Comparative effects of two different artificial body fluids on Candida albicans adhesion to soft lining materials

Silicones for Maxillofacial Prostheses and Their Modifications in Service

The biomedical applications of silicones are countless due to their outstanding properties. In dentistry, silicone for maxillofacial and plastic surgery has become indispensable, from both physiological and aesthetic points of view. In this mini-review, silicone materials for dentistry and facial prostheses are discussed, focusing on their properties and alterations when exposed for long periods to different environments. A significant number of studies reported in the literature have been conducted in vitro, mimicking some of the main degradative factors which have been identified as triggers for discoloration and deterioration of the mechanical properties. Among these, in artificial aging and accelerated natural aging studies, UV radiation is considered the most important. Other weathering factors, biological contamination, and disinfection agents may have dramatic effects as well. Several general properties of silicones are described at the beginning, with a focus on biocompatibility, cross-linking mechanisms, and applications in dentistry and maxillofacial prosthetics. We discuss the ongoing cross-linking and/or possible exudation after manufacturing, which also affects the stability of the prosthesis over time, and possibly the patient. Next, the main environmental factors that affect the prostheses in service are presented, including the role of cigarettes smoke, which has been discussed very little so far. A few aspects, such as biofilm formation, its negative effects, and proposed solutions to overcome this phenomenon regarding silicones, are also described. We conclude by proposing a set of topics for future research and development based on the gaps that have been identified in the literature. Although silicones are probably irreplaceable in maxillofacial prosthetics, improvements in terms of base materials, additives, surface treatments, and maintenance are possible and necessary for long-lasting and safer prostheses.

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

PURPOSE

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

MATERIALS & METHODS

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

RESULTS

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

CONCLUSIONS

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

The Influence of Decontamination Procedures on the Surface of Two Polymeric Liners Used in Prosthodontics

Polymeric liners are materials commonly used in prosthodontics to reshape denture surfaces contacting the soft tissues of the oral cavity. The aim of the study was to determine the impact of different cleaning methods on two polymeric materials used in prosthodontics as non-adhesive permanent liners. The material for the research consisted of samples made from Mollosil Plus (Detax, Ettlingen, Germany)-direct polysiloxan liner; and Plastitanium (Pressing Dental, San Marino, Republic of San Marino)-an injection-molded liner. A total of 198 samples were made, 99 of each assessed material. They were exposed to different cleaning methods-a toothbrush, a toothbrush and soap, a toothbrush and toothpaste (BlendaMed, Procter&Gamble, Cincinnati, OH, USA), a toothpaste and denture cleaning paste (Protefix Hygiene Denture Paste, Queisser Pharma, Germany), denture cleansing tablets (Protefix Hygiene Cleaning Tablets, Queisse Pharma, Germany), and a disinfecting spray (Aftermat, Port Jefferson Station, New York City, NY, USA)-for 1 min, 5 min, 10 min, and 15 min. The image acquisition was performed with scanning electron microscopy and samples were analyzed for the homogeneity of their surfaces-the presence of holes, grooves, precipitate, and small and large separating pieces of the material marking departures from this homogeneity. For each type of damage, one point was given. Continuous data from two groups were compared with Mann-Whitney U testing. Due to a small sample size and distribution of variables other than normal, to compare more than two groups, Kruskal-Wallis testing with post hoc analysis (Dunn test with Bonferroni correction) was used. Categorical data were compared with the chi-square test and the Fisher's exact test. The Mollosil Plus material should be decontaminated with the use of a toothbrush or toothbrush with soap, while Plastitanium material should be disinfected. Plastitanium samples are more susceptible to damage during the decontamination procedures than Mollosil Plus.

Surface morphology of silicone soft relining material after mechanical and chemical cleaning

PURPOSE

The objective was to investigate the influence of chemical and mechanical cleaning on the surface morphology of a silicone soft relining material.

METHODS

Three plate-shaped specimens were prepared for each group (Control, Hard and Soft) by laminating a 1.5-mm-thick silicone soft relining material. The Control group specimens were stored in water, and the Hard and Soft group specimens were cleaned with hard and soft bristle denture brushes, respectively. Abrasion testing with a toothbrush and immersion testing with an enzyme-containing peroxide denture cleanser were performed, simulating a period of approximately 4 months. The arithmetic mean roughness (Sa) and maximum height of the cross-section (Sz) were measured before and after abrasion and immersion testing.

