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Ammar MM, Elkammar HA, Abdelkhalek AA, Abdelrazek NA, Emam AA, Abdelhameed BM. In vitro analysis of a novel dimethylaminododecyl methacrylate modification of dental acrylic soft liner material. Sci Rep 2024; 14:19855. [PMID: 39191880 PMCID: PMC11349986 DOI: 10.1038/s41598-024-69836-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2024] [Accepted: 08/09/2024] [Indexed: 08/29/2024] Open
Abstract
Soft denture liners have limitations like short lifespan and increased microbial buildup. Despite promise as a non-leaching antimicrobial polymer in dentistry, the impact of dimethylaminododecyl methacrylate (DMADDM) on soft liner performance remains unexplored. This study aimed to evaluate the effect of integrating different concentrations of DMADDM to cold cure acrylic resin soft liner, on its antimicrobial activity, cytotoxicity, and physical properties. The same properties were compared to a conventional commercially available denture soft liner. The study employed a control group (conventional soft liner) and three test groups containing 3.3%, 6.6%, and 10% (total mass fraction) DMADDM, respectively. Antimicrobial activity against Candida albicans and Streptococcus mutans was assessed through colony counts and biofilm biomass. Cytotoxicity was evaluated using an oral epithelial cell line. Additionally, wettability and hardness were measured to assess physical properties. Incorporation of DMADDM significantly reduced Candida albicans and Streptococcus mutans counts, and biofilm biomass, compared to the control. Additionally, DMADDM improved the soft liner's wettability and mitigated long-term hardness increase. In conclusion, DMADDM holds promise in enhancing soft liner performance. However, careful selection of its optimum concentration is crucial to ensure both safety and efficacy for future clinical use.
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Affiliation(s)
- Mohamed M Ammar
- Biomaterials Department, Faculty of Oral and Dental Medicine, Future University in Egypt, New Cairo, 11865, Egypt
| | - Hala A Elkammar
- Oral Pathology Department, Faculty of Oral and Dental Medicine, Future University in Egypt, New Cairo, 11865, Egypt.
| | - Abdelfattah A Abdelkhalek
- Microbiology Department of Supplementary General Science, Faculty of Oral and Dental Medicine, Future University in Egypt, New Cairo, 11865, Egypt
| | - Nada A Abdelrazek
- Microbiology and Immunology Department, Faculty of Pharmacy, Future University in Egypt, New Cairo, 11865, Egypt
| | - Ahmed A Emam
- Medical Experimental Research Center (MERC), Faculty of Medicine, Mansoura University, Mansoura, 35511, Egypt
| | - Bassem M Abdelhameed
- Removable Prosthodontic Department, Faculty of Oral and Dental Medicine, Future University in Egypt, New Cairo, 11865, Egypt
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Chladek G, Kalamarz I, Pakieła W, Barszczewska-Rybarek I, Czuba Z, Mertas A. A Temporary Acrylic Soft Denture Lining Material Enriched with Silver-Releasing Filler-Cytotoxicity, Mechanical and Antifungal Properties. MATERIALS (BASEL, SWITZERLAND) 2024; 17:902. [PMID: 38399153 PMCID: PMC10890124 DOI: 10.3390/ma17040902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 02/07/2024] [Accepted: 02/13/2024] [Indexed: 02/25/2024]
Abstract
Colonization of temporary denture soft linings and underlying tissues by yeast-like fungi is an important clinical problem due to the negative influence on the process of prosthetic treatment. Typical hygienic procedures are often insufficient to prevent fungal infections, so in this study, an antimicrobial filler (silver sodium hydrogen zirconium phosphate) was introduced into acrylic soft liner at concentrations of 1, 2, 4, 6, 8 and 10% (w/w). The effect of this modification on antifungal properties against Candida albicans, cytotoxicity, Shore A hardness, tensile strength and tensile bond strength, sorption and solubility was investigated, considering the recommended 30-day period of temporary soft lining use. The most favorable compilation of properties was obtained at a 1 to 6% filler content, for which nearly a total reduction in Candida albicans was registered even after 30 days of sample storing. The tensile and bond strength of these composites was at the desired and stable level and did not differ from the results for the control material. Hardness increased with the increasing concentration in filler but were within the range typical for soft lining materials and their changes during the experiment were similar to the control material. The materials were not cytotoxic and sorption and solubility levels were stable.
