 45) = 90.77, P < 0.0001). The build angle has a significant impact on the surface topography. Furthermore, quantitative results revealed that the printing-layer thickness significantly affected C. albicans adhesion (F (2, 99) = 6.96, P = 0.0015).

CONCLUSIONS

The surface roughness was significantly affected by the printing-layer thickness and the build angle. Additionally, the surface topography was mainly determined by the build angle. Furthermore, the adhesion of C. albicans to the DLP-printed denture surfaces was significantly affected by the printing-layer thickness but not by the build angle. Consequently, it is critical to decrease the thickness of the printing layer to produce digital dentures with optimal material properties.

Microbial adhesion and biofilm formation by Candida albicans on 3D-printed denture base resins

This study evaluated surface properties and adhesion/biofilm formation by Candida albicans on 3D printed denture base resins used in 3D printing. Disc-shaped specimens (15 mm x 3 mm) of two 3D-printed resins (NextDent Denture 3D+, NE, n = 64; and Cosmos Denture, CO, n = 64) and a heat-polymerized resin (Lucitone 550, LU, control, n = 64) were analyzed for surface roughness (Ra μm) and surface free energy (erg cm-2). Microbiologic assays (90-min adhesion and 48-h biofilm formation by C. albicans) were performed five times in triplicate, with the evaluation of the specimens' surface for: (i) colony forming units count (CFU/mL), (ii) cellular metabolism (XTT assay), and (iii) fluorescence and thickness of biofilm layers (confocal laser scanning microscopy). Data were analyzed using parametric and nonparametric tests (α = 0.05). LU presented higher surface roughness Ra (0.329±0.076 μm) than NE (0.295±0.056 μm) (p = 0.024), but both were similar to CO (0.315±0.058 μm) (p = 1.000 and p = 0.129, respectively). LU showed lower surface free energy (47.47±2.01 erg cm-2) than CO (49.61±1.88 erg cm-2) and NE (49.23±2.16 erg cm-2) (p<0.001 for both). The CO and NE resins showed greater cellular metabolism (p<0.001) and CO only, showed greater colonization (p = 0.015) by C. albicans than LU in the 90-min and 48-hour periods. It can be concluded that both 3D-printed denture base resins are more prone to colonization by C. albicans, and that their surface free energy may be more likely associated with that colonization than their surface roughness.

The effects of different surface treatments applied to milled PMMA denture base material on repair bond strength

The high cost of CAD/CAM systems and materials is a severe economic burden. Therefore, repair of CAD/CAM PMMA, selecting appropriate repair materials, and surface modifications are clinically important. This study aims to evaluate the shear bond strength of PMMA repair materials after various surface treatments on CAD/CAM PMMA denture base material. For this purpose, a total of 480 CAD/CAM PMMA denture base test specimens were manufactured. Then all test specimens were divided into 6 groups, and different surface treatments were applied. Group A: sandblasting, Group B: 4% hydro fluoric acid, Group C: tungsten carbide bur, Group D: dichloromethane + methyl methacrylate mixture, Group E: dichloromethane and methyl methacrylate, Group F: no surface treatment. Each group is then divided into 4 different subcategories; repair processes were performed using; heat-cured acrylic resin (n:20), auto-polymerized acrylic resin (n:20), gingiva composite (n:20), and CAD/CAM PMMA tooth material (n:20). After repairs, thermal aging was applied to half of the test specimens in each subcategory. The shear bond strength value was measured with a universal test device. Sandblasting group showed the highest surface roughness value in all test specimens (p < 0.001). Heat-cured acrylic resin with sandblasting exhibited the highest bond strength, while the untreated gingiva composite resin exhibited the lowest value. Thermal aging decreased bond strength in all repair materials (p < 0.001). Among the surface treatment groups, sandblasting with Al2O3 particles exhibited the highest surface roughness value and repair bond strength. The application of organic solvents to the surface increased the surface roughness and repair bond strength. Applying dichloromethane and methyl methacrylate monomer separately is more effective than applying it as a mixture. The ideal bonding among repair materials was obtained with heat-cured acrylic resin.

Attachment of Respiratory Pathogens and Candida to Denture Base Materials-A Pilot Study

