Fourier-transform infrared study on effects of ageing, oestrogen level and altered dietary loading on rat mandibular condylar cartilage.

OBJECTIVE: Mandibular condylar cartilage (MCC) of the rat was examined with the Fourier-transform infrared (FITR) spectroscopic imaging to study the effects of ageing, oestrogen level and altered dietary loading on the structure of MCC. MATERIALS AND METHODS: The Sprague-Dawley rats (n = 96) aged 5 and 14 months were divided into 12 subgroups according to age, oestrogen status (ovariectomized [OVX], non-ovariectomized [non-OVX)]) and diet (hard, normal, soft). Specimens of the MCC were examined with FTIR spectroscopic imaging to quantify the distribution of collagens and proteoglycans. MCC was divided sagittally into three segments: anterior, most superior and posterior. From each segment, the collagen and proteoglycan contents at different depths of cartilage were statistically compared between the groups using an N-way analysis of variance (ANOVA). RESULTS: The amount of collagen content was significantly associated with old age in the deep layer of the anterior segment and in the middle layer of the posterior segment of MCC. In the deep layer of the most superior segment, the collagen content also increased with ageing. The amount of proteoglycan content increased significantly when dietary loading increased, and the oestrogen level decreased in the deep layer of the most superior segment of MCC. CONCLUSION: Ageing, oestrogen level and altered dietary loading have a significant effect on the location and content of collagens and proteoglycans of rat MCC. Ageing significantly increased the amount of collagen content in the superior and posterior segments, being highest in the older soft-diet rats. Decreased oestrogen levels and increased dietary loading increased the amount of proteoglycan content.

Association of climacterium with temporomandibular disorders at the age of 46 years - a cross-sectional study.

OBJECTIVE: Hormonal factors have been suggested to contribute to female dominance among subjects with temporomandibular disorders (TMD). Aim of the study was to examine the association of climacteric status with TMD amongst female participants in the Northern Finland Birth Cohort (NFBC) 1966 at 46 years of age. MATERIAL AND METHODS: Among female subjects in NFBC1966, climacteric status was determined based on menstrual anamnesis and measurement of blood follicle-stimulating hormone (FSH) levels. Women with FSH > 25 IU/L and amenorrhoea > 4 months were defined as climacteric (case group, n = 71); women not diagnosed as climacteric were defined as preclimacteric (control group, n = 656). Differences between cases and controls were evaluated on self-reported TMD pain, clinical TMD signs and TMD diagnoses using modified Diagnostic Criteria for TMD (DC/TMD) protocol. Crosstabulation and logistic regression models were used to analyse differences between cases and controls. RESULTS: Compared to preclimacteric women, climacteric women had significantly more often pain on palpation in temporomandibular joints (TMJs) (OR = 2.64, 95% CI 1.12-6.21, p= .026) and more crepitus in TMJs (OR = 2.92, 95% CI 1.13-7.56, p= .027). Degenerative joint disease diagnoses were more common in climacteric than preclimacteric women (OR = 2.27, 95% CI 1.05-4.91, p= .037). Differences were statistically significant after adjusting for confounding factors (body mass index (BMI), smoking, parity). No statistically significant differences in self-reported TMD pain were noted between groups. CONCLUSION: Among females at the age of 46 years, climacterium seems associated with TMD by increasing pain on palpation in TMJs, subjective symptoms, and clinical signs indicating degenerative changes in TMJs when using DC/TMD.

Association of self-reported bruxism with temporomandibular disorders - Northern Finland Birth Cohort (NFBC) 1966 study.

OBJECTIVE: To investigate the prevalence of self-reported bruxism and its association with temporomandibular disorders (TMD). The hypothesis of the study was that self-reported bruxism is associated with TMD. METHODS: The data were gathered from 1962 subjects who participated in a field study in 2012-2013, including a questionnaire concerning bruxism and TMD symptoms as well as clinical sub-diagnoses of TMD using the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD). Statistical method was chi-square test. Bonferroni correction was made, and a p-value of <0.003 was considered as significant. RESULTS: The prevalence of self-reported bruxism was 39.6%: 34.0% in men and 44.5% in women. Those who reported sleep bruxism (SB) or awake bruxism (AB) had significantly more pain-related TMD symptoms and signs compared to those not reporting bruxism. CONCLUSION: The prevalence of self-reported bruxism is high among middle-aged adults and is associated with TMD pain-related symptoms and signs, as well as TMD diagnoses.

Occlusal characteristics in facial pain cases and controls - 12-year follow-up of the Northern Finland Birth Cohort (NFBC) 1966.

