Influence of the Manufacturing Method on the Adhesion of Candida albicans and Streptococcus mutans to Oral Splint Resins

Effect of nanogold incorporation into polymethyl methacrylate denture bases on microbial activity in implant-retained mandibular overdentures

PURPOSE

In this randomized clinical trial, we examined the incorporation of nanogold particles into polymethyl methacrylate denture bases and compared these modified bases with conventional ones in mandibular implant-retained overdentures, focusing on microbiological growth and adhesion characteristics.

METHODS

In this study, twenty-two male patients who were completely edentulous participated in a rehabilitation program involving mandibular overdentures retained by two dental implants placed in the canine area. The subjects were categorized into two equal groups, each comprising eleven patients. Group I received mandibular overdentures fabricated from conventional acrylic denture bases, whereas Group II received mandibular overdentures with bases that had undergone nanogold treatment. Microbial growth and colonization were evaluated around the implant's necks and the fitting surface of each patient's mandibular dentures. Three types of bacteria were studied: Candida albicans, Escherichia coli, and Streptococcus mutans. The mean difference in the counts of bacteria before the denture was inserted and after two, four, and six months has been calculated and analyzed statistically.

RESULTS

Regarding colony count (log 10 CFUs/mmL), there was a significant difference between the research groups. Group II had significantly lower values measured at 2, 4, and 6 months for Candida albicans, Escherichia coli, and Streptococcus mutans, respectively, than group I.

CONCLUSION

The addition of gold nanoparticles to PMMA denture bases was of greater benefit in inhibiting microbial growth than conventional acrylic resin bases.

Next-Generation Dental Materials: Exploring Bacterial Biofilm Formation on 3D-Printable Resin-Based Composites

This study evaluated the microbial growth profile of subgingival multispecies biofilm on 3D-printable resin-based composites (PRBCs). A 96-well cell plate cultivated a 39-species biofilm associated with periodontitis over 7 days. Cylindrical specimens with 12 mm high and 3 mm diameters were prepared by the PRBC group (Cosmos Temp-Yller; Prizma 3D Bio Crown; Prizma 3D Bio Prov) and an acrylic resin as control. Further, these specimens were immersed in the well plate to allow biofilm formation. After growing for 7 days, the metabolic biofilm activity was evaluated by colorimetric assay and the microbial profile by DNA-DNA hybridization. Kruskal-Wallis and Mann-Whitney tests evaluated each bacteria count and complex group. A greater biofilm formation was observed on PRBC groups than on acrylic resin. The microbiological profile of PRBC was associated with a less pathogenic biofilm, with an absence of a red complex. Acrylic resin showed low biofilm growth, but the biofilm profile was related to periodontal disease, characterized by red-complex bacteria. The selection of PRBC may contribute more effectively to maintaining periodontal health than acrylic resin.

Biocompatibility of 3D-printed vs. thermoformed and heat-cured intraoral appliances

Objectives

The development of additive manufacturing has the potential to revolutionize the fabrication of medical devices. This technology, also known as 3D printing, offers precise, cost-effective, and personalized approaches, which could be particularly beneficial in the production of intraoral appliances. Despite its promise, research on the biocompatibility of 3D-printed intraoral devices is still limited. Our study aims to address this gap.

Methods

We examined the cytotoxicity of materials processed via three techniques commonly used for the fabrication of different intraoral appliances: 3D printing (Dental LT Clear), thermoforming (Duran adjusted with Durasplint LC), and conventional heat-curing (Villacryl H Plus). We also investigated the impact of chemical or UVC disinfection on the biocompatibility of these materials. We assessed the biological effects induced in human gingival fibroblasts (HGFs) through both direct contact tests (MTT and LDH assays) and extract tests (PrestoBlue, DCF, and cell death type assays). Additionally, we observed changes in cellular morphology and migration rate under an inverted light microscope. The surface roughness of materials was evaluated using contact profilometry. Statistical analysis was conducted using two-way analysis of variance.