Denture prostheses are an ideal and extensive reservoir for microorganisms to attach to their surfaces. The aim of the study was to elucidate interactions between materials for the fabrication of denture bases and the attachment of microorganisms, focusing on respiratory pathogens and Candida species. Specimens (6 mm × 1 mm) with a standardized surface roughness (Sa = 0.1 µm) were prepared from heat-pressed polymethyl methacrylate (PMMA), CAD/CAM-processed PMMA, and CAD/CAM-processed polyether ether ketone (PEEK). The specimens were randomly placed in the vestibular areas of complete upper dentures in seven patients and were removed either after 24 h without any oral hygiene measures or after a period of four weeks. The microorganisms adherent to the surface of the specimens were cultivated and subsequently analyzed using mass spectrometry (MALDI-TOF). The means and standard deviations were calculated, and the data were analyzed using a two-way analysis of variance (ANOVA) and Tukey post-hoc test where appropriate (α = 0.05). There was a significant increase (p ≤ 0.004) in the total bacterial counts (CFU/mL) between the first (24 h) and the second (four weeks) measurements. Regarding quantitative microbiological analyses, no significant differences between the various materials were identified. Respiratory microorganisms were detected in all samples at both measurement time points, with a large variance between different patients. Only after four weeks, Candida species were identified on all materials but not in all participants. Candida species and respiratory microorganisms accumulate on various denture base resins. While no significant differences were identified between the materials, there was a tendency towards a more pronounced accumulation of microorganisms on conventionally processed PMMA.

Clinical Applications and Mechanical Properties of CAD-CAM Materials in Restorative and Prosthetic Dentistry: A Systematic Review

Clinical outcomes of dental restorations depend primarily on the choice of materials used, and nowadays, dental CAD-CAM (Computer-Aided Design Computer-Aided Manufacturing) materials have strongly changed daily clinical practice. The aim of this systematic review is to analyze CAD-CAM dental materials according to their mechanical properties and in relation to their clinical applications. A literature review was performed on PubMed, Scopus, Web of Knowledge, and the Cochrane Library. Articles addressing at least one of the following topics regarding dental materials for CAD-CAM systems: manufacturers, mechanical features, materials' composition, optical properties, clinical indications, and/or outcomes were included in the review. A flowchart was performed as described in the PRISMA guidelines. Among the 564 articles found, 63 were analyzed and evaluated. Within the limitations of this systematic review, it can be concluded that CAD-CAM materials present a wide range of clinical applications due to their improved mechanical properties. Specifically, in addition to materials that have been in use for a long time (such as feldspathic ceramics), resin block composites can also be used for permanent restorations.

Synthesis of nanostructured novel ion-imprinted polymer for selective removal of Cu2+ and Sr2+ ions from reverse osmosis concentrated brine

This study aims to prepare an ion-imprinted polymer (IIP) using copper sulfate as a template and potassium persulfate as an initiator to selectively adsorb copper ions (Cu²⁺) from aqueous solutions and in an attempt to also test its applicability for removing strontium ions (Sr²⁺). The prepared polymer was denoted by IIP-Cu. Various physical and chemical characterizations were performed for the prepared IIP-Cu. The scanning electron microscopy and transmission electron microscopy analyses confirmed the cavities formed after the removal of the template. It also indicated that the IIP-Cu had a rough and porous topology. The X-ray photoelectron spectroscopy confirmed the successful removal of the Cu template from IIP-Cu. The Brunauer-Emmet-Teller revealed that the surface area of IIP-Cu is as high as 152.3 m²/g while the pore radius is 8.51 nm. The effect of pH indicated that the maximum adsorption of Cu²⁺ was achieved at pH 8 with 98.7%. Isotherm studies revealed that the adsorption of Cu²⁺ was best explained using Langmuir models with a maximum adsorption capacity of 159 mg/g. The effect of temperature revealed that an increase in temperature had an adverse impact on Cu²⁺ removal from the aqueous solution, which was further confirmed by thermodynamic studies. The negative value of standard enthalpy change (-4.641 kJ/mol) revealed that the adsorption of Cu²⁺ onto IIP-Cu was exothermic. While the continuous increase in Gibbs free energy from -6776 kJ/mol to -8385 kJ/mol with the increase in temperature indicated that the adsorption process was spontaneous and feasible. Lastly, the positive value of the standard entropy change (0.023 J/mol.K) suggested that the Cu²⁺ adsorption onto IIP-Cu had a good affinity at the solid-liquid surface. The efficiency of the prepared IIP-Cu was also tested by studying the adsorption capacity using Sr²⁺ and real brine water. The results revealed that IIP-Cu was able to remove 63.57% of Sr²⁺ at pH 8. While the adsorption studies revealed that the experiment was best described using the Langmuir model with a maximum adsorption capacity of 76.92 mg/g. Additionally, IIP-Cu was applied in a real brine sample, which consisted of various metal ions. The highest percentage of Cu²⁺ removal was 90.6% and the lowest was 65.63% in 1:4 and 1:1 brine ratios, respectively. However, this study indicates the successful application of IIP-Cu in a real sample when it comes to the effective and efficient removal of Cu²⁺ in a solution consisting of various competing ions.

