Enhanced antimicrobial efficacy of chlorhexidine-encapsulated halloysite nanotubes incorporated in presurgical orthopedic appliances: an in vitro, controlled study

AIMS AND OBJECTIVE

Presurgical infant's orthopedic appliances (PSIOs) play an increasingly crucial role in the interdisciplinary management of neonatal CLP, aiming to improve and maintain adequate nasolabial aesthetics, followed by primary lip/nasal surgery in both unilateral and bilateral CLP cases. The use of PSIOs in cleft lip and palate patients can lead to contamination with oral microflora, acting as a potential reservoir for infectious microorganisms. Acrylic surfaces might provide retention niches for microorganisms to adhere, and inhabit, which is difficult to control in immunocompromised patients, thus predisposing them to increased infection risks. The objective of this multi-assay in vitro study was to investigate the effects of incorporating chlorhexidine-loaded halloysite nanotubes (CHX-HNTs) fillers on the morphological, cytotoxic, release, and antimicrobial characteristics of self-cured acrylic polymethyl methacrylate (PMMA) material used in pre-surgical orthopedic appliances.

METHODS

Disk-shaped PMMA specimens were prepared with varying proportions of CHX-HNTs. A control group without any addition served as a reference, and four experimental samples contained a range of different concentrations of CHX-HNTs (1.0, 1.5, 3, and 4.5 wt%). The antimicrobial efficacy was assessed using an agar diffusion test against common reference microorganisms: Candida albicans, Staphylococcus aureus, Streptococcus pneumoniae, and Streptococcus agalactiae. Cytotoxicity was examined using the L929 cell line (mouse fibroblasts) through a (3-[4,5-dimethylthiazol-2-yl]-2,5-diphenyl tetrazolium bromide, MTT) cell viability assay. The release kinetics of CHX were monitored using UV-spectral measurements. The statistical analysis used a one-way ANOVA followed by Tukey's post hoc test.

RESULTS

The integration of CHX-HNTs in PMMA exhibited a substantial dose-dependent antifungal and antibacterial effect against microorganisms at tested mass fractions (1.0 to 4.5 wt%). CHX release was sustained for up to 60 days, supporting prolonged antimicrobial activity. Furthermore, no significant cytotoxicity was determined in the L929 fibroblast cell line (control), indicating the biocompatibility of the CHX-HNTs-enhanced PMMA.

CONCLUSION

Incorporating CHX-HNTs in PMMA successfully enhanced its antimicrobial properties, providing sustained CHX release and superior antimicrobial efficacy. These findings demonstrate the potential of antimicrobial nanoparticles in dental therapies to improve therapeutic outcomes. However, rigorous further clinical trials and observational studies are warranted to validate the practical application, safety, and efficacy.

CLINICAL RELEVANCE

This study has the potential to make a major impact on the health of infants born with cleft lip and palate by helping to reduce the prevalence of infectious illnesses. The incorporation of CHX-HNTs into PMMA-based appliances is a novel promising preventive approach to reduce microbial infections.

Polymeric Denture Base Materials: A Review

An ideal denture base must have good physical and mechanical properties, biocompatibility, and esthetic properties. Various polymeric materials have been used to construct denture bases. Polymethyl methacrylate (PMMA) is the most used biomaterial for dentures fabrication due to its favorable properties, which include ease of processing and pigmenting, sufficient mechanical properties, economy, and low toxicity. This article aimed to comprehensively review the current knowledge about denture base materials (DBMs) types, properties, modifications, applications, and construction methods. We searched for articles about denture base materials in PubMed, Scopus, and Embase. Journals covering topics including dental materials, prosthodontics, and restorative dentistry were also combed through. Denture base material variations, types, qualities, applications, and fabrication research published in English were considered. Although PMMA has several benefits and gained popularity as a denture base material, it has certain limitations and cannot be classified as an ideal biomaterial for fabricating dental prostheses. Accordingly, several studies have been performed to enhance the physical and mechanical properties of PMMA by chemical modifications and mechanical reinforcement using fibers, nanofillers, and hybrid materials. This review aimed to update the current knowledge about DBMs' types, properties, applications, and recent developments. There is a need for specific research to improve their biological properties due to patient and dental staff adverse reactions to possibly harmful substances produced during their manufacturing and use.