Results

Our findings suggest that all three fabrication techniques induced a slight cytotoxic effect in HGFs, as evidenced by both direct contact and extract tests. However, these materials could be considered nontoxic according to the ISO 10993-5:2009 norm, as the decrease in metabolic activity observed was always less than 30% compared to the untreated control.

Conclusion

This novel study confirms that 3D printing may be a safe alternative to conventional methods for fabricating intraoral appliances. However, further tests assessing the long-term intraoral usage are still needed.

Denture microbiome shift and changes of salivary inflammatory markers following insertion of 3D printed removable partial PMMA denture: a pilot study

BACKGROUND

The aim of this study was to investigate the microbiome shift of denture biofilm formation, the incidence of Candida and changes of salivary inflammatory markers following insertion of 3-dimensional printed PMMA denture.

METHODS

This was a pilot study of 6 patients provided with 3D printed (test group) or conventionally heat-cured (control group) removable partial acrylic dentures followed up for 6 weeks. 3 denture swabs were collected at week 1, 3 and 6; and saliva samples were collected at baseline, week 1, 3 and 6 following denture insertion. Microbial DNA was isolated, and the 16S rRNA gene was amplified and sequenced to assess the denture microbiota. The presence of Candida was determined using PCR assay. The levels of salivary biomarkers lactoferrin (LTF) and histatin (HTN) were determined using ELISA.

RESULTS

Denture microbiome of both groups exhibited similar microbial compositions at weeks 1, 3 and 6. However, the percentage of Streptococcus in the test group was significantly lower at week 1 (p < 0.05). Greater bacterial diversity was detected in the test group (p < 0.05; pairwise Wilcoxon) after 6 weeks. The presence of Candida was only detected in one sample of the 3D printed denture (test group) after 6 weeks. The level of LTF biomarkers increased in both groups after 6 weeks, however, the level of HTN increased only in the control group.

CONCLUSIONS

Denture microbiome of both groups demonstrated similar microbial compositions. After 6 weeks, 3D printed denture demonstrated higher diversity with delayed microbiome shift compared to conventional heat cure dentures. 3D printed denture may be a viable alternative to conventional denture and it has a potential to delay microbial dysbiosis.

CLINICAL RELEVANCE

Among wearers, 3D printed denture can potentially reduce the risk of denture stomatitis. A greater diversity may delay or slow the transition of denture microbiome to dysbiosis.

Effect of postpolymerization time and atmosphere on surface properties and biofilm formation in additively manufactured resins for definitive restorations

OBJECTIVES

To investigate how postpolymerization time (PPT) and atmosphere (PPA) influence the surface properties, protein adsorption, and microbial adhesion of two types of additively manufactured (AM) resins used for definitive restorations.

METHODS

Two different types of commercially available AM resins for definitive restorations (UR and CR) were used to create disk-shaped specimens. These specimens were divided into eight groups based on resin type (UR and CR), PPT (standard or extended), and PPA (air or nitrogen). After postpolymerization, the surface roughness (Ra and Sa) and surface free energy (SFE) of all specimens were measured. The study also evaluated protein adsorption, microbial attachment, and cytotoxicity. A non-parametric factorial analysis of variance with post-hoc analyses was conducted, using a significance level (α) of 0.05.

RESULTS

The Ra and Sa values for CR were higher than those for UR, regardless of PPT or PPA (P < 0.05). For UR, SFE was higher with extended PPT compared to standard PPT. CR had higher SFE than UR under standard PPT. The interaction between PPT and PPA had a significant effect on protein adsorption (P < 0.05). When PPT was standard, nitrogen significantly increased protein adsorption compared to air. The interaction between resin type and PPA, and between resin type and PPT, significantly affected microbial adhesion (P < 0.05). The changes in PPT or PPA did not affect the cytotoxicity of either AM resin.

CONCLUSION

Surface properties, protein adsorption, and microbial attachment were influenced by the interactions among PPT, PPA, and resin type. These factors can have implications for resin-based definitive restorations.