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Affiliation(s)
- Grzegorz Chladek
- Materials Research Laboratory, Faculty of Mechanical Engineering, Silesian University of Technology, 18a Konarskiego Str., 41-100 Gliwice, Poland
| | - Igor Kalamarz
- Igor Kalamarz Dental Practice, 6 Kotlarza Str., 40-139 Katowice, Poland;
| | - Wojciech Pakieła
- Department of Engineering Materials and Biomaterials, Faculty of Mechanical Engineering, Silesian University of Technology, 18a Konarskiego Str., 41-100 Gliwice, Poland;
| | - Izabela Barszczewska-Rybarek
- Department of Physical Chemistry and Technology of Polymers, Faculty of Chemistry, Silesian University of Technology, Strzody 9 Str., 44-100 Gliwice, Poland;
| | - Zenon Czuba
- Department of Microbiology and Immunology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, 19 Jordana Str., 41-808 Zabrze, Poland; (Z.C.); (A.M.)
| | - Anna Mertas
- Department of Microbiology and Immunology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, 19 Jordana Str., 41-808 Zabrze, Poland; (Z.C.); (A.M.)
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Chladek G, Nowak M, Pakieła W, Barszczewska-Rybarek I, Żmudzki J, Mertas A. The Effect of Exposure to Candida Albicans Suspension on the Properties of Silicone Dental Soft Lining Material. MATERIALS (BASEL, SWITZERLAND) 2024; 17:723. [PMID: 38591629 PMCID: PMC10856526 DOI: 10.3390/ma17030723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 01/19/2024] [Accepted: 01/31/2024] [Indexed: 04/10/2024]
Abstract
While functioning in the oral cavity, denture soft linings (SL) are exposed to contact with the microbiota. Dentures can offer perfect conditions for the multiplication of pathogenic yeast-like fungi, resulting in rapid colonisation of the surface of the materials used. In vitro experiments have also shown that yeast may penetrate SL. This may lead to changes in their initially beneficial functional properties. The aim of this work was to investigate the effect of three months of exposure to a Candida albicans suspension on the mechanical properties of SL material and its bond strength to the denture base polymer, and to additionally verify previous reports of penetration using a different methodology. Specimens of the SL material used were incubated for 30, 60 and 90 days in a suspension of Candida albicans strain (ATCC 10231). Their shore A hardness, tensile strength, and bond strength to acrylic resin were tested. The colonization of the surface and penetration on fractured specimens were analysed with scanning electron and inverted fluorescence microscopes. Exposure to yeast did not affect the mechanical properties. The surfaces of the samples were colonised, especially in crystallized structures of the medium; however, the penetration of hyphae and blastospores into the material was not observed.
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Affiliation(s)
- Grzegorz Chladek
- Materials Research Laboratory, Faculty of Mechanical Engineering, Silesian University of Technology, 18a Konarskiego Str., 41-100 Gliwice, Poland
| | - Michał Nowak
- Nova Clinic, 22 Jankego Str., 40-612 Katowice, Poland;
| | - Wojciech Pakieła
- Department of Engineering Materials and Biomaterials, Faculty of Mechanical Engineering, Silesian University of Technology, 18a Konarskiego Str., 41-100 Gliwice, Poland; (W.P.); (J.Ż.)
