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

Mapping the research landscape of nanoparticles and their use in denture base resins: a bibliometric analysis

BACKGROUND

Nanoparticles are increasingly used in dentistry for various applications, including enhancing the mechanical properties of denture base resins. This study aimed to comprehensively review and analyze the research landscape of nanoparticles and their effect on the flexural strength of denture base resins to identify key research areas and trends and to highlight the importance of collaboration between authors and institutions.

METHODS

A Bibliometric Analysis was conducted using the Keywords "Nanoparticle*" AND "Denture*" OR "CAD/CAM." The literature search from the WOS database was restricted to the publication years 2011 to 2022.

RESULTS

Key findings encompass an increase in research publications but a decline in citations. Saudi Arabia, China, and Iraq led this research, with specific institutions excelling. Notable journals with high impact factors were identified. Authorship patterns show variations in citation impact. Additionally, keyword analysis revealed that current research trends offer insights into influential authors and their networks.

CONCLUSIONS

The analysis of nanoparticles and denture base resins reveals a dynamic and evolving landscape that emphasizes the importance of collaboration, staying current with research trends, and conducting high-quality research in this ever-evolving domain.

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.

Evaluating the Translucency, Surface Roughness, and Cytotoxicity of a PMMA Acrylic Denture Base Reinforced with Bioactive Glasses

The colonisation of the surface of removable acrylic dentures by various types of microorganisms can lead to the development of various diseases. Therefore, the creation of a bioactive material is highly desirable. This study aimed to develop a denture base material designed to release bioactive ions into the oral environment during use. Four types of bioactive glasses (BAG)-S53P4, Biomin F, 45S5, and Biomin C-were incorporated into the PMMA acrylic resin, with each type constituting 20 wt.% (10 wt.% non-silanised and 10% silanised) of the mixture, while PMMA acrylic resin served as the control group. The specimens were subsequently immersed in distilled water, and pH measurements of the aqueous solutions were taken every seven days for a total of 38 days. Additionally, surface roughness and translucency measurements were recorded both after preparation and following seven days of immersion in distilled water. The cytotoxicity of these materials on human fibroblast cells was evaluated after 24 and 48 h using Direct Contact and MTT assays. Ultimately, the elemental composition of the specimens was determined through energy-dispersive X-ray (EDX) spectroscopy. In general, the pH levels of water solutions containing BAG-containing acrylics gradually increased over the storage period, reaching peak values after 10 days. Notably, S53P4 glass exhibited the most significant increase, with pH levels rising from 5.5 to 7.54. Surface roughness exhibited minimal changes upon immersion in distilled water, while a slight decrease in material translucency was observed, except for Biomin C. However, significant differences in surface roughness and translucency were observed among some of the BAG-embedded specimens under both dry and wet conditions. The composition of elements declared by the glass manufacturer was confirmed by EDX analysis. Importantly, cytotoxicity analysis revealed that specimens containing BAGs, when released into the environment, did not adversely affect the growth of human gingival fibroblast cells after 48 h of exposure. This suggests that PMMA acrylics fabricated with BAGs have the potential to release ions into the environment and can be considered biocompatible materials. Further clinical trials are warranted to explore the practical applications of these materials as denture base materials.

Pathogenesis and preventions of denture stomatitis

Denture stomatitis (DS) is one of the frequent oral diseases caused by multiple factors among denture wearers and is an erythematous lesion of the mucosa in the denture-bearing area, which is a limited and non-specific damage that seriously endangers the oral health of denture wearers. Traditional drug treatment for DS is effective, but it is prone to the development of drug-resistant strains. Therefore, it is important to find new treating options. For the prevention and treatment of DS, there are various methods such as direct administration of azole and polyene antibiotics to the mucosal lesions, extra-oral cleaning of the denture by cleansers and physical disinfection, and modification of denture materials. Natural ingredient preparations that have emerged in recent years are safe, convenient, inexpensive, and less likely to produce drug-resistant strains, and are seen as new sources of drugs for DS treatment. Photodynamic therapy has shown superior antibacterial properties and is also considered promising due to the convenience and safety of the treatment process and the ease of developing drug resistance. Antibacterial agents endow dentures with new characteristics, and denture modification will be a new way to treat DS. In addition, combining different prevention and control methods has shown better antibacterial activity against Candida albicans, which also provides new ideas for prevention and treatment of DS in the future.