CLINICAL SIGNIFICANCES

Clinicians should understand the impact of PPT and PPA on the surface properties of AM resins for definitive restorations, particularly regarding protein adsorption and microbial adhesion. Additionally, the type of AM resin (based on chemical composition) could affect its biological properties.

Influence of post-processing on the adhesion of dual-species biofilm on polylactic acid obtained by additive manufacturing

Introduction

Post-processing (PP) is performed to improve the surface, which can favor microbial adhesion and consequent pathological manifestations that impair the indication of polylactic acid (PLA) obtained by fused filament fabrication (FFF) for biomedical applications. This aims to evaluate the influence of chemical, thermal, and mechanical PP on the adhesion of Streptococcus mutants and Candida albicans, roughness, and wettability of the PLA obtained by FFF with and without thermal aging.

Methods

The specimens were designed in the 3D modeling program and printed. The chemical PP was performed by immersion in chloroform, the thermal by the annealing method, and the mechanical by polishing. Thermal aging was performed by alternating the temperature from 5 °C to 55 °C with 5000 cycles. Colony-forming unit (CFU/mL) counting was performed on dual-species biofilm of C. albicans and S. mutans. Roughness was analyzed by rugosimeter and wettability by the sessile drop technique. Data were verified for normality using the Shapiro-Wilk test, two-way ANOVA (α = 0.05) applied for CFU and wettability, and Kruskal-Wallis (α = 0.05) for roughness.

Results

Chemical, thermal, and mechanical PP methods showed no influence on CFU/mL of C. albicans (p = 0.296) and S. mutans (p = 0.055). Thermal aging did not influence microbial adhesion. Chemical PP had lower roughness, which had increased after aging. Wettability of the mechanical PP was lower.

Conclusions

Post-processing techniques, do not present an influence on the adhesion of S. mutans and C. albicans in PLA obtained by FFF, chemical PP reduced roughness, and mechanical reduced wettability. Thermal aging did not alter the microbial adhesion and altered the roughness and wettability.

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.

Antibacterial coating of orthodontic elastomeric ligatures with silver and bismuth nanofilms by magnetron sputtering: A feasibility study

OBJECTIVES

Magnetron sputtering was evaluated to equip surfaces of orthodontic elastomeric ligatures with silver and bismuth nanofilms.

MATERIAL AND METHODS

Antibacterial properties were evaluated by the adhesion of Streptococcus mutans. Polyurethane-based elastomeric ligatures were coated with silver and bismuth nanofilms via direct current magnetron sputtering. Surface roughness (Ra ) and surface-free energy (SFE) were assessed. Coated specimens were incubated with S. mutans for 2 h. Adhering bacteria were visualized by Hoechst staining and quantified by an ATP-based luminescence assay. One-way analysis of variance with Tukey post hoc testing and Pearson correlation analysis were performed (p < .05) to relate bacterial adhesion to surface roughness and surface-free energy.

RESULTS

Elastomeric ligatures were successfully coated with silver and bismuth nanofilms. Ra was significantly reduced by silver coating. Silver and bismuth coatings showed significantly higher SFE than controls. Adhesion of S. mutans was significantly decreased by silver coating. No correlation between bacterial adhesion and SFE was found. Correlation between bacterial adhesion and Ra was positive but not statistically significant.

CONCLUSIONS

Magnetron sputtering proved to be a feasible method to equip orthodontic elastomeric ligatures with silver and bismuth nanofilms. Silver coatings of elastomeric ligatures may reduce white spots and carious lesions in orthodontic patients. Future research is required to stabilize coatings.

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.

Antimicrobial activity, surface properties, and cytotoxicity of microencapsulated phytochemicals incorporated into three-dimensionally printable dental polymers

OBJECTIVES

This study aimed to investigate the antimicrobial properties of three dimensionally-printed dental polymers (3DPs) incorporated with microencapsulated phytochemicals (MPs) and to assess their surface characteristics and cytotoxicity.