Biofilm Formation on the Surfaces of CAD/CAM Dental Polymers

Dental polymers are now available as monolithic materials which can be readily used in computer-aided design and computer-aided manufacturing (CAD/CAM) systems. Despite possessing numerous advantages over conventionally produced polymers, the polymers produced by either of these systems fail to exhibit immunity to surface microbial adhesion when introduced into the oral environment, leading to the development of oral diseases. The aim of this study was to analyze the biofilm formation of six microorganisms from the oral cavity and its correlation to the surface characteristics of CAD/CAM dental polymers. A total of ninety specimens were divided into three groups: resin-based composite, polymethyl methacrylate, and polyether ether ketone. The experimental procedure included surface roughness and water contact angle measurements, colony forming unit counting, and scanning electron microscopy analysis of biofilm formed on the surface of the tested materials. The data were analyzed using the Kruskal-Wallis test, with a Dunn's post hoc analysis, and one way analysis of variance, with a Tukey's post hoc test; the correlation between the measurements was tested using Spearman's correlation coefficient, and descriptive statistics were used to present the data. Despite using the same manufacturing procedure, as well as the identical manufacturer's finishing and polishing protocols, CAD/CAM dental polymers revealed significant differences in surface roughness and water contact angle, and the increased values of both parameters led to an increase in biofilm formation on the surface of the materials. The CAD/CAM resin-based composite showed the lowest number of adhered microorganisms compared to CAD/CAM polymethyl methacrylate and CAD/CAM polyether ether ketone.

Influence of Fabrication Technique on Adhesion and Biofilm Formation of Candida albicans to Conventional, Milled, and 3D-Printed Denture Base Resin Materials: A Comparative In Vitro Study

The aim of this study was to evaluate the adhesion and biofilm formation of Candida albicans (C. albicans) on conventionally fabricated, milled, and 3D-printed denture base resin materials in order to determine the susceptibility of denture contamination during clinical use. Specimens were incubated with C. albicans (ATCC 10231) for 1 and 24 h. Adhesion and biofilm formation of C. albicans were assessed using the field emission scanning electron microscopy (FESEM). The XTT (2,3-(2-methoxy-4-nitro-5-sulphophenyl)-5-[(phenylamino) carbonyl]-2H-tetrazolium hydroxide) assay was used for the quantification of fungal adhesion and biofilm formation. The data were analyzed using GraphPad Prism 8.02 for windows. One-way ANOVA with Tukey's post hoc testing were performed with a statistical significance level set at α = 0.05. The quantitative XTT biofilm assay revealed significant differences in the biofilm formation of C. albicans between the three groups in the 24 h incubation period. The highest proportion of biofilm formation was observed in the 3D-printed group, followed by the conventional group, while the lowest candida biofilm formation was observed in the milled group. The difference in biofilm formation among the three tested dentures was statistically significant (p < 0.001). The manufacturing technique has an influence on the surface topography and microbiological properties of the fabricated denture base resin material. Additive 3D-printing technology results in increased candida adhesion and the roughest surface topography of maxillary resin denture base as compared to conventional flask compression and CAD/CAM milling techniques. In a clinical setting, patients wearing additively manufactured maxillary complete dentures are thus more susceptible to the development of candida-associated denture stomatitis and accordingly, strict oral hygiene measures and maintenance programs should be emphasized to patients.

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

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

Hardness and surface roughness of differently processed denture base acrylic resins after immersion in simulated gastric acid

STATEMENT OF PROBLEM

The effect of gastric acid on the surface properties of denture base acrylic resin is unknown.

PURPOSE

The purpose of this in vitro study was to evaluate changes in the surface roughness and hardness of denture base acrylic resins after immersion in simulated gastric acid.

MATERIAL AND METHODS

Acrylic resin specimens (n=10) were prepared with 3 different processing techniques (compression-molded, injection-molded, and computer-aided design and computer-aided manufacturing [CAD-CAM] milled) and exposed to either gastric acid or artificial saliva (control). Surface roughness and hardness were measured at baseline (T0) and after 24-hour (T24) and 96-hour (T96) immersion in the solutions. The surface roughness and hardness data were analyzed by 3-way ANOVA and the Tukey HSD test (α=.05).

RESULTS

At T24, the greatest change in surface hardness was observed for compression-molded specimens in gastric acid (P<.05). At T96, changes in hardness values were higher in compression-molded specimens than those in milled specimens (P<.05). Regarding surface roughness, at T24, compression-molded and injection-molded specimens showed higher values than milled specimens in gastric acid (P<.05). Concerning specimens in artificial saliva, compression-molded specimens showed significantly higher changes in roughness than those of the others (P<.05). At T96, injection-molded specimens had the greatest roughness values (P<.05). Among specimens immersed in artificial saliva, milled specimens showed lower roughness values than the injection-molded or compression-molded specimens (P<.05).

CONCLUSIONS

Gastric acid exposure adversely affected the roughness and hardness of all the acrylic resins evaluated. CAD-CAM milled specimens showed better resistance to acid exposure after 24 and 96 hours in terms of roughness and hardness.