Objective: The purpose of this study was to investigate the occlusal characteristics in Finnish adults at 12-year follow-up based on the Northern Finland Birth Cohort 1966 (NFBC1966) subjects.Methods: The occlusal analyses were performed at ages 34 and 46 years of facial pain cases (n = 52) and controls (n = 49) by two different methods.Results: At 12-year follow-up, a significant decrease in upper anterior segment peer assessment rating (PAR) score was found in the controls, indicating improvement in teeth alignment. In facial pain cases, left lateral occlusal relationship and midline asymmetry were significantly decreased. Occlusal asymmetry and overjet were significantly increased. In controls, the left canine showed a more normal occlusal relationship, cuspid asymmetry was changed, and midline asymmetry was significantly decreased.Conclusion: During a 2-year period, occlusal asymmetry and overjet increased significantly in facial pain cases, while occlusal relationship showed more normal characteristics in controls.

Association of temporomandibular disorders with pain sensitivity: A cohort study.

BACKGROUND: Pain related to temporomandibular disorders (TMD) can be linked with multiple site pain (MSP), and may associate with increased pain sensitivity, more frequently among women than men. The aim of the study was to examine the associations of pressure pain threshold (PPT) and tolerance (PPTo) with TMD and associated MSP in the Northern Finland Birth Cohort 1966 (NFBC1966) study. METHODS: Altogether 1961 NFBC1966 subjects attended clinical medical and dental examination at the Institute of Dentistry, University of Oulu in 2012-2013. Clinical examinations were carried out using a modified Diagnostic Criteria for TMD protocol (DC/TMD). MSP was defined based on questions regarding body pain sites. Additionally, PPT and PPTo were assessed using algometer measurements. Mann-Whitney U-test and Tobit regression models were used to analyse associations between TMD sub-diagnoses, MSP, PPT and PPTo, stratified by sex. Further models were adjusted with anxiety and depressive symptoms, which were assessed using Hopkins Symptom Checklist-25 (HSCL-25) and two-way interaction terms. RESULTS: Among females, lower PPT and PPTo were associated with myalgia and arthralgia. Among males, lower PPT and PPTo were associated with MSP-linked TMD. Tobit regression analysis showed significantly lower PPT and PPTo values in the myalgia and arthralgia subgroups among female TMD subjects. Among females, disc displacement with reduction had an inverse association with PPT and PPTo. Among males, lower PPTo was associated with degenerative joint disease and MSP-linked TMD. CONCLUSIONS: The pain regulatory mechanisms behind TMD act differently between the genders as local TMD among females and MSP-linked TMD among males were associated with pain sensitivity. SIGNIFICANCE: The study shows that there are differences in the associations of painful TMD with pressure pain tolerance, pressure pain sensitivity and MSP between male and female subjects.

Thermographic findings related to facial pain - a survey of 40 subjects.

Objective: The purpose of this study was to assess how thermography findings relate painful symptoms and signs of temporomandibular disorders (TMD).Methods: Thermography, combined with chewing of paraffin wax, was performed on 40 subjects. The results were analyzed according to gender and pain-related TMD symptoms and clinical signs.Results: The overall temperatures after chewing were higher in TMD patients than in controls. For females, the most significant findings were the thermal increase between the relaxed state and subjects' state after chewing in temporal and temporomandibular joint (TMJ) regions. For males, all calculated parameters demonstrated a poor ability to discriminate TMD from controls.Conclusion: Thermography could be a potential tool in diagnostics of female TMD patients. The results suggest that the thermal information assessed in specific facial areas could help to discriminate TMD patients from non-TMD patients and could be used to quantify the pain associated with TMD.

Effects of Estrogen Level, Dietary Loading, and Aging on Types I, II, and X Collagen Expression and Structure of Rat Mandibular Condylar Cartilage.

AIMS: To investigate how estrogen level, dietary loading, and aging affect cartilage structure and the expression of major collagens (types I, II, and X) in rat mandibular condylar cartilage (MCC). METHODS: A total of 96 outbred Sprague Dawley female rats were randomly divided into two groups by ovariectomy (OVX) at 7 weeks old. One week later, the rats in each group were further divided into three subgroups on the basis of food hardness: hard food (diet board), normal food (pellet), and soft food (powder). The rats were sacrificed at the age of 5 or 14 months. The thickness of the fibrous, proliferative, and chondroblastic layers of the mandibular condylar cartilage were measured after toluidine blue staining. Immunohistochemical analysis was performed to evaluate the expression levels of types I, II, and X collagen. A linear regression model was used to investigate the main factors affecting changes in thickness and collagen expression. RESULTS: The expression levels of types II and X collagen were decreased by ovarian estrogen deficiency and increased by dietary loading. Increased dietary loading was the main factor affecting an increase in thickness of the cartilage layers, while aging was the main factor affecting a decrease in thickness of the fibrous layer. A significant age-related increase was found in the expression of type I collagen. There was some degree of interaction between aging and dietary loading that affected the thickness of the chondroblastic layer and the expression of type X collagen. CONCLUSION: The physiologic level of estrogen plays a role in MCC development by promoting the expression of types II and X collagen. Dietary loading is essential to increase the expression of types II and X collagen, as well as the thickness of cellular layers, to maintain the integrity of the MCC. Aging seems to reduce the ability of the MCC to withstand occlusal loading.