METHODS

MPs derived from phytoncide oil and their specific chemical components were introduced into suspensions of three microbial species: Streptococcus gordonii, Streptococcus oralis, and Candida albicans. Optical density was measured to determine the microbial growth in the presence of MPs for testing their antimicrobial activity. MPs at 5% (w/w) were mixed with dental polymers and dispersants to 3DP discs. These microbial species were then seeded onto the discs and incubated for 24 h. The antibacterial and antifungal activities of MP-containing 3DPs were evaluated by counting the colony-forming units (n = 3). The biofilm formation on the 3DP was assessed by crystal violet staining assay (n = 3). Microbial viability was determined using a live-dead staining and CLSM observation (n = 3). Surface roughness and water contact angle were assessed (n = 10). Cytotoxicity of MP-containing 3DPs for human gingival fibroblast was evaluated by MTT assay.

RESULTS

MPs, particularly (-)-α-pinene, suppressed the growth of all tested microbial species. MP-containing 3DPs significantly reduced the colony count (P ≤ 0.001) and biofilm formation (P ≤ 0.009), of all tested microbial species. Both surface roughness (P < 0.001) and water contact angle (P < 0.001) increased. The cytotoxicity remained unchanged after incorporating MPs to the 3DPs (P = 0.310).

CONCLUSIONS

MPs effectively controlled the microbial growth on 3DPs as evidenced by the colony count, biofilm formation, and cell viability. Although MPs modified the surface characteristics, they did not influence the cytotoxicity of 3DPs.

CLINICAL SIGNIFICANCE

Integration of MPs into 3DPs could produce dental prostheses or appliances with antimicrobial properties. This approach not only provides a proactive solution to reduce the risk of oral biofilm-related infection but also ensures the safety and biocompatibility of the material, thereby improving dental care.

Different Polymers for the Base of Removable Dentures? Part II: A Narrative Review of the Dynamics of Microbial Plaque Formation on Dentures

This review focuses on the current disparities and gaps in research on the characteristics of the oral ecosystem of denture wearers, making a unique contribution to the literature on this topic. We aimed to synthesize the literature on the state of current knowledge concerning the biological behavior of the different polymers used in prosthetics. Whichever polymer is used in the composition of the prosthetic base (poly methyl methacrylate acrylic (PMMA), polyamide (PA), or polyether ether ketone (PEEK)), the simple presence of a removable prosthesis in the oral cavity can disturb the balance of the oral microbiota. This phenomenon is aggravated by poor oral hygiene, resulting in an increased microbial load coupled with the reduced salivation that is associated with older patients. In 15-70% of patients, this imbalance leads to the appearance of inflammation under the prosthesis (denture stomatitis, DS). DS is dependent on the equilibrium-as well as on the reciprocal, fragile, and constantly dynamic conditions-between the host and the microbiome in the oral cavity. Several local and general parameters contribute to this balance. Locally, the formation of microbial plaque on dentures (DMP) depends on the phenomena of adhesion, aggregation, and accumulation of microorganisms. To limit DMP, apart from oral and lifestyle hygiene, the prosthesis must be polished and regularly immersed in a disinfectant bath. It can also be covered with an insulating coating. In the long term, relining and maintenance of the prosthesis must also be established to control microbial proliferation. On the other hand, several general conditions specific to the host (aging; heredity; allergies; diseases such as diabetes mellitus or cardiovascular, respiratory, or digestive diseases; and immunodeficiencies) can make the management of DS difficult. Thus, the second part of this review addresses the complexity of the management of DMP depending on the polymer used. The methodology followed in this review comprised the formulation of a search strategy, definition of the inclusion and exclusion criteria, and selection of studies for analysis. The PubMed database was searched independently for pertinent studies. A total of 213 titles were retrieved from the electronic databases, and after applying the exclusion criteria, we selected 84 articles on the possible microbial interactions between the prosthesis and the oral environment, with a particular emphasis on Candida albicans.

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.

Is microbial adhesion affected by the build orientation of a 3-dimensionally printed denture base resin?

STATEMENT OF PROBLEM

How the build orientation of a 3-dimensionally (3D) printed denture affects microbial adhesion is unclear.