| | - Izabela Barszczewska-Rybarek
- Department of Physical Chemistry and Technology of Polymers, Faculty of Chemistry, Silesian University of Technology, Strzody 9 Str., 44-100 Gliwice, Poland;
| | - Jarosław Żmudzki
- Department of Engineering Materials and Biomaterials, Faculty of Mechanical Engineering, Silesian University of Technology, 18a Konarskiego Str., 41-100 Gliwice, Poland; (W.P.); (J.Ż.)
| | - Anna Mertas
- Department of Microbiology and Immunology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, 19 Jordana Str., 41-808 Zabrze, Poland;
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Gradinaru I, Ciubotaru BI, Butnaru M, Cojocaru FD, Covașă CT, Bibire T, Dascalu M, Bargan A, Cazacu M, Zaltariov MF. The Impact of the Addition of Vitamins on a Silicone Lining Material to the Oral Mucosa Tissue-Evaluation of the Biocompatibility, Hydrolytic Stability and Histopathological Effect. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1936. [PMID: 38003985 PMCID: PMC10673301 DOI: 10.3390/medicina59111936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Revised: 10/20/2023] [Accepted: 10/27/2023] [Indexed: 11/26/2023]
Abstract
Background and Objectives: One's quality of life depends on overall health, and in particular, oral health, which has been and continues to become a public health issue through frequent manifestations in various forms, from simple oral stomatitis (inflammations of the oral cavity) to the complicated oral health pathologies requiring medical interventions and treatments (caries, pulp necrosis and periodontitis). The aim of this study focused on the preparation and evaluation of vitamins (vitamin A, B1 and B6) incorporated into several silicone-based lining materials as a new alternative to therapeutically loaded materials designed as oral cavity lining materials in prosthodontics. Materials and Methods: Silicone-based liners containing vitamins were prepared by mixing them in solution and becoming crosslinked, and then they were characterized using Fourier-transform infrared (FT-IR) spectroscopy to confirm the incorporation of the vitamins into the silicone network; scanning electron microscopy (SEM) to evidence the morphology of the liner materials; dynamic vapor sorption (DVS) to evaluate their internal hydrophobicity, swelling in environments similar to biological fluids and mechanical test to demonstrate tensile strength; MTT to confirm their biocompatibility on normal cell cultures (fibroblast) and mucoadhesivity; and histopathological tests on porcine oral mucosa to highlight their potential utility as soft lining materials with improved efficiency. Results: FT-IR analysis confirmed the structural peculiarities of the prepared lining materials and the successful incorporation of vitamins into the silicone matrix. The surface roughness of the materials was lower than 0.2 μm, while in cross-section, the lining materials showed a compact morphology. It was found that the presence of vitamins induced a decrease in the main mechanical parameters (strength and elongation at break, Young's modulus) and hydrophobicity, which varied from one vitamin to another. A swelling degree higher than 8% was found in PBS 6.8 (artificial saliva) and water. Hydrolytic stability studies in an artificial saliva medium showed the release of low concentrations of silicone and vitamin fragments in the first 24 h, which increased the swelling behavior of the materials, diffusion and solubility of the vitamins. The microscopic images of fibroblast cells incubated with vitamin liners revealed very good biocompatibility. Also, the silicone liners incorporating the vitamins showed good mucoadhesive properties. The appearance of some pathological disorders with autolysis processes was more pronounced in the case of vitamin A liners. Conclusions: The addition of the vitamins was shown to have a beneficial effect that was mainly manifested as increased biocompatibility, hydrolytic stability and mucoadhesiveness with the mucosa of the oral cavity and less of an effect on the mechanical strength. The obtained lining materials showed good resistance in simulated biological media but caused a pronounced autolysis phenomenon, as revealed by histopathological examination, showing that these materials may have broad implications in the treatment of oral diseases.