Biomonitoring of children and adolescents using orthodontic appliances made of acrylic resins through micronucleus testing of exfoliated buccal and palatal mucosa cells

INTRODUCTION

The present study aimed to investigate the occurrence of micronuclei and the degenerative nuclear alterations indicative of apoptosis and necrosis in the exfoliated buccal and palatal mucosa cells of children and adolescents using orthodontic appliances made of self-curing acrylic resins.

METHODS

The micronuclei and nuclear alterations were evaluated in a minimum of 2000 cells collected from the cheeks and palates of 30 patients of both sexes, aged between 6 and 12 years. The cell evaluations were performed before appliance installation and 15 to 21 days after installation. A conditional test was used. In all analyses, the significance level was 5%.

RESULTS

No differences in the occurrence of micronuclei or the nuclear degenerative changes indicative of apoptosis and necrosis were observed in the cheek cells between the 2 time points (P > 0.05). However, evaluation of the palate cells revealed a significant increase in the occurrence of micronuclei and the nuclear alterations indicative of apoptosis (P < 0.01) but not of karyolysis (P > 0.05).

CONCLUSIONS

Direct contact of orthodontic appliances made of acrylic resins with the oral mucosa increases the incidence of chromosomal damage and degenerative nuclear alterations.

Elution behavior of a 3D-printed, milled and conventional resin-based occlusal splint material

OBJECTIVE

The elution of unpolymerized (co-)monomers and additives from methacrylic resin-based materials like polymethyl methacrylate (PMMA) can cause adverse side effects, such as mutagenicity, teratogenicity, genotoxicity, cytotoxicity and estrogenic activity. The aim of this study was to quantify the release and the cytotoxicity of residual (co-)monomers and additives from PMMA-based splint materials under consideration of real splint sizes. Three different materials used for additive (3D printing), subtractive (milling) and conventional (powder and liquid) manufacturing were examined.

METHODS

The splint materials SHERAprint-ortho plus (additive), SHERAeco-disc PM20 (subtractive) and SHERAORTHOMER (conventional) were analysed. 16 (n = 4) sample discs of each material (6 mm diameter and 2 mm height) were polished on the circular and one cross-section area and then eluted in both distilled water and methanol. The discs were incubated at 37 °C for 24 h or 72 h and subsequently analysed by gas chromatography/mass spectrometry (GC/MS) for specifying and quantifying released compounds. XTT-based cell viability assays with human gingival fibroblasts (HGFs) were performed for Tetrahydrofurfuryl methacrylate (THFMA), 1,4-Butylene glycol dimethacrylate (BDDMA) and Tripropylenglycol diacrylate (TPGDA). In order to project the disc size to actual splint sizes in a worst-case scenario, lower and upper jaw occlusal splints were designed and volumes and surfaces were measured.

RESULTS

For SHERAeco-disc PM20 and for SHERAORTHOMER no elution was determined in water. SHERAprint-ortho plus eluted the highest THFMA concentration of 7.47 μmol/l ±2,77 μmol/l after 72 h in water. Six (co-)monomers and five additives were detected in the methanol eluates of all three materials tested. The XTT-based cell viability assays resulted in a EC₅₀ of 3006 ± 408 μmol/l for THFMA, 2569.5 ± 308 μmol/l for BDDMA and 596.7 ± 88 μmol/l for TPGDA.

SIGNIFICANCE

With the solvent methanol, released components from the investigated splint materials exceeded cytotoxic concentrations in HGFs calculated for a worst-case scenario in splint size. In the water eluates only the methacrylate THFMA could be determined from SHERAprint-ortho plus in concentrations below cytotoxic levels in HGFs.

Release and toxicity of bisphenol-A (BPA) contained in orthodontic adhesives: A systematic review

OBJECTIVE

The objectives of this systematic review of the literature are to search for BPA release from biomaterials used in orthodontics and to highlight their possible impact on human health.

MATERIALS AND METHODS

Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) model, digital and manual searches were conducted in February 2020 in the database of CENTRAL, MEDLINE and EMBASE. Thirteen parameters relating to the release and biological effects of BPA were identified and analysed.

RESULTS

Thirty-one non-randomized clinical trials were included. In general, the level of evidence was low, and the risk of bias ranged from moderate to high. Furthermore, although at different concentrations, most of in vitro and in vivo studies found BPA release from orthodontic adhesives. The lack of standardized protocols and the clinical and methodological heterogeneity of the studies prevented a valid interpretation of the actual results. Concerning the possible toxicity of BPA, no conclusive scientific evidence could be drawn, but it seems that orthodontic biomaterials containing BPA have potential adverse biological effects in humans.