PURPOSE

The purpose of this in vitro study was to compare the adherence of Streptococcus spp. and Candida spp. on 3D-printed denture bases prepared at different build orientations with conventional heat-polymerized resin.

MATERIAL AND METHODS

Resin specimens (n=5) with standardized 28.3 mm² surface area were 3D printed at 0 and 60 degrees, and heat-polymerized (3DP-0, 3DP-60, and HP, respectively). The specimens were placed in a Nordini artificial mouth (NAM) model and exposed to 2 mL of clarified whole saliva to create a pellicle-coated substratum. Suspensions of Streptococcus mitis and Streptococcus sanguinis, Candida albicans and Candida glabrata, and a mixed species, each at 10⁸ cfu/mL were pumped separately into the model for 24 hours to promote microbial adhesion. The resin specimens were then removed, placed in fresh media, and sonicated to dislodge attached microbes. Each suspension (100 μL) was aliquoted and spread on agar plates for colony counting. The resin specimens were also examined under a scanning electron microscope. The interaction between types of specimen and groups of microbes was examined with 2-way ANOVA and then further analysis with Tukey honest significant test and Kruskal-Wallis post hoc tests (α=.05).

RESULTS

A significant interaction was observed between the 3DP-0, 3DP-60, and HP specimen types and the groups of microbes adhering to the corresponding denture resin specimens (P<.05). The difference was statistically significant among 3DP-0, 3DP-60, and HP specimens (P<.05). The adherence of candida was 3.98-times lower on the 3DP-0 than that of HP (P<.05). However, adherence of the mixed-species microbes and streptococci on the 3DP-60 were 1.75 times and 2-fold higher, respectively (P<.05). The scanning electron micrographs showed that 3DP-0 exhibited the lowest microbial adherence compared with HP and 3DP-60.

CONCLUSIONS

Adherence affinity of denture base resin is affected by the build orientation rather than by the group of different microbes. Three-dimensionally printed denture base resin fabricated at a 0-degree build orientation exhibited low affinity for microbial adhesion. Three-dimensionally printed dentures may reduce microbial adhesion when printed at a 0-degree build orientation.

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.

Bacterial Adhesion on Dental Polymers as a Function of Manufacturing Techniques

The microbiological behavior of dental polymer materials is crucial to secure the clinical success of dental restorations. Here, the manufacturing process and the machining can play a decisive role. This study investigated the bacterial adhesion on dental polymers as a function of manufacturing techniques (additive/subtractive) and different polishing protocols. Specimens were made from polyaryletherketone (PEEK, PEKK, and AKP), resin-based CAD/CAM materials (composite and PMMA), and printed methacrylate (MA)-based materials. Surface roughness (R_z; R_a) was determined using a laser scanning microscope, and SFE/contact angles were measured using the sessile drop method. After salivary pellicle formation, in vitro biofilm formation was initiated by exposing the specimens to suspensions of Streptococcus mutans (S. mutans) and Streptococcus sanguinis (S. sanguinis). Adherent bacteria were quantified using a fluorometric assay. One-way ANOVA analysis found significant influences (p < 0.001) for the individual parameters (treatment and material) and their combinations for both types of bacteria. Stronger polishing led to significantly (p < 0.001) less adhesion of S. sanguinis (Pearson correlation PC = -0.240) and S. mutans (PC = -0.206). A highly significant (p = 0.010, PC = 0.135) correlation between S. sanguinis adhesion and R_z was identified. Post hoc analysis revealed significant higher bacterial adhesion for vertically printed MA specimens compared to horizontally printed specimens. Furthermore, significant higher adhesion of S. sanguinis on pressed PEEK was revealed comparing to the other manufacturing methods (milling, injection molding, and 3D printing). The milled PAEK samples showed similar bacterial adhesion. In general, the resin-based materials, composites, and PAEKs showed different bacterial adhesion. Fabrication methods were shown to play a critical role; the pressed PEEK showed the highest initial accumulations. Horizontal DLP fabrication reduced bacterial adhesion. Roughness < 10 µm or polishing appear to be essential for reducing bacterial adhesion.