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.

Evaluation of candida albicans adherence to CAD-CAM milled, 3D-printed, and heat-cured PMMA resin and efficacy of different disinfection techniques: an in-vitro study

PURPOSE

Candida albicans has been regarded as the most predominant oral fungal pathogen and the main cause of denture stomatitis. This study aimed to investigate C. albicans adherence to three types of denture base polymers: heat-cured polymethylmethacrylate (PMMA), CAD-CAM milled and 3D-printed. The efficacy of four common disinfection techniques, glutaraldehyde, brushing, microwave irradiation, and Polident overnight tablets, were also examined.

MATERIAL AND METHODS

Sixty blocks of pink acrylic specimens were fabricated from each polymer group. To investigate the C. albicans adherence, as well as the efficacy of different disinfection techniques on removing the yeast from the different materials, specimens were cultured within the fungal culture overnight followed by disinfection. The adhered C. albicans on the materials were then obtained by vortexing in phosphate buffered saline (PBS), and the numbers of the yeast in the suspensions were evaluated by measuring the optical density and/or colony-forming units on agar plates. Data were expressed as mean ± SEM (standard error of the mean). Statistical differences were evaluated by one-way analysis of variance (ANOVA) followed by the post-hoc Tukey HSD tests.

RESULTS

Significant differences in C. albicans adherence to the three polymers were noted. CAD-CAM milled and heat-cured PMMA showed significantly less C. albicans adherence compared with 3D printed PMMA. No significant difference was noted between milled and heat-cured PMMA. In the disinfection test, microwave irradiation, mechanical brushing, and Polident tablets were found to be effective in removing fungal attachment on the different denture materials, while glutaraldehyde was found to be the least effective.

CONCLUSION

C. albicans adherence to the polymers varies greatly based on the types of PMMA. 3D-printed had the highest fungal biofilm attachment. Microwave irradiation, mechanical brushing, and Polident overnight tablets had comparable results in removing C. albicans from all types of PMMA, while glutaraldehyde was not as effective. This article is protected by copyright. All rights reserved.

Tissue Surface Adaptation and Clinical Performance of CAD-CAM Milled versus Conventional Implant-Assisted Mandibular Overdenture

Purpose

To evaluate the surface adaptation and maximal biting force of CAD-CAM milled mandibular overdenture (CAD-CAM MOD) compared to conventional compression mold mandibular overdenture (CC MOD).

Materials and Methods

Ten completely edentulous subjects with persistent complaints of their complete mandibular dentures were received four dental implants in the anterior mandible. Three months after osseointegration, subjects were randomly received either conventional compression mold or CAD-CAM MOD in a crossover design. To assess tissue surface adaptation, the fitting surfaces of each denture base were scanned and placed on the reference master cast. Three and six months after each overdenture was inserted, clinical performance in the form of maximum biting force was evaluated.

Results

The results of this study indicated that the tissue surface adaptation of the CAD-CAM MOD bases was significantly better than the conventional (compression mold technique) processed bases where (P=0.0001). Regarding clinical performance (maximum biting force), the CAD-CAM MOD exhibited better clinical performance (P=0.0001).

Conclusions

In denture processing methods, the CAD-CAM overdenture delivered more precise adaption and clinical performance than the compression mold technique.

Adherence Of Candida Albicans to Five Long-Term Silicone-Based Denture Lining Materials Bonded to CAD-CAM Denture Base

PURPOSE

Knowledge about quantifying the number as well as the retention and adhesion of Candida albicans blastoconidia to silicone denture liners is limited. Thus, the aim of this in vitro study was to explore the adherence of Candida albicans to the surface of five long-term silicone-based soft denture lining materials, using artificial saliva.

MATERIALS & METHODS

A total of 50 specimens (10 × 10 × 3 mm) of five long-term resilient liners (Molloplast-B; GC Reline Soft; Elite Soft Relining; Tokuyama Sofreliner S; Ufigel SC), bonded to a computer-aided design and computer-aided manufacturing denture base, were prepared. The specimens were inoculated and incubated in artificial saliva for 1h and 24h with a standardized (2.8 × 10⁶ cfu/ml) Candida albicans suspension. At the end of the incubation period, the specimens were stained with acridine orange and observed, using fluorescence microscopy.

RESULTS

After 1h and in 24h, Molloplast B demonstrated significantly earlier adherence of Candida albicans cells compared to the other chairside materials (p<0.001 and p<0.001, respectively), where the mean number of cells also increased in the frontal parts. Regarding the rate of Candida albicans proliferation from 1h to 24 hours within the materials, there was an increase in all materials (Molloplast B: p<0.001; GC Reline Soft: p = 0.220; Elite Soft Relining: p = 0.032; Tokuyama Sofreliner S: p = 0.001; Ufigel Sc: p = 0.001). The Ufigel Sc showed a significant 2.5-fold increase at 24h.