DISCUSSION AND CONCLUSION

Until we have solid evidence from clinical trials, clinicians should consider that orthodontic adhesives containing BPA have potential short- and long-term adverse biological effects in humans. Careful consideration should therefore be given to bonding, polymerization and debonding protocols in orthodontics.

Influence of polymerization method on the cytotoxicity of three different denture base acrylic resins polymerized in different methods

Statement of Problem

Acrylic plastics are used for over 80 years for the manufacture of prostheses. This kind of material has some limitations, one of them is a residual monomer, that remains after the polymerization has been terminated, which can influence the biological properties of the final medical device.

The purpose

The aim of this investigations was a comparison of the residual monomer concentration and cytotoxic effect of three various acrylic materials which differ in the polymerization method (hot-cured, polymerized under pressure and at lower temperatures).

Material and methods

The cytotoxicity of three different acrylic resins from the same producer were tested on the in vitro model (VERO CCL-81) by MTT assay. The residual monomer of acrylic materials was detected by gas chromatography.

Results

The Superacryl Plus material polymerized in hot water has a residual monomer concentration of 0.67 ± 0.05%, Superpont C + B hardened under pressure of 2.61 ± 0.208%, and Premacryl Plus after cold curing process has 3.53 ± 0.27% of uncured MMA. The results revealed that the least cytotoxic effect were observed in case of a thermally polymerized material.

Conclusion

Material polymerized in high temperatures has lower residual monomer concentration and not affect cell cultures. Self-curing materials polymerized in lower temperature have a higher concentration of residual monomer, which reduces the number of living cells by 20%, which can cause allergic reaction shortly after new denture was prepared.

In vitro evaluation of physicochemical properties of soft lining resins after incorporation of chlorhexidine

STATEMENT OF PROBLEM

Incorporating chlorhexidine into soft lining materials has been suggested to reduce biofilm development on the material surface and treat denture stomatitis. However, evaluation of the physicochemical properties of this material is necessary.

PURPOSE

The purpose of this in vitro study was to evaluate the physicochemical properties of resin-based denture soft lining materials modified with chlorhexidine diacetate (CDA).

MATERIAL AND METHODS

Two soft lining resins were tested, one based on polymethyl methacrylate (PMMA) and the other on polyethyl methacrylate (PEMA), into which 0.5%, 1.0%, or 2.0% of CDA was incorporated; the control group had no CDA. The specimens were stored for 2 hours, 48 hours, 7, 14, 21, and 28 days and then analyzed for polymer crystallinity, Shore A hardness, degree of monomer conversion, residual monomer leaching, and CDA release. Data were analyzed by using a 3-way ANOVA and the Tukey HSD test (α=.05).

RESULTS

The polymer crystallinity of PEMA and PMMA did not change after CDA incorporation. Shore A hardness increased over time, but not for any CDA concentrations tested after 28 days (P>.05). Considering the degree of conversion, PMMA-based resin showed no statistically significant difference (P>.05). However, PEMA-based resin showed a significant decrease (P<.05), which was reflected in a significant increase in residual monomer leaching from PEMA-based resin with the incorporation of 0.5% and 1.0% CDA (P<.05), mainly in the first 48 hours. PMMA-based resin showed no change in monomer leaching (P>.05). For both resins, the CDA release kinetics were related to monomer leaching; for PEMA-based resin, the values were significantly higher in the first 48 hours (P<.05), and for PMMA-based resin, the values were more sustained up to the last day of analysis.

CONCLUSIONS

The incorporation of CDA did not affect the physicochemical properties of soft resins. The properties of PMMA were better than those of PEMA.

Effect of surface treatment of prefabricated teeth on shear bond strength of orthodontic brackets

Objective:

The aim of this in vitro study was to evaluate and compare the effects of grinding, drilling, sandblasting, and ageing prefabricated teeth (PfT) on the shear bond strength (SBS) of orthodontic brackets, as well as the effects of surface treatments on the adhesive remnant index (ARI).

Methods:

One-hundred-ninety-two PfT were divided into four groups (n = 48): Group 1, no surface treatment was done; Group 2, grinding was performed with a cylindrical diamond bur; Group 3, two drillings were done with a spherical diamond bur; Group 4, sandblasting was performed with 50-µm aluminum oxide. Before the experiment, half of the samples stayed immersed in distilled water at 37^oC for 90 days. Brackets were bonded with Transbond XT and shear strength tests were carried out using a universal testing machine. SBS were compared by surface treatment and by ageing with two-way ANOVA, followed by Tukey’s test. ARI scores were compared between surface treatments with Kruskal-Wallis test followed by Dunn’s test.