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Affiliation(s)
- Irina Gradinaru
- Department of Implantology, Removable Dentures, Technology, “Grigore T. Popa” University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania;
| | - Bianca Iulia Ciubotaru
- Department of Inorganic Polymers, “Petru Poni” Institute of Macromolecular Chemistry, Aleea Grigore Ghica Voda 41 A, 700487 Iasi, Romania; (B.I.C.); (M.D.); (A.B.); (M.C.)
| | - Maria Butnaru
- Biomedical Sciences Department, Faculty of Medical Bioengineering, “Grigore T. Popa” University of Medicine and Pharmacy, 9-13 Kogalniceanu Street, 700454 Iasi, Romania; (M.B.); (F.D.C.)
| | - Florina Daniela Cojocaru
- Biomedical Sciences Department, Faculty of Medical Bioengineering, “Grigore T. Popa” University of Medicine and Pharmacy, 9-13 Kogalniceanu Street, 700454 Iasi, Romania; (M.B.); (F.D.C.)
| | - Costică Toader Covașă
- Faculty of Veterinary Medicine, “Ion Ionescu de la Brad” University of Life Sciences—IULS, Aleea Mihail Sadoveanu nr. 3, 700490 Iasi, Romania;
| | - Teofana Bibire
- Faculty of General Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania;
| | - Mihaela Dascalu
- Department of Inorganic Polymers, “Petru Poni” Institute of Macromolecular Chemistry, Aleea Grigore Ghica Voda 41 A, 700487 Iasi, Romania; (B.I.C.); (M.D.); (A.B.); (M.C.)
| | - Alexandra Bargan
- Department of Inorganic Polymers, “Petru Poni” Institute of Macromolecular Chemistry, Aleea Grigore Ghica Voda 41 A, 700487 Iasi, Romania; (B.I.C.); (M.D.); (A.B.); (M.C.)
| | - Maria Cazacu
- Department of Inorganic Polymers, “Petru Poni” Institute of Macromolecular Chemistry, Aleea Grigore Ghica Voda 41 A, 700487 Iasi, Romania; (B.I.C.); (M.D.); (A.B.); (M.C.)
| | - Mirela-Fernanda Zaltariov
- Department of Inorganic Polymers, “Petru Poni” Institute of Macromolecular Chemistry, Aleea Grigore Ghica Voda 41 A, 700487 Iasi, Romania; (B.I.C.); (M.D.); (A.B.); (M.C.)
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Mutahar M, Al Ahmari NM, Gadah TS, Kariri MAM, Madkhli HY, Somaili DM, Mobarki YMY, Darraj OA, Halawi SM, Al Moaleem MM. Comparative Evaluation of Hardness and Energy Absorption of Some Commercially Available Chairside Silicone-Based Soft Denture Liners and a Heat-Cured Soft Denture Liner. Clin Cosmet Investig Dent 2023; 15:205-213. [PMID: 37814630 PMCID: PMC10560481 DOI: 10.2147/ccide.s433519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 09/28/2023] [Indexed: 10/11/2023] Open
Abstract
Aim To investigate the hardness and energy absorption of four commercially available chairside types of silicone materials and compare their properties with heat-cured silicone material. Materials The chairside materials investigated were GC reline soft, mucopren soft, sofreliner soft and elite soft relining. The heat-cured polymer silicone material was Molloplast B. All soft lining materials were processed according to manufacturers' instructions. Two properties were investigated. Ten specimens for each test were prepared for each soft liner except for the water absorption and solubility test, for which only five specimens were prepared. The specimens of energy absorption (10 × 10 × 3 mm) were tested using a Lloyd instruments testing machine. Hardness specimens (38 × 38 × 3) were tested using a shore A durometer and were divided into two subgroups; dry and wet storage. Results The specimens of energy absorption (10 × 10 × 3 mm) were tested using a Lloyd instruments testing machine. Sofreliner soft was significantly softer than Molloplast B. GC reline soft was significantly harder than molloplast B. At high loads, sofreliner soft and elite soft relining was significantly more resilient than molloplast B. Mucopren soft was significantly stiffer than Molloplast B. At low loads, all materials showed similarities in stiffness and resilience; the difference between them was insignificant. After one month of immersion, GC reline and mucopren significantly increased hardness values. Conclusion In all conditions and at all four-time points, the hardness values for GC Reline soft were the greatest, and hardness values for Sofreliner Soft were the least. Some chairside soft denture lining materials could have similar significant properties to molloplast-B, such as sofreliner soft and elite.