CONCLUSIONS

Long-term silicone denture liners accumulate a significant amount of Candida albicans blastoconidia and their coverage by them increases progressively over time. This article is protected by copyright. All rights reserved.

Bio-functionalization of microfluidic platforms made of thermoplastic materials: A review

As a result of their favorable physical and chemical characteristics, thermoplastics have garnered significant interest in the area of microfluidics. The moldable nature of these inexpensive polymers enables easy fabrication, while their durability and chemical stability allow for resistance to high shear stress conditions and functionalization, respectively. This review provides a comprehensive examination several commonly used thermoplastic polymers in the microfluidics space including poly(methyl methacrylate) (PMMA), cyclic olefin polymer (COP) and copolymer (COC), polycarbonates (PC), poly(ethylene terephthalate) (PET), polystyrene (PS), poly(ethylene glycol) (PEG), polylactic acid (PLA), acrylonitrile butadiene styrene (ABS), and polyester. We describe various biofunctionalization strategies applied within thermoplastic microfluidic platforms and their resultant applications. Lastly, emerging technologies with a focus on applying recently developed microfluidic and biofunctionalization strategies into thermoplastic systems are discussed.

Assessment of Conventionally and Digitally Fabricated Complete Dentures: A Comprehensive Review

CAD/CAM technology is gaining popularity and replacing archaic conventional procedures for fabricating dentures. CAD/CAM supports using a digital workflow reduce the number of visits, chair time, and laboratory time, making it attractive to patients. This study aimed to provide a comparative review of complete dentures manufactured using CAD/CAM and conventional methods. The PubMed/Medline, Science Direct, Cochrane, and Google Scholar databases were searched for studies published in English within the last 11 years (from 2011 to 2021). The keywords used were “computer-engineered complete dentures”, “CAD/CAM complete dentures”, “computer-aided engineering complete dentures”, and “digital complete dentures”. The search yielded 102 articles. Eighteen relevant articles were included in this review. Overall, computer-engineered complete dentures have several advantages over conventional dentures. Patients reported greater satisfaction with computer-engineered complete dentures (CECDs) due to better fit, reduced chair time, shorter appointments, and fewer post-insertion visits. CAD/CAM allows for precision and reproducibility with fewer procedures compared to conventional dentures. Polymethyl methacrylate is used as the denture base material for conventional dentures. For CECDs, the resin can be modified and cross-linked to improve its mechanical properties. The advantages of CECDs include a reduced number of appointments, saving chairside time, a digital workflow allowing easy reproducibility and greater patient satisfaction with a better fit.

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

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

Microbial Adhesion to Dental Polymers for Conventional, Computer-Aided Subtractive and Additive Manufacturing: A Comparative In Vitro Study

Modern structural materials are represented by a variety of polymer materials used for dental patients’ rehabilitation. They differ not only in physico-chemical properties, but also in microbiological properties, which is one of the reasons why these materials are chosen. The study focused on the microbial adhesion of clinical isolates of normal (5 types), periodontopathogenic (2 types), and fungal (2 types) microbiotas to various materials based on polymethylmethacrylate (PMMA) intended for traditional (cold-cured and hot-cured polymers), computer-aided subtractive and additive manufacturing. A comparative analysis was carried out on the studied samples of polymer materials according to the microorganisms’ adhesion index (AI). The lowest level of microorganisms’ AI of the three types of microbiotas was determined in relation to materials for additive manufacturing. The AI of hot-cured polymers, as well as materials for subtractive manufacturing, corresponded to the average level. The highest level of microorganisms’ adhesion was found in cold-cured polymers. Significant differences in AI for materials of the same technological production type (different manufacturers) were also determined. The tendency of significant differences in the indicators of the microorganisms’ adhesion level for the studied polymer materials on the basis of the type of production technology was determined.

Computer-Aided Design and Computer-Aided Manufacturing (CAD/CAM) Complete Dentures for Atrophic Alveolar Ridges: Workflow Combining Conventional and Novel Techniques

Extreme residual ridge resorption is a challenging clinical situation for the fabrication of complete dental prostheses. Computer-aided design and computer-aided manufacturing (CAD/CAM) complete dentures have been shown to have superior fit and material strength to conventionally fabricated dentures, but no clinical protocols have been described for cases of extreme residual ridge resorption. This report describes a workflow combining conventional and novel techniques for CAD/CAM complete dentures fabrication for atrophic alveolar ridges and demonstrates that a CAD/CAM workflow is an effective tool for solving this complex situation.