Mechanical and Biocompatibility Properties of 3D-Printed Dental Resin Reinforced with Glass Silica and Zirconia Nanoparticles: In Vitro Study

This study aimed to assess the mechanical and biocompatibility properties of dental resin reinforced with different nanoparticle additives. Temporary crown specimens were 3D-printed and grouped based on nanoparticle type and amount, including zirconia and glass silica. Flexural strength testing evaluated the material's ability to withstand mechanical stress using a three-point bending test. Biocompatibility was tested using MTT and dead/live cell assays to assess effects on cell viability and tissue integration. Fractured specimens were analysed using scanning electron microscopy (SEM) and energy-dispersive X-ray spectroscopy (EDS) for fracture surface examination and elemental composition determination. Results show that adding 5% glass fillers and 10-20% zirconia nanoparticles significantly improves the flexural strength and biocompatibility of the resin material. Specifically, the addition of 10%, 20% zirconia, and 5% glass silica by weight significantly increases the flexural strength of the 3D-printed resins. Biocompatibility testing reveals cell viabilities greater than 80% in all tested groups. Reinforced 3D-printed resin holds clinical potential for restorative dentistry, as zirconia and glass fillers have been shown to enhance mechanical and biocompatibility properties of dental resin, making it a promising option for dental restorations. The findings of this study may contribute to the development of more effective and durable dental materials.

Antifungal efficiency and cytocompatibility of polymethyl methacrylate modified with zinc dimethacrylate

Objectives

Considering the high incidence rates of denture stomatitis, research that providing dental biomaterials with antifungal property are essential for clinical dentistry. The objectives of the present study were to investigate the effect of zinc dimethacrylate (ZDMA) modification on the antifungal and cytotoxic properties, as well as the variance in surface characteristics and other physicochemical properties of polymethyl methacrylate (PMMA) denture base resin.

Methods

PMMA with various mass fraction of ZDMA (1 wt%, 2.5 wt% and 5 wt%) were prepared for experimental groups, and unmodified PMMA for the control. Fourier-transform infrared spectroscopy (FTIR) was applied for characterization. Thermogravimetric analysis, atomic force microscopy and water contact angle were performed to investigate the thermal stability and surface characteristics (n=5). Antifungal capacities and cytocompatibility were evaluated with Candida albicans (C. albicans) and human oral fibroblasts (HGFs), respectively. Colony-forming unit counting, crystal violet assay, live/dead biofilm staining and scanning electron microscopy observation were performed to assess antifungal effects, and the detection of intracellular reactive oxygen species production was applied to explore the possible antimicrobial mechanism. Finally, the cytotoxicity of ZDMA modified PMMA resin was evaluated by the 3-(4,5-dimethyl-thiazol-2-yl)-2,5-diphenyl-tetrazolium bromide (MTT) assay and live/dead double staining.

Results

The FTIR analyses confirmed some variation in chemical bonding and physical blend of the composites. Incorporation of ZDMA significantly enhanced the thermal stability and hydrophilicity compared with unmodified PMMA (p < 0.05). The surface roughness increased with the addition of ZDMA while remained below the suggested threshold (≤ 0.2 µm). The antifungal activity significantly improved with ZDMA incorporation, and cytocompatibility assays indicated no obvious cytotoxicity on HGFs.

Conclusions

In the present study, the ZDMA mass fraction up to 5 wt% in PMMA performed better thermal stability, and an increase in surface roughness and hydrophilicity without enhancing microbial adhesion. Moreover, the ZDMA modified PMMA showed effective antifungal activity without inducing any cellular side effects.

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.