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Affiliation(s)
- Mahdi Mutahar
- Dental Academy, University of Portsmouth, Portsmouth, PO1 2QG, UK
| | - Nasser M Al Ahmari
- Prosthetic Department, College of Dentistry, King Khalid University, Abha, 62529, Saudi Arabia
| | - Thrya S Gadah
- Prosthetic Department, College of Dentistry, King Khalid University, Abha, 62529, Saudi Arabia
| | | | - Hana Y Madkhli
- Dental Department, Samtah General Hospital, Ministry of Health, Jazan, Saudi Arabia
| | - Dawood M Somaili
- Dental Department, Dayhamah Primary Health Center, Ministry of Health, Jazan, Saudi Arabia
| | - Yahya M Y Mobarki
- Dental Department, Aldureah Primary Health Center, Ministry of Health, Jazan, Saudi Arabia
| | - Omar Ahmed Darraj
- Dental Department, Algahw Primary Health Center, Ministry of Health, Jazan, Saudi Arabia
| | - Sultan M Halawi
- Dental Department, Al Raha Primary Health Center, Ministry of Health, Jazan, Saudi Arabia
| | - Mohammed M Al Moaleem
- Department of Prosthetic Dental Science, College of Dentistry, Jazan University, Jazan, 45142, Saudi Arabia
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Obturator Manufacturing for Oronasal Fistula after Cleft Palate Repair: A Review from Handicraft to the Application of Digital Techniques. J Funct Biomater 2022; 13:jfb13040251. [PMID: 36412892 PMCID: PMC9680338 DOI: 10.3390/jfb13040251] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 11/09/2022] [Accepted: 11/15/2022] [Indexed: 11/19/2022] Open
Abstract
An oronasal fistula (ONF) is an abnormal structure between the oral and nasal cavities, which is a common complication of cleft palate repair due to the failure of wound healing. When some patients with ONF are unsuitable for secondary surgical repair, the obturator treatment becomes a potential method. The objectives of the obturator treatment should be summarized as filling the ONF comfortably and cosmetically restoring the dentition with partial function. The anatomy of patients with cleft palate is complex, which may lead to a more complex structure of the ONF. Thus, the manufacturing process of the obturator for these patients is more difficult. For performing the design and fabrication process rapidly and precisely, digital techniques can help, but limitations still exist. In this review, literature searches were conducted through Medline via PubMed, Wiley Online Library, Science Direct, and Web of Science, and 122 articles were selected. The purpose of this review was to introduce the development of the obturator for treating patients with ONF after cleft palate repair, from the initial achievement of the obstruction of the ONF to later problems such as fixation, velopharyngeal insufficiency, and infection, as well as the application of digital technologies in obturator manufacturing.