Results:

Surface treatments on PfT enhanced SBS of brackets (p< 0.01), result not observed with ageing (p= 0.45). Groups II, III, and IV showed higher SBS and greater ARI than the Group 1 (p< 0.05). SBS was greater in the groups 3 and 4 (drilling, sandblasting) than in the Group 2 (grinding) (p< 0.05). SBS and ARI showed a positive correlation (Spearman’s R²= 0.57; p< 0.05).

Conclusion:

Surface treatment on PfT enhanced SBS of brackets, however ageing did not show any relevance. Sandblasting and drilling showed greater SBS than grinding. There was a positive correlation between SBS and ARI.

Effect of degree of conversion on in vivo biocompatibility of flowable resin used for bioprotection of mini-implants

Objective: 

To test the hypothesis that there is no difference between the biocompatibility and degree of monomer conversion of flowable resins used as bioprotective materials of orthodontic mini-implants.

Materials and Methods: 

Forty-eight male Wistar rats were divided into four groups (n  =  12). Group Control (polyethylene), Group Wave, Group Top Comfort, and Group Filtek. The animals were sacrificed after time intervals of 7, 15, and 30 days and tissues were analyzed under optical microscopy for inflammatory infiltrate, edema, necrosis, granulation tissue, multinucleated giant cells, and collagen formation. The degree of conversion was evaluated by the Fourier method. Biocompatibility and degree of conversion were evaluated by the Kruskal-Wallis and Dunn tests, and analysis of variance and the Tukey test, respectively (P &lt; .05).

Results: 

An intense inflammatory infiltrate was observed on the seventh day, with Groups Top Comfort and Filtek differing statistically from Group Control (P  =  .016). Edema, necrosis, granulation tissue, and giant cells showed greater expressiveness at 7 days, without statistical difference between them (P &gt; .05). For the presence of collagen fibers, Group Top Comfort was shown to differ statistically from Group Control (P  =  .037) at 15 days and from Groups Filtek and Control (P  =  .008) at 30 days. Monomer conversion ranged from 62.3% in Group Top Comfort at 7 days to 79.1% in Group Filtek at 30 days.

Conclusions: 

The hypothesis was rejected. The resin Top Comfort demonstrated lower tissue repair capacity with a lower number of collagen fibers compared with Filtek and Wave resins. The resin Top Comfort showed the lowest conversion values during the experiment.

In vitro cytotoxicity of self-curing acrylic resins of different colors

Objective

The aim of this study was to assess the in vitro cytotoxicity of acrylic resins of different colors over time.

Methods

Specimens were divided into 4 groups (n = 6) according to the color of the acrylic resin (Orto Class, Clássico, Campinas, São Paulo, Brazil): Group 1: clear acrylic resin; group 2: pink acrylic resin; group 3: blue acrylic resin and group 4: green acrylic resin. All specimens were fabricated according to the mass manipulation technique and submitted to mechanical polishing protocol. The control was performed with an amalgam specimen (C+), a glass specimen (C-) and cell control (CC). Specimens were immersed in Minimum Eagle's Medium (MEM) and incubated for 24 h at 37ºC. The extracts from the experimental material were filtered and mixed with L929 fibroblast. Cytotoxicity was evaluated at 4 different times, 24, 48, 72 and 168 h. After contact, cells were incubated for 24 h and added to 100 µ of 0.01% neutral red dye. The cells were incubated for 3 h for pigment incorporation and fixed. Cells viability was determined by a spectroscopic (BioTek, Winooski, Vermont, USA) with a 492-nm wavelength λ=492 nm).

Results

There were no statistical differences between the experimental groups and the CC and C- groups.

Conclusion

Clear, pink, blue and green self-curing acrylic resins fabricated by means of the mass manipulation technique and mechanically polished are not cytotoxic. Neither the pigment added to the self-curing acrylic resin nor the factor of time influenced the cytotoxicity of the material.