Prospects on Tuning Bioactive and Antimicrobial Denture Base Resin Materials: A Narrative Review

Denture base resin (DBR) materials are used in dentistry in constructing removable dentures and implant-supported prostheses. A plethora of evidence has demonstrated that DBR materials are associated with a high risk of denture stomatitis, a clinical complication where the soft oral tissues underneath the resin-based material are inflamed. The prevalence of denture stomatitis among denture wearers is high worldwide. Plaque accumulation and the infiltration of oral microbes into DBRs are among the main risk factors for denture stomatitis. The attachment of fungal species, mainly Candida albicans, to DBRs can irritate the underneath soft tissues, leading to the onset of the disease. As a result, several attempts were achieved to functionalize antimicrobial compounds and particles into DBRs to prevent microbial attachment. This review article explored the advanced approaches in designing bioactive and antimicrobial DBR materials. It was reported that using monomer mixtures, quaternary ammonium compounds (QACs), and organic and inorganic particles can suppress the growth of denture stomatitis-related pathogens. This paper also highlighted the importance of characterizing bioactive DBRs to be mechanically and physically sustainable. Future directions may implement a clinical translational model to attempt these materials inside the oral cavity.

Comparative Experimental Investigation of Biodegradable Antimicrobial Polymer-Based Composite Produced by 3D Printing Technology Enriched with Metallic Particles

Due to the prevailing existence of the COVID-19 pandemic, novel and practical strategies to combat pathogens are on the rise worldwide. It is estimated that, globally, around 10% of hospital patients will acquire at least one healthcare-associated infection. One of the novel strategies that has been developed is incorporating metallic particles into polymeric materials that neutralize infectious agents. Considering the broad-spectrum antimicrobial potency of some materials, the incorporation of metallic particles into the intended hybrid composite material could inherently add significant value to the final product. Therefore, this research aimed to investigate an antimicrobial polymeric PLA-based composite material enhanced with different microparticles (copper, aluminum, stainless steel, and bronze) for the antimicrobial properties of the hybrid composite. The prepared composite material samples produced with fused filament fabrication (FFF) 3D printing technology were tested for different time intervals to establish their antimicrobial activities. The results presented here depict that the sample prepared with 90% copper and 10% PLA showed the best antibacterial activity (99.5%) after just 20 min against different types of bacteria as compared to the other samples. The metallic-enriched PLA-based antibacterial sheets were remarkably effective against Staphylococcus aureus and Escherichia coli; therefore, they can be a good candidate for future biomedical, food packaging, tissue engineering, prosthetic material, textile industry, and other science and technology applications. Thus, antimicrobial sheets made from PLA mixed with metallic particles offer sustainable solutions for a wide range of applications where touching surfaces is a big concern.

Assessment of Zinc-Bound Phosphate-Based Glass-Coated Denture-Relining Material with Antifungal Efficacy for Inhibiting Denture Stomatitis

This study investigated the surface properties, biocompatibility, and antifungal activity against Candida albicans of a denture-relining material coated with zinc-bound phosphate-based glass. First, zinc-bound phosphate-based glass was fabricated. A polymerized denture-relining disk was coated with zinc-bound phosphate-based glass (2%, 4%, and 6%). The surface properties of the control and experimental groups were measured, including the wettability, microhardness, color difference, and gloss. The biocompatibility was evaluated using the MTT assay according to ISO 10993-5. The antifungal activity was investigated by counting the number of colony-forming units of Candida albicans. The results were analyzed using a one-way ANOVA and Tukey's test (p = 0.05). The results of this study indicate that, despite the antimicrobial effect of zinc-bound phosphate-based glass, a coated denture-relining material does not degrade the surface properties and biocompatibility. Therefore, this novel material is considered promising for use as a dental material with antimicrobial properties that can potentially prevent denture stomatitis.