Flexural and Surface Properties of PMMA Denture Base Material Modified with Thymoquinone as an Antifungal Agent.

PURPOSE: To evaluate the effect of addition of different concentrations of thymoquinone (TQ) on the flexural strength, elastic modulus, surface roughness, and hardness of PMMA denture base material. MATERIALS AND METHODS: A total of 160 rectangular specimens were prepared from heat-polymerized acrylic resin, with dimensions of 65 × 10 × 2.5 mm3 for flexural strength testing and 10 × 20 × 3 mm3 for surface property testing. The specimens were divided into eight groups of 20 specimens: one control group without addition of TQ and seven test groups prepared by adding TQ to acrylic powder in concentrations of 0.5, 1, 1.5, 2, 2.5, 3, and 5 wt%. The polymer was added to the monomer before being mixed, packed, and processed using the conventional water bath method. A universal testing machine was used to measure flexural strength and elastic modulus. A profilometer and a Vickers hardness tester were used to measure surface roughness and hardness, respectively. One-way ANOVA and the Tukey-Kramer multiple-comparison test were used for statistical analysis, with statistical significance at p ≤ 0.05. RESULTS: Addition of TQ to PMMA denture base material significantly decreased flexural strength and elastic modulus at high concentrations (p < 0.01), while no significant differences were observed at low concentrations (0.5%, 1% TQ) in comparison with the control group. At high TQ concentrations, surface roughness increased while hardness decreased (p < 0.0001), and no significant differences were observed at low concentrations (0.5%, 1% TQ) in comparison with the control group. The most favorable addition values were 0.5% and 1% TQ in all TQ groups. CONCLUSIONS: Addition of TQ did not affect the flexural and surface properties of PMMA denture base material at low concentrations (0.5%, 1% TQ) and could be incorporated into PMMA denture base material as an antifungal agent.

The effect of nanodiamonds on candida albicans adhesion and surface characteristics of PMMA denture base material - an in vitro study.

Candida albicans is the main causative pathogen of denture stomatitis, which affects many complete denture patients. OBJECTIVE: To evaluate the effect of different concentrations of nanodiamonds (NDs) added to polymethyl methacrylate (PMMA) denture base material on Candida albicans adhesion as well as on surface roughness and contact angle. METHODOLOGY: Acrylic resin specimens sized 10×10×3 mm3 were prepared and divided into four groups (n=30) according to ND concentration (0%, 0.5%, 1%, 1.5% by wt). Surface roughness was measured with a profilometer, and the contact angle with a goniometer. The effect of NDs on Candida albicans adhesion was evaluated using two methods: 1) slide count and 2) direct culture test. Analysis of variance (ANOVA) and Tukey's post hoc test were used in the statistical analyses. RESULTS: Addition of NDs decreased the Candida albicans count significantly more than in the control group (p<0.05), with a lowest of 1% NDs. Addition of NDs also significantly decreased the surface roughness (p<0.05), but the contact angle remained the same. Incorporation of NDs into the PMMA denture base material effectively reduced Candida albicans adhesion and decreased surface roughness. CONCLUSION: PMMA/NDs composites could be valuable in the prevention of denture stomatitis, which is considered one of the most common clinical problems among removable denture wearers.

Influence of tooth loss on mandibular morphology: A cone-beam computed tomography study.

BACKGROUND: Tooth loss adversely affects patients' health and psychosocial wellbeing. In addition, it changes mandibular morphology. Objective: To evaluate the effect of tooth loss, age, and gender on mandibular morphology. MATERIAL AND METHODS: Cone-beam computed tomographic (CBCT) scans of 101 patients were examined to measure the gonial angle (GA), ramus height (RH) and condylar height (CH). Patients' age, gender, and dental status were recorded. Repeated measures analysis of variance (ANOVA) was used to assess the impact of gender, age, and tooth loss on the GA, RH and CH. The mean measurements of the GA, RH and CH were compared between dentate/edentulous patients after splitting by gender. RESULTS: The GA was larger in edentulous patients compared to dentate ones, in females than in males, and in older than in younger. RH on the right side was significantly longer than on the left side (P< 0.0001), and also longer in males and younger patients. CH was shorter in younger than in older patients and in dentate than in edentulous patients. CONCLUSIONS: Tooth loss is associated with changes in mandibular morphology and its prevention would avoid these irreversible changes. Key words:Tooth loss, mandibular morphology, Cone-Beam computed tomography, gender, age.