Efficacy of Denture Cleansers on Microbial Adherence and Surface Topography of Conventional and CAD/CAM-Processed Denture Base Resins

This study assessed the efficacy of five denture cleansers on the microbial adherence and surface topography of conventional and CAD/CAM denture base resins. Acrylic resin discs were fabricated using conventional, milling, and 3D printing methods (N = 180). The discs were contaminated with dual species of Candida albicans and Streptococcus mutans biofilm for 72 h and then disinfected with either of the denture cleansers (Fittydent cleansing tablets, 2% Chlorhexidine gluconate, 0.2% Chlorhexidine gluconate, 0.5% sodium hypochlorite, and 1% sodium hypochlorite (n = 10). Distilled water served as the control group. The colony-forming units of the microorganisms were calculated, followed by post-treatment surface roughness. Data were statistically analyzed using one-way ANOVA, paired t-test, and post hoc Tukey HSD test (α = 0.05). Among the denture cleansers, 2% Chlorhexidine gluconate, 0.5% sodium hypochlorite, and 1% sodium hypochlorite had the best cleansing effect on the resin discs and demonstrated zero growth of colonies for both the species. Comparing the material groups, the 3D-processed discs showed higher colony-forming units followed by the conventional and CAD/CAM milled group. The highest surface roughness was demonstrated by the 3D-printed discs (0.690 ± 0.08 μm), followed by the conventional (0.493 ± 0.11 μm) and the milled groups (0.301 ± 0.08 μm). The tested chemical denture cleansers affected the Candida albicans and Streptococcus mutans adhesion compared to control discs immersed in distilled water. The clinician may recommend to their patient to use 2% chlorhexidine gluconate for the disinfection of CAD/CAM PMMA denture base materials.

Antimicrobial efficiency of Tinospora cordifolia and Ocimum tenuiflorum against Streptococcus mutans and Candida albicans

Background

The application of traditional medicinal plants and their products for treatment has been an integral part of our culture and continues to play a key role as many infectious microorganisms are resistant to synthetic drugs. Tinospora cordifolia and Ocimum tenuiflorum herbs have shown medicinal properties and have gained importance in modern research.

Aims

This study assessed the antimicrobial activities of Tinospora cordifolia and Ocimum tenuiflorum against Streptococcus mutans and Candida albicans to conventional medications such as chlorhexidine and nystatin.

Methodology

The S. mutans and C. albicans were grown and maintained on Columbia agar plates and yeast malt extract agar respectively. An ethanolic extract was made and subjected to rotary evaporation to remove the ethanol. The antimicrobial activity of plant extracts was determined using the Kirby-Bauer disc diffusion method. The standard drugs, 10 μg/disc nystatin and 0.12% chlorhexidine, were used as a positive control. The zone of inhibition was measured after 24 hours.

Results

At a concentration of 3 mgs., the zone of inhibition of 25.6 mm was found with T. cordifolia, followed by 15.8 mm with O. tenuiflorum against S. mutans, and 0.12% chlorhexidine, at 21.7 ± 0.43 mm. A zone of inhibition of 23 mm and 22.9 mm was observed in both T. cordifolia and O. tenuiflorum against C. albicans, respectively. Positive control of nystatin showed 26.1 ± 0.46 mm.

Conclusion

Tinospora cordifolia has better antimicrobial activity against S. mutans compared to Ocimum tenuiflorum. Whereas at higher concentrations, both extracts were effective against C. albicans.

Energy drinks alter the surface morphology and roughness of composites, fissure sealants and titanium: An in vitro study

Objectives

The influence of energy drinks on dental materials are relatively under addressed. Our aim was to investigate the effect of energy drinks on dental materials used intraorally in young individuals. Commonly used preventive, restorative, and orthodontic materials were tested in vitro.