RESULTS

Sa was 4.9±0.9, 22.1±4.2 and 44.2±4.0μm in the Control, Soft and Hard groups, respectively. Sz was 257.5±31.7, 392.0±23.8 and 452.2±41.9μm in the Control, Soft and Hard groups, respectively. After abrasion testing, Sa and Sz differed significantly between the Soft and Control groups and between the Hard and Control groups. Sa was 2.2±1.2μm before and after immersion, and Sz was 142.1±81.4μm before and after immersion. No significant difference was noted in either Sa or Sz in the Control specimens before or after immersion.

CONCLUSIONS

Surfaces cleaned using a soft bristle brush were less likely to roughen than those cleaned with a hard bristle brush under the conditions of this study. Additionally, chemical cleaning using the enzyme+neutral peroxide denture cleanser did not roughen the surface of the silicone soft relining material.

Influence of the mechanical properties of resilient denture liners on the retention of overdenture attachments

STATEMENT OF PROBLEM

Information is lacking about the selection criteria for silicone resilient denture liners applied as a matrix material for attachments on overdentures.

PURPOSE

The purpose of this in vitro study was to investigate the mechanical properties of silicone resilient denture liners and their influence on the initial retention force of overdenture attachments and the reduction in retention force over time.

MATERIAL AND METHODS

Nine types of silicone resilient denture liner were injected and fixed to the matrix section of an experimental denture base. They were then fitted to an epoxy resin model that simulated the residual ridge with a patrix ball attachment (n=10). The retention force of the denture was measured with a digital force gauge, and the maximum force of traction (N) was regarded as the initial retention force. The retention force reduction (N) after repeated insertion and removal (n=5) was calculated by subtracting the retention force after 3348 cycles (3-year simulated insertion and removal) from the initial retention force. The intaglio of the matrix was observed with a scanning electron microscope (SEM) before and after the 3348 cycles. Four mechanical properties (hardness, strain-in-compression, tensile strength, and arithmetic mean roughness) of the resilient denture liners were measured. One-way ANOVA of the initial retention force of each lining material was performed, followed by the Scheffe test (α=.05). Pearson correlation analysis was used (α=.05) to analyze correlations of the initial retention force with the retention force reduction after insertion and removal and the mechanical properties of each material. Multiple regression analysis with the stepwise method extracted the initial retention force and the retention force reduction as dependent variables, and the resilient denture liner mechanical properties as explanatory variables (α=.05).

RESULTS

The initial retention force of the resilient denture liners was 1.3 to 5.4 N. Multiple comparisons showed significant differences in some groups (P<.05). The retention force reduction of the resilient denture liners was 0.2 to 1.9 N. Multiple regression analysis with the stepwise method extracted hardness and strain-in-compression as explanatory variables for the initial retention force and the retention force reduction.

CONCLUSIONS

Within the limitations of this in vitro study, hardness was found to influence the initial retention force of the overdenture, and strain-in-compression influenced the retention force reduction in the 3-year simulation.

An In-vitro Evaluation of Retention, Colonization and Penetration of Commonly Used Denture Lining Materials By Candida albicans

INTRODUCTION

Colonization of the surface by Candida albicans and related Candida species is one of the major concerns of denture lining materials.

AIM

We evaluated retention, colonization and penetration of the four denture lining materials namely Molloplast B, Permaflex, GC Soft Liner and Ufi Gel Hard C by Candida albicans.

MATERIAL AND METHODS

a) Evaluation of retention: Five test discs of each material with smooth surface on one side and rough on the other were prepared and surface roughness (Ra) was measured with profilometer. Retention of C. albicans to discs was monitored after one hour of incubation (37°C) with standardized (2.8 x 10⁶ cfu/ml) washed cell suspension. Discs were stained with acridine orange and attached cells were counted using inverted microscope; b) Evaluation of colonization and penetration: Eight test discs of each material in sterile artificial saliva, were inoculated with C. albicans and incubated for six weeks. Two sections were cut across each test disc to provide three replicate samples. Candida cells on cut disc sections were fixed, dehydrated, air dried and viewed via fluorescence microscope; c) Evaluation of antifungal action: Two test discs of each material were placed onto diagnostic sensitivity testing the agar plate. After incubation at 37°C for 24 hours, the zone of inhibition formed around the samples were measured at four places, and the mean calculated.

RESULTS

a) All rough surfaces showed higher retention of C. albicans than smooth surfaces. Among the smooth surfaces, Molloplast B and GC Soft Liner showed highest and lowest retention of C. albicans respectively (p=0.0090). Among the rough surfaces, the variation in the retention of C. albicans was not statistically significant; b) Penetration of C. albicans was observed through all three sections of the test discs of each material. There was no statistically significant difference among the test materials; c) Molloplast B and Permaflex produced a mean zone of inhibition of 16.9±4.8mm and 14.80±3.8mm respectively.