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

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

Comparison of the flexural and surface properties of milled, 3D-printed, and heat polymerized PMMA resins for denture bases: an in vitro study

PURPOSE

To compare the flexural properties and the adhesion of Lactobacillus salivarius (LS), Streptococcus mutans (SM), and Candida albicans (CA) on heat-polymerized (CV), CAD-CAM milled (CAD), or 3D-printed (3D) Poly (methylmethacrylate) (PMMA).

METHODS

Ultimate Flexural Strength (UFS), Flexural Strain (FS) (%) at Flexural Strength, and Flexural Modulus (FM) of specimens (65.0×10.0×3.3 mm) from each PMMA group (n=6) were calculated by using the 3-point bending test. The surface roughness profiles (R) were measured before and after polishing with a contact profilometer. LS, SM, and CA adhesion on PMMA specimens (n=18) (10 mm in diameter, 3 mm in height) was assessed after 90 minutes and 16 hours by using scanning electron microscopy. The Kruskal-Wallis test with post hoc analysis was performed to compare the groups (alpha=0.05).

RESULTS

Mean UFS values were 80.79±7.64 MPa for CV, 110.23±5.03 MPa for CAD, and 87.34±6.39 MPa for 3D. Mean FS values were 4.37±1.04% for CV, 4.71±0.62% for CAD, and 6.19±0.13 % for 3D. Mean FM values were 2542±301 MPa for CV, 3435±346 MPa for CAD, and 2371±197 MPa for 3D. CAD had the lowest average R value (0.29±0.16 µm) before polishing, and bacterial adhesion after 90 minutes of incubation. R value and microbial adhesion were not different amongst groups after polishing and 16 hours of incubation, respectively.

CONCLUSION

The CAD group displayed the best flexural properties, except for FS, the lowest roughness before polishing and bacterial adhesion after 90 minutes of incubation. All tested PMMAs had similar surface roughness after polishing, and microbial adhesion after 16 hours of incubation.

Effect of additive manufacturing method and build angle on surface characteristics and Candida albicans adhesion to 3D printed denture base polymers

OBJECTIVES

To investigate the influence of additive manufacturing method and build angle on surface characteristics and Candida albicans (C. albicans) adhesion to 3D printed denture base polymers.

METHODS

Specimens of 3D printing denture base polymers were prepared by two printers, namely, stereolithography (SLA, Form 3B) and digital light processing technology (DLP, Solflex 350 plus). Three build angles were used: 0°, 45°, and 90°. Surface topography was examined by scanning electron microscopy. Also, arithmetical mean height (S_a) values were calculated. An adhesion test was performed to observe initial C. albicans adhesion to the specimens. The data were statistically analyzed using the two-way analysis of variance and Tukey's multiple comparison test.

RESULTS

The data of S_a values had statistically significant differences, which were mainly determined by the main factor of build angle (p < 0.05). Moreover, the quantitative results of C. albicans adhesion exhibited no significant differences: printing techniques (p = 0.7794) and build angle (p = 0.0589), respectively.

CONCLUSIONS

Surface roughness was significantly influenced by the build angle rather than by the AM method. Whereas, AM method (SLA and DLP) and build angle (0°, 45°, and 90º) had no impacts on the C. albicans adhesion to the 3D printed denture bases.

CLINICAL SIGNIFICANCE

Build angle dominates the surface roughness and topography of the 3D printed denture polymers. Our results indicate that C. albicans' adhesion might not be influenced by AM method and build angle.

Comparative Effect of Different Surface Treatments on the Shear Bond Strength of Two Types of Artificial Teeth Bonded To Two Types of Denture Base Resins

PURPOSE

This in vitro study aims to assess the impact of various surface treatments on the shear bond strength (SBS) of two types of artificial teeth and denture base resins (DBRs).

MATERIALS AND METHODS

Two types of DBRs (CAD/CAM-milled and heat-polymerized) and two types of denture teeth (acrylic and composite) were investigated. Teeth were cut into slices (5 × 5 × 2 mm) and divided according to surface treatment into four subgroups (n = 10): no treatment (control), air abrasion (Alumina-blasting; AB), bur roughening, and dichloromethane (DCM) subgroups. According to manufacturer recommendations, the treated tooth slices were bonded to the acrylic disk of DBRs. The SBS test was performed using a universal testing machine. ANOVA was used for results analysis followed by Tukey's post hoc tests (α = 0.05).

RESULTS

DCM and AB increased the SBS of acrylic teeth to heat-polymerized DBR compared with other groups (p < 0.001). All surface treatments showed no significant difference in CAD/CAM DBR with acrylic teeth (p = 0.059; AB, p = 0.319; bur roughening, p = 0.895; DCM), while there was a significant decrease in SBS with composite teeth (p ˂ 0.001). Between teeth, acrylic teeth showed a statistically significant increase in SBS compared to composite teeth (p < 0.001).