Methods

The effect of two commercially available energy drinks (HELL, BURN) was investigated on different dental materials: machined, anodized Titanium (grade 5: Ti6Al4V) and composites (Grandio Seal, VOCO; Filtek Z250, 3M ESPE; Estelite SQ, TOKUYAMA). The roughness (Ra) and morphological changes were examined by atomic force microscopy (AFM) and scanning electron microscopy (SEM).

Results

AFM and SEM revealed significant differences in the Ra and morphology of the samples. AFM results for the machined and anodized titanium samples showed that the two energy drinks modified the surface roughness differently; BURN changed the roughness of machined samples significantly, while anodized discs were not altered significantly by the two energy drinks. In case of composite samples there was no significant difference for the Estelite SQ, relative low differences for the Filtek Z250 and significant changes in the morphology and surface roughness of Grandio Seal.

Significance

On all tested materials, changes in the surface roughness and morphology were more or less detected, proving energy drinks do in fact have a harmful effect. It can be concluded that material erosion depends on the material composition and particle arrangement. Where the surface is characterized by a regular, uniform particle arrangement, energy drinks are less able to influence the roughness, while for samples where the surface is rich in aggregates, the material erodes the surface much more easily.

•

Consumption of energy drinks is increasing amongst children and young individuals.

•

Preventive, restorative, and orthodontic materials used in young individuals are affected by energy drinks.

•

Roughness and morphological change of dental materials is observed in case of Hell and Burn impact.

•

Burn damages more titanium, fissure sealant and composite materials.

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.

Cytotoxicity of 3D‐printed, milled, and conventional oral splint resins to L929 cells and human gingival fibroblasts

Objectives

Evidence on the biocompatibility of three‐dimensional (3D)‐printed and milled resins for oral splints is limited. This in vitro study assessed the influence of the manufacturing method on the cytotoxicity of oral splint resins on L929 cells and human gingival fibroblasts (GF1).

Materials and Methods

Standardized specimens of four 3D‐printed, two‐milled, one‐thermoformed, and one‐pressed splint resin were incubated with L929 and GF1 cells for 24 h. Immunofluorescence and WST‐8 assay were performed to evaluate cytotoxic effects. One‐way analysis of variance and Tukey's multiple comparison test were applied with the variables “splint resin” and “manufacturing method” (p < .05).

Results

Immunofluorescence showed attachment of L929 and GF1 cells to the splint resins. Irrespective of the manufacturing method, the WST‐8 assay revealed significant differences between splint resins for the viability of L929 and GF1 cells. L929 cells generally showed lower viability rates than GF1 cells. The evaluation of cell viability by the manufacturing method showed no significant differences between 3D printing, milling, and conventional methods.

Conclusions

The cytotoxic effects of 3D‐printed, milled, and conventional oral splint resins were similar, indicating minor influence of the manufacturing method on biocompatibility. Cytotoxicity of the resins was below a critical threshold in GF1 cells. The chemical composition might be more crucial than the manufacturing method for the biocompatibility of splint resins.

Pros and Cons of CAD/CAM Technology for Infection Prevention in Dental Settings during COVID-19 Outbreak

The purpose of this commentary is to update the evidence reported in our previous review on the advantages and limitations of computer-aided design/computer-aided manufacturing technology in the promotion of dental business, as well as to guarantee patient and occupational safety. The COVID-19 pandemic led to an unprecedented focus on infection prevention; however, waves of COVID-19 follow one another, asymptomatic cases are nearly impossible to identify by triage in a dental setting, and the effectiveness of long-lasting immune protection through vaccination remains largely unknown. Different national laws and international guidelines (mainly USA-CDC, ECDC) have often brought about dissimilar awareness and operational choices, and in general, there has been very limited attention to this technology. Here, we discuss its advantages and limitations in light of: (a) presence of SARS-CoV-2 in the oral cavity, saliva, and dental biofilm and activation of dormant microbial infections; (b) the prevention of SARS-CoV-2 transmission by aerosol and fomite contamination; (c) the detection of various oral manifestations of COVID-19; (d) specific information for the reprocessing of the scanner tip and the ward from the manufacturers.