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Wyszyńska M, Białożyt-Bujak E, Chladek G, Czelakowska A, Rój R, Białożyt A, Gruca O, Nitsze-Wierzba M, Kasperski J, Skucha-Nowak M. Analysis of Changes in the Tensile Bond Strenght of Soft Relining Material with Acrylic Denture Material. MATERIALS 2021; 14:ma14226868. [PMID: 34832270 PMCID: PMC8625846 DOI: 10.3390/ma14226868] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 11/07/2021] [Accepted: 11/11/2021] [Indexed: 11/16/2022]
Abstract
Abrasions and pressure ulcers on the oral mucosa are most often caused by excessive pressure or incorrect fitting of the denture. The use of soft relining materials can eliminate pain sensations and improve patient comfort. The main functional feature of soft elastomeric materials is the ability to discharge loads from the tissues of the mucosa. (1) Background: The aim of the work was a comparative laboratory study of ten materials used for the soft lining of acrylic dentures. (2) Methods: There were materials based on acrylates (Vertex Soft, Villacryl Soft, Flexacryl Soft) and silicones (Sofreliner Tough Medium, Sofreliner Tough Medium, Ufi Gel SC, GC Reline Soft, Elite Soft Relining, Molloplast). Laboratory tests include the analysis of the tensile bond strength between the relining material and the acrylic plate of the prosthesis. The tests were conducted taking into account 90-day term aging in the distilled water environment based on the methodology presented in the European Standard ISO 10139-2. (3) Results: After three months of observation, the highest strength of the joint was characterized by Flexacryl Soft acrylic, for which the average value was 2.5 MPa. The lowest average value of 0.89 MPa was recorded for the GC Reline Soft silicone material. Over time, an increase in the value of the strength of the combination of acrylic materials and a decrease in these values in the case of silicone materials was observed. (4) Conclusion: Each of the tested silicone materials showed all three types of damage, from adhesive to mixed to cohesive. All acrylic-based materials showed an adhesive type of failure. Time did not affect the type of destruction.
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Affiliation(s)
- Magdalena Wyszyńska
- Unit of Dental Material Sciences, Department/Institute of Prosthetic Dentistry and Dental Material Sciences, Medical University of Silesia in Katowice, 15 Poniatowskiego Street, 40-055 Katowice, Poland;
- Correspondence: (M.W.); (E.B.-B.)
| | - Ewa Białożyt-Bujak
- Unit of Dental Material Sciences, Department/Institute of Prosthetic Dentistry and Dental Material Sciences, Medical University of Silesia in Katowice, 15 Poniatowskiego Street, 40-055 Katowice, Poland;
- Correspondence: (M.W.); (E.B.-B.)
| | - Grzegorz Chladek
- Department of Engineering Materials and Biomaterials, Faculty of Mechanical Engineering, Silesian University of Technology, Konarskiego 18A Street, 44-100 Gliwice, Poland;
| | - Aleksandra Czelakowska
- Department/Institute of Prosthetic Dentistry and Dental Material Sciences, Medical University of Silesia in Katowice, 15 Poniatowskiego Street, 40-055 Katowice, Poland; (A.C.); (R.R.); (O.G.); (M.N.-W.); (J.K.)
| | - Rafał Rój
- Department/Institute of Prosthetic Dentistry and Dental Material Sciences, Medical University of Silesia in Katowice, 15 Poniatowskiego Street, 40-055 Katowice, Poland; (A.C.); (R.R.); (O.G.); (M.N.-W.); (J.K.)
| | - Agata Białożyt
- Unit of Dental Material Sciences, Department/Institute of Prosthetic Dentistry and Dental Material Sciences, Medical University of Silesia in Katowice, 15 Poniatowskiego Street, 40-055 Katowice, Poland;
| | - Olaf Gruca
- Department/Institute of Prosthetic Dentistry and Dental Material Sciences, Medical University of Silesia in Katowice, 15 Poniatowskiego Street, 40-055 Katowice, Poland; (A.C.); (R.R.); (O.G.); (M.N.-W.); (J.K.)
| | - Monika Nitsze-Wierzba
- Department/Institute of Prosthetic Dentistry and Dental Material Sciences, Medical University of Silesia in Katowice, 15 Poniatowskiego Street, 40-055 Katowice, Poland; (A.C.); (R.R.); (O.G.); (M.N.-W.); (J.K.)
| | - Jacek Kasperski
- Department/Institute of Prosthetic Dentistry and Dental Material Sciences, Medical University of Silesia in Katowice, 15 Poniatowskiego Street, 40-055 Katowice, Poland; (A.C.); (R.R.); (O.G.); (M.N.-W.); (J.K.)
| | - Małgorzata Skucha-Nowak
- Unit of Dental Propedeutics, Department of Conservative Dentistry with Endodontics, Division of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, 15 Poniatowskiego Street, 40-055 Katowice, Poland;
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