CONCLUSION

AB and DCM application improved the SBS for acrylic teeth with the heat-polymerized DBR when compared with the untreated group, but none of the surface treatment agents showed significant improvement with CAD/CAM DBR. All surface treatment agents reduced the SBS for composite teeth with CAD/CAM DBR while AB only increased the SBS with heat-polymerized DBR.

CAD-CAM complete denture resins: an evaluation of biocompatibility, mechanical properties, and surface characteristics

OBJECTIVES

This study evaluated the biocompatibility, mechanical properties, and surface roughness of CAD-CAM milled and rapidly-prototyped/3D-printed resins used for manufacturing complete dentures.

METHODS

Six groups of resin specimens were prepared, milled-base (MB), milled-tooth shade (MT), printed-tooth shade (PT), printed-base with manufacturer-recommended 3D-printer (PB1), printed-base with third-party 3D-printer (PB2), printed-base in a vertical orientation (PB2V). Human epithelial (A-431) and gingival (HGF-1) cells were cultured and tested for biocompatibility using Resazurin assays. Three-point bending and nanoindentation tests measured the mechanical properties of the resin groups. Surface roughness was evaluated using a high-resolution laser profilometer. ANOVA and post-hoc tests were used for statistical analyses (α = 0.05).

RESULTS

There were no significant differences in biocompatibility between any of the investigated groups. MB revealed a higher ultimate strength (p = 0.008), elastic modulus (p = 0.002), and toughness (p = 0.014) than PB1. MT had significantly higher elastic modulus than PT (p < 0.001). Rapidly-prototyped resin samples with a manufacturer-recommended 3D-printer (PB1) demonstrated higher ultimate strength (p = 0.008), elastic modulus (p < 0.001), hardness (p < 0.001) and a reduced surface roughness (p < 0.05) when compared with rapidly-prototyped groups using a third-party 3D-printer (PB2). Rapidly-prototyped samples manufactured with a vertical printing orientation (PB2V) revealed a significantly lower elastic modulus than samples groups manufactured using horizontal printing orientation (PB2) (p = 0.011).

CONCLUSIONS

Within the limits of this present study, CAD-CAM milled and rapidly-prototyped complete denture resins performed similarly in terms of biocompatibility and surface roughness. However, the milled denture resins were superior to the rapidly-prototyped denture resins with regard to their mechanical properties. Printing orientation and type of 3D-printer can affect the resin strength and surface roughness.

CAD-CAM removable complete dentures: A systematic review and meta-analysis of trueness of fit, biocompatibility, mechanical properties, surface characteristics, color stability, time-cost analysis, clinical and patient-reported outcomes

OBJECTIVES

This review compared Computer-aided designand Computer-aided manufactured (CAD-CAM) and conventionally constructed removable complete dentures (CDs).

DATA

Seventy-three studies reporting on CAD-CAM (milled/3D-printed) CDs were included in this review. The most recent literature search was performed on 15/03/2021.

SOURCES

Two investigators searched electronic databases [PubMed (MEDLINE), Embase, CENTRAL], online search engines (Google) and research portals. Hand searches were performed to identify literature not available online.

STUDY SELECTION

Studies on CAD-CAM CDs were included if they reported on trueness of fit, biocompatibility, mechanical, surface, chemical, color , microbiological properties, time-cost analysis, and clinical outcomes. Inter-investigator reliability was assessed using kappa scores. Meta-analyses were performed on the extracted data .

RESULTS

The kappa score ranged between 0.897-1.000. Meta-analyses revealed that 3D-printed CDs were more true than conventional CDs (p = 0.039). Milled CDs had a higher flexural-strength than conventional and 3D-printed CDs (p < 0.0001). Milled CDs had a higher flexural-modulus than 3D-printed CDs (p < 0.0001). Milled CDs had a higher yield-strength than injection-molded (p = 0.004), and 3D-printed CDs (p = 0.001). Milled CDs had superior toughness (p < 0.0001) and surface roughness characteristics (p < 0.0001) than other CDs . Rapidly-prototyped CDs displayed poor color-stability compared to other CDs (p = 0.029). CAD-CAM CDs d displayed better retention than conventional CDs (p = 0.015). Conventional CDs had a higher strain at yield point than milled CDs (p < 0.0001), and had superior esthetics than 3D-printed (p < 0.0001). Fabrication of CAD-CAM CDs required less chairside time (p = 0.037) and lower overall costs (p < 0.0001) than conventional CDs.

CONCLUSIONS

This systematic review concludes that CAD-CAM CDs offer a number of improved mechanical/surface properties and are not inferior when compared to conventional CDs.

CLINICAL SIGNIFICANCE

CAD-CAM CDs should be considered for completely edentulous patients whenever possible, since this technique offers numerous advantages including better retention, mechanical and surface properties but most importantly preserves a digital record. This can be a great advantage for older adults with limited access to dental care.