Differences of cytotoxicity of orthodontic bands assessed by survival tests in Saccharomyces cerevisiae

The aim of this study was to evaluate the cytotoxicity induced by orthodontic bands through survival tests on Saccharomyces cerevisiae, a microorganism that presents several genetic and biochemical characteristics similar to human cells. Three groups of bands were evaluated: silver soldered (SSB), laser soldered (LSB), and bands without any solder (WSB). Yeast cells were directly exposed to the bands and indirectly, when a previous elution of the metals in artificial saliva was performed. The negative control was composed of yeast cells or artificial saliva not exposed to any kind of metal. In the direct exposure experiments, all tested groups of bands induced a slight reduction in yeast viability compared to the control. This effect was more intense for the SSB, although not statistically significant. For the indirect exposure experiments, the SSB induced a statistically significant decrease in cell viability compared to the LSB. There were no significant differences between the survival rates of the negative control and the LSB group in both direct and saliva tests. SSBs were cytotoxic, whilst LSBs were not, confirming that laser soldering may be a more biocompatible alternative for use in connecting wires to orthodontic appliances.

Miniscrew covering: an alternative to prevent traumatic lesions

During orthodontic treatment with miniscrews, complications such as aphthous ulceration, soft-tissue coverage of the miniscrew head, soft-tissue inflammation, infection, and peri-implantitis can occur. Good hygiene can prevent inflammation by infection but does not prevent traumatic oral mucosal lesions at the buccal mucosa. The purpose of this article was to describe the use of a physical barrier--a light-cured temporary filling material--to cover the miniscrew head and prevent soft-tissue trauma.

Real-time cell analysis of the cytotoxicity of the components of orthodontic acrylic materials on gingival fibroblasts

INTRODUCTION

The aim of this study was to evaluate the cytotoxicity of 3 orthodontic acrylic materials and 2 manipulation methods.

METHODS

The orthodontic acrylic materials Orthocryl EQ (Dentaurum, Ispringen, Germany), Orthoplast (Vertex Dental, Zeist, The Netherlands), and O-80 (Imicryl, Konya, Turkey) were prepared with 2 polymerization methods (doughing and spray on). Totally, 60 cylinders (5 × 2 mm), fabricated by using a different acrylic and method, were divided into 6 groups. Gingival fibroblasts were isolated from gingival connective tissue of systemically healthy subjects. Materials were incubated in Dulbecco's modified eagle's medium culture medium (Biological Industries, Beit Haemek, Israel) for 72 hours according to ISO 10993-5 standards (surface area to volume ratio of the specimen to cell-culture medium: 3 cm(2)/mL). Gingival fibroblasts were maintained with Dulbecco's modified eagle medium containing 10% fetal bovine serum. A real-time cell analyzer (RT-CES, xCELLigence; Roche Applied Science, Mannheim, Germany, and ACEA Biosciences, San Diego, Calif) was used to evaluate cell survival. After seeding 200 μL of the cell suspensions into the wells (20,000 cells/well) of the E-plate 96, gingival fibroblasts were treated with bioactive components released by the acrylic materials (1/1 and 1/2 dilutions) and monitored every 15 minutes for 121 hours. For the proliferation experiments, the statistical analyses used were 1-way analysis of variance (ANOVA) and Tukey-Kramer multiple comparisons tests.

RESULTS

There was no significant difference between the cell indexes of the control and study groups for the 1/1 and 1/2 dilutions at 21 and 32 hours. When evaluated at 68 hours, all 1/2 dilutions of acrylic materials showed statistically insignificant differences (P >0.05) except for Orthoplast (P <0.05). But all acrylic materials were different from the control group in the 1/1 dilutions (P <0.001). At 121 hours, all test groups were significantly different from the untreated control group (P <0.001).

CONCLUSIONS

The results indicate that the long cycle increased the cytotoxicity of the tested materials, and there was no significant difference between the spray-on and doughing methods on cytotoxicity.

Chromatic stability of acrylic resins of artificial eyes submitted to accelerated aging and polishing

Esthetics and durability of materials used to fabricate artificial eyes has been an important eissue since artificial eyes are essential to restore esthetics and function, protect the remaining tissues and help with patients' psychological therapy. However, these materials are submitted to degrading effects of environmental agents on the physical properties of the acrylic resin.

Biocompatibilidade dos materiais em Ortodontia: mito ou realidade?

O objetivo deste trabalho é apresentar uma revisão sobre os conceitos relacionados à biocompatibilidade dos materiais empregados em Ortodontia. Fatos relacionados às reações de hipersensibilidade aos diversos materiais ortodônticos são discutidos, sendo apresentadas as condutas recomendáveis nestas situações.