Impact of Polymerization Technique and ZrO2 Nanoparticle Addition on the Fracture Load of Interim Implant-Supported Fixed Cantilevered Prostheses in Comparison to CAD/CAM Material

ZrO₂ nanoparticles (ZNPs) have excellent physical properties. This study investigated the fracture load of implant-supported, fixed cantilevered prosthesis materials, reinforced with ZNPs and various polymerization techniques, compared with conventional and CAD/CAM materials. Sixty specimens were made from two CAD/CAM; milled (MIL) (Ceramill TEMP); and 3D-printed (NextDent Denture 3D+). Conventional heat-polymerized acrylic resin was used to fabricate the other specimens, which were grouped according to their polymerization technique: conventionally (HP) and autoclave-polymerized (AP); conventionally cured and reinforced with 5 wt% ZNPs (HPZNP); and autoclave reinforced with 5 wt% ZNPs (APZNP). The specimens were thermocycled (5000 cycles/30 s dwell time). Each specimen was subjected to static vertical loading (1 mm/min) using a universal Instron testing machine until fracture. Scanning electron microscopy was used for fracture surface analyses. The ANOVA showed significant fracture load differences between all the tested groups (p = 0.001). The Tukey post hoc tests indicated a significant difference in fracture load between all tested groups (p ˂ 0.001) except HP vs. HPZNP and AP vs. MIL. APZNP had the lowest mean fracture load value (380.7 ± 52.8 N), while MIL had the highest (926.6 ± 82.8 N). The CAD/CAM materials exhibited the highest fracture load values, indicating that they could be used in long-term interim prostheses. Autoclave polymerization improved fracture load performance, whereas ZrO₂ nanoparticles decreased the fracture load performance of cantilevered prostheses.

The Effect of Zirconium Dioxide (ZrO2) Nanoparticles Addition on the Mechanical Parameters of Polymethyl Methacrylate (PMMA): A Systematic Review and Meta-Analysis of Experimental Studies

The number of studies on the subject of effects of zirconium dioxide (ZrO2) nanoparticles addition on the mechanical parameters of polymethyl methacrylate (PMMA) is still very limited. Therefore, in this research, the authors wanted to assess PMMA modified with the nano-ZrO2 additive in terms of changes in flexural, impact and tensile strength values in relation to PMMA without such component. A systematic review and meta-analysis were performed to evaluate the effect of incorporating nano-ZrO2 into PMMA on individual types of material strength. The obtained numerical data were tabulated and analyzed in the search for percentage changes in those parameters. It was then calculated for each set and the procured model was examined using residual sum of squares (RSS) to assess the discrepancy between the data and the estimation model whilst mean absolute deviation (MAD) was employed to determine robustness. The results of the systematic review were composed of data obtained from individual studies presented in eight independent articles. Overall, the addition of nano-ZrO2 increases the flexural strength of the composite with the PMMA matrix depending on the size of the ZrO2 grains administered. Unfortunately, these conclusions are based on a very limited amount of research and require further verification, especially regarding tensile strength.

How Effective Are Antimicrobial Agents on Preventing the Adhesion of Candida albicans to Denture Base Acrylic Resin Materials? A Systematic Review

Denture stomatitis is a common oral infection caused by Candid albicans. It occurs under removable dentures due to several causative and contributing factors. If not treated, it can lead to fatal systemic candida infections. Different materials and techniques have been used to treat denture stomatitis; however, no single treatment has succeeded. The purpose of this study was to review novel techniques for incorporating antimicrobial and protein repellent agents into denture acrylic resin materials and their effect on the adhesion of Candida albicans to denture base acrylic resin materials to prevent and/or treat denture stomatitis. A systematic review was conducted in which an electronic search was undertaken using different databases and relevant keywords. The literature search revealed numerous studies describing different antifungal materials incorporated into different denture acrylic resin materials. The investigated materials showed significant antimicrobial activity with slight or no effect on the physical and mechanical properties; however, the optical properties were particularly affected with higher concentrations. The incorporation of antimicrobial agents to reduce or prevent Candida albicans biofilm formation on acrylic resin proved to be very effective, and this effect was found to be proportional to the percentage of the material used. The latter should be considered carefully not to alter the physical, mechanical or optical characteristics of the denture base material.

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.