Comparison of CAD/CAM and Conventional Denture Base Resins: A Systematic Review

At present, complete dentures (CDs) remain the only treatment available for the majority of edentulous patients. CDs are primarily fabricated using a conventional method using polymethylmethacrylate (PMMA) resin. The steps involved in PMMA polymerisation directly affect the quality of the resin prosthetic base and any error reduces retention and occlusal accuracy of CDs. Furthermore, when using the conventional technique, the residual monomer alters the resin mechanical properties and may cause mucosal reactions. Recently, computer aided design and computer aided manufacture (CAD/CAM) techniques were increasingly used to fabricate CDs by machining resin discs that have been manufactured under high pressure and temperature. This systematic review compares CAD/CAM and conventional CDs according to their mechanical, physical and chemical characteristics, as well as the clinical impact of any differences between them. A review was conducted according to the preferred reporting items for systematic reviews and meta-analyses checklist on 392 publications from both PubMed and backward research. Fifteen studies have been included. Results showed that CAD/CAM resins had globally better physical and mechanical properties than conventional resins. The use of machined resin could improve the clinical performance, maintenance and longevity of CDs. Further studies in clinical use would be required to complement these results.

Effect of thermocycling on the surface properties of CAD-CAM denture base materials after different surface treatments

PURPOSE

To evaluate the effect of thermocycling on the water contact angle (WCA), surface roughness (SR), and microhardness (MH) of different CAD-CAM PMMA denture base materials after different surface treatments (conventional laboratory polishing, polishing kit, or surface sealant).

MATERIALS AND METHODS

Disk-shaped specimens (10 × 2 mm) of 3 different CAD-CAM PMMAs, AvaDent (AV); Merz M-PM (M-PM); Polident (Poli), and a conventional heat-polymerized PMMA (Vynacron) (CV) (n=21) were divided into 3 different surface treatment groups (n=7): conventional laboratory polishing (CLP), polishing with acrylic resin polisher kit (PK), and a surface sealant (Palaseal) (SSC). Stereomicroscopic images were taken both before and after thermocycling. WCA, SR, and MH of all specimens were measured before and after thermocycling and compared by using a 2-way ANOVA (α=0.05).

RESULTS

After thermocycling, WCA significantly increased for CLP- or PK -applied (P<.001) specimens of all materials and SSC-applied M-PM (P=.002), SR significantly increased for CLP-applied M-PM (P=.027) and PK-applied Poli (P=.041), and MH significantly decreased for CLP- or PK-applied AV (P = .001, P < .001, respectively), CV (P=.033, P=.023, respectively), and M-PM (P=.003, P=.001, respectively), SSC-applied M-PM (P<.001), and CLP-applied Poli (P<.001). Stereomicroscopic images revealed rougher surfaces for PK-applied specimens.

CONCLUSIONS

After thermocycling, surface treatment had a significant effect on water contact angle and surface roughness. CLP or PK application resulted in hydrophobic surfaces compared with before thermocycling. CLP or SSC application on CAD-CAM PMMAs resulted in smoother surfaces. Thermocycling lowered the microhardness of all PMMAs, and the decrease was significant in CLP- or PK-applied PMMAs, except for PK-applied Poli.

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

Purpose:

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

Materials and methods:

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

Results:

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

Conclusion:

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

Properties of Acrylic Resin For CAD/CAM: A Systematic Review and Meta-Analysis of In Vitro Studies

PURPOSE

This systematic review and meta-analysis of in vitro studies compared the prepolymerized acrylic resin used for CAD/CAM complete denture manufacturing versus the heat-polymerized acrylic resin for conventional complete dentures in terms of surface roughness, wettability, hardness and flexural strength.

MATERIALS AND METHODS

An electronic search was performed in the PubMed, Embase, LILACS and Web of Science databases, without language or date restrictions. Gray literature and manual search tools were also used. The systematic review was carried out by two researchers independently, following the inclusion criteria: in vitro studies testing the CAD/CAM acrylic resin with a control group of heat-polymerized acrylic resin which compared at least one of the four material properties above. The meta-analysis was performed separately for each property, using a random effect model.

RESULTS

Of the 914 studies found by means of search strategies, 698 were selected for the systematic review. After applying the eligibility criteria, only 17 articles were selected for the qualitative analysis in the systematic review; among these, 14 were included in the quantitative meta-analysis. The CAD/CAM prepolymerized acrylic resin in blocks had similar properties when compared to heat-polymerized acrylic resin in almost all outcome measures, with the exception of a statistically significant reduction in surface roughness.

CONCLUSIONS

Based on the findings of this systematic review and meta-analysis, equally satisfactory results can be expected from dental prosthesis manufactured by the CAD/CAM system when compared to conventional ones, with the additional potential of reducing the pigmentation and attached microorganisms due to the reduced surface roughness of the prepolymerized resin.

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

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