CONCLUSION

a) Smoother surfaces retain fewer cells than rough surfaces; b) Denture lining materials permit infiltration of Candida through their structure; c) Denture lining materials have insignificant anti-fungal properties.

Prevention and treatment of Candida colonization on denture liners: a systematic review

STATEMENT OF PROBLEM

Denture liners are well known for their poor physical properties that favor the accumulation of plaque and colonization by Candida species, which can irritate the oral tissues and lead to denture stomatitis.

PURPOSE

A systematic review was conducted to determine the feasibility of a prevention protocol for Candida colonization in denture liners and an effective treatment after the fungi has colonized the material.

MATERIAL AND METHODS

Clinical and in vitro investigations that assessed the treatment and/or prevention of Candida colonization and biofilm formation in denture liners were selected according to the PRISMA statement. Seven electronic databases were searched from 1950 to April 2012 with the keywords "denture liner" OR "reline*" OR "tissue conditioner" AND "Candida" OR "denture stomatitis" OR "oral candidiasis" OR "antifungal agents" OR "denture clean*".

RESULTS

The incorporation of nystatin (in general, 500 000 units) into tissue conditioners to prevent the onset of the disease and immersion in sodium hypochlorite for disinfection were the methods most often described in this systematic review, and both methods were able to prevent or inhibit Candida colonization, depending on their concentrations. The 0.5% sodium hypochlorite concentration can disinfect tissue conditioners and denture liners. Microwave irradiation has also been described an alternative method of disinfection. Because of a lack of standardized results (especially with regard to the method used to perform microbial counts), a meta-analysis could not be performed.

CONCLUSIONS

The literature suggests that the use of 0.5% sodium hypochlorite can help disinfect denture liners and tissue conditioners. The incorporation of nystatin in those materials is also able to treat or prevent oral candidiasis. However, as most of the studies were in vitro, there is insufficient reliable evidence to truly provide recommendations regarding the ideal cleaning method or whether the addition of antifungal agents is worthwhile. Well-designed randomized controlled trials are needed to provide answers to these questions.

Effects of surface roughness and dimorphism on the adhesion of Candida albicans to the surface of resins: scanning electron microscope analyses of mode and number of adhesions

AIM

Candida albicans is a common oral fungus but can cause serious conditions such as Candida stomatitis. We investigated C. albicans adhesion to the surface of denture-base resins at two growth phases.

METHODS

Fungal suspensions of logarithmic (9 h) and stationary phase (24 h) C. albicans (JCM2085) were used. Scanning electron microscopy (SEM) confirmed that yeast and mycelial forms were predominant in 9-h and 24-h cultures, respectively. Resin strips were polished to three surface roughness levels (Ra 3.2 μm, Ra 0.48 μm and Ra 0.06 μm) and were then immersed in C. albicans suspensions for both phases. The SEM images were taken at five sites on each strip.

RESULTS

Adhesion of mycelial-form C. albicans on rough surfaces (Ra = 3.2) was 2.2 times higher than on smooth surfaces (Ra = 0.06; 7030 vs 3580 adhesions/mm(2), P < 0.01). The hyphae of these mycelial forms fully penetrated the surface cracks. Fewer adhesions occurred for yeast-form C. albicans, regardless of surface type (440-620 adhesions/mm(2), P = n.s.).

CONCLUSION

Adhesion of yeast-form C. albicans was indifferent to surface roughness. In contrast, mycelial adhesion increased with surface roughness of the resin because mycelia infiltrated the minute protuberances on rough surfaces.

Microbial biofilms on facial prostheses

The composition of microbial biofilms on silicone rubber facial prostheses was investigated and compared with the microbial flora on healthy and prosthesis-covered skin. Scanning electron microscopy showed the presence of mixed bacterial and yeast biofilms on and deterioration of the surface of the prostheses. Microbial culturing confirmed the presence of yeasts and bacteria. Microbial colonization was significantly increased on prosthesis-covered skin compared to healthy skin. Candida spp. were exclusively isolated from prosthesis-covered skin and from prostheses. Biofilms from prostheses showed the least diverse band-profile in denaturing gradient gel electrophoresis (DGGE) whereas prosthesis-covered skin showed the most diverse band-profile. Bacterial diversity exceeded yeast diversity in all samples. It is concluded that occlusion of the skin by prostheses creates a favorable niche for opportunistic pathogens such as Candida spp. and Staphylococcus aureus. Biofilms on healthy skin, skin underneath the prosthesis and on the prosthesis had a comparable composition, but the numbers present differed according to the microorganism.