The role of occlusion in temporomandibular disorders (TMD) in the Northern Finland Birth Cohort (NFBC) 1966.

OBJECTIVE: To investigate the role of occlusion in temporomandibular disorders (TMDs) in the Northern Finland Birth Cohort 1966 (NFBC 1966). METHODS: Subjects (n = 1962) participated in clinical medical and dental examinations. The association between TMD signs and diagnoses with occlusal disturbances, i.e. malocclusions and occlusal interferences, was examined. Pearson's chi-square test, as expressed by odds ratios (OR) and 95% confidence intervals (CI) and logistic regression models, were used in the analysis. RESULTS: A statistically significant association was found between myalgia and lateral scissor bite and also between arthralgia and lateral deviation in the retruded contact position and intercuspal contact position (RCP-ICP) slide. Pain in the masticatory muscles was associated with negative overjet and the amount of RCP-ICP slide. DISCUSSION: Occlusal factors showed a statistically significant association with TMD. The TMD signs were associated with unstable occlusion, especially the amount and lateral deviation in RCP-ICP slide, as well as negative overjet.

MMP-3 and MMP-8 in rat mandibular condylar cartilage associated with dietary loading, estrogen level, and aging.

OBJECTIVES: The structure of the mandibular condylar cartilage (MCC) is regulated by dynamic and multifactorial processes. The aim of this study was to examine the effects of altered dietary loading, estrogen level, and aging on the structure of the condylar cartilage and the expressions of matrix metalloproteinase (MMP) -3 and MMP-8 of rat MCC. METHODS: In this study, Crl:CD (SD) female rats were randomly divided into 3 groups according to dietary hardness: hard diet (diet board), normal diet (pellet), and soft diet (powder). In each group, the rats were further divided into 2 subgroups by ovariectomy at the age of 7 weeks. The rats were sacrificed at 5- and 14-month-old. Histomorphometric analysis of the MCC thickness was performed after toluidine blue staining. Immunochemical staining was done for MMP-3 and MMP-8. A linear mixed model was used to assess the effects of dietary loading, estrogen level, and aging. RESULTS: Increased dietary loading was the main factor to increase the MMP-3 expression and the anterior and central thickness of the MCC. Lack of estrogen was the main factor associated with decreased MMP-8. Aging was associated with the thickness changes of the whole condylar cartilage and the reduced expression of MMP-8. CONCLUSION: The condylar cartilage structure and metabolism of the female rats are sensitive to dietary loading changes, estrogen level as well as aging. The proper balance of these factors seems to be essential for the maintenance of the condylar cartilage.

The effect of nanodiamonds on candida albicans adhesion and surface characteristics of PMMA denture base material - an in vitro study

Abstract Candida albicans is the main causative pathogen of denture stomatitis, which affects many complete denture patients. Objective: To evaluate the effect of different concentrations of nanodiamonds (NDs) added to polymethyl methacrylate (PMMA) denture base material on Candida albicans adhesion as well as on surface roughness and contact angle. Methodology: Acrylic resin specimens sized 10×10×3 mm3 were prepared and divided into four groups (n=30) according to ND concentration (0%, 0.5%, 1%, 1.5% by wt). Surface roughness was measured with a profilometer, and the contact angle with a goniometer. The effect of NDs on Candida albicans adhesion was evaluated using two methods: 1) slide count and 2) direct culture test. Analysis of variance (ANOVA) and Tukey's post hoc test were used in the statistical analyses. Results: Addition of NDs decreased the Candida albicans count significantly more than in the control group (p<0.05), with a lowest of 1% NDs. Addition of NDs also significantly decreased the surface roughness (p<0.05), but the contact angle remained the same. Incorporation of NDs into the PMMA denture base material effectively reduced Candida albicans adhesion and decreased surface roughness. Conclusion: PMMA/NDs composites could be valuable in the prevention of denture stomatitis, which is considered one of the most common clinical problems among removable denture wearers.

Association of risk factors with temporomandibular disorders in the Northern Finland Birth Cohort 1966.

OBJECTIVE: To investigate the association between risk factors and pain-related symptoms and clinical signs of temporomandibular disorders (TMD) in Northern Finland Birth Cohort (NFBC) 1966. MATERIAL AND METHODS: A total of 1962 subjects (1050 women, 912 men) attended the follow-up study. The questionnaires included the subjects' background information concerning living conditions and general health, socioeconomic factors, and dental health. The clinical examination was performed using the modified protocol of Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) presented at the International Association for Dental Research (IADR) Conference in 2010. Cross-tabulation, a chi-square test and Fisher's exact test were used to analyze differences between groups. RESULTS: Female gender showed statistically significant association with symptoms and signs of TMD, while marital status, living conditions, and socioeconomic group showed no association. A strong association was found between self-reported health condition as well as general health problems [i.e. depression, migraine, fibromyalgia (FM), gastrointestinal diseases] and TMD pain-related symptoms and pain on palpation in the masticatory muscles and TMJs. CONCLUSION: In conclusion, general health problems and female gender had a strong association with pain-related symptoms and clinical signs of TMD. These findings are important to take into account when diagnosing and treating TMD patients. Conversely to earlier presented results, no statistically significant association was shown here between marital status, living conditions or socioeconomic group and pain-related symptoms and clinical signs of TMD.

Changes in Type I and Type II Collagen Expression in Rat Mandibular Condylar Cartilage Associated with Aging and Dietary Loading.

AIMS: To evaluate the usefulness of diet board feeding as a model for temporomandibular joint (TMJ) research, characterize dietary loading-related morphometric changes in the mandibular condylar cartilage of aging rats, and investigate changes in type I and type II collagen expression in different age, sex, and diet groups. METHODS: Material was collected from a study that examined the effects of 1-year and 2-year diet board feeding on rats. In diet board feeding, rats must gnaw wood to reach their food, leading to a higher masticatory workload. The material analyzed was comprised of 150 TMJ samples from 75 Hsd:Sprague Dawley rats grouped according to feeding method (diet board [experimental group] or ad libitum [control group]), sex, and experiment length (1 or 2 years). The rats were sacrificed at the age of 15 or 26 months (15-M rats or 26-M rats). From the TMJ samples, 5-µm-thick sections were cut parallel to the sagittal plane of the mandibular condyle. Histomorphometric analysis of the thickness of the condylar cartilage and the number of cartilage cells was performed after toluidine blue staining. Immunohistochemical staining included type I and type II collagen antigens. Differences in the thickness of the cellular layer and the number of cells in the condylar cartilage were analyzed by means of a repeated-measures analysis of variance (ANOVA) model, and differences in the type of collagen with a one-way random-effects ANOVA model. RESULTS: Condylar cartilage was significantly thicker in the 15-M diet board-fed rats than in the 15-M control rats and in the 26-M rats than in the 15-M rats. The number of cells was larger in the 26-M female rats than in the 26-M male rats. Type I collagen expression was significantly higher in the 15-M diet board-fed female rats than in the 15-M controls. Type II collagen showed increased expression in older rats compared to younger rats. CONCLUSION: Condylar cartilage is sensitive to the interplay between loading, aging, and sex of middle-aged and older rats. High loading of condylar cartilage increased the thickness of cartilage in younger rats.

Inter-arch digital model vs. manual cast measurements: Accuracy and reliability.

OBJECTIVES: The purpose of this study was to evaluate the accuracy and reliability of inter-arch measurements using digital dental models and conventional dental casts. METHODS: Thirty sets of dental casts with permanent dentition were examined. Manual measurements were done with a digital caliper directly on the dental casts, and digital measurements were made on 3D models by two independent examiners. Intra-class correlation coefficients (ICC), a paired sample t-test or Wilcoxon signed-rank test, and Bland-Altman plots were used to evaluate intra- and inter-examiner error and to determine the accuracy and reliability of the measurements. RESULTS: The ICC values were generally good for manual and excellent for digital measurements. The Bland-Altman plots of all the measurements showed good agreement between the manual and digital methods and excellent inter-examiner agreement using the digital method. CONCLUSION: Inter-arch occlusal measurements on digital models are accurate and reliable and are superior to manual measurements.

Association of indirect restorations with past caries history and present need for restorative treatment in the Northern Finland Birth Cohort 1966.

OBJECTIVES: The objective of this study is to examine the prevalence of indirect restorations and their association with past caries history and present need for restorative treatment among adults in Northern Finland. MATERIALS AND METHODS: The study population was a subsample of the Northern Finland Birth Cohort 1966 (n = 1961). The oral examinations were performed in 2012-2013. Indirect restorations (inlays/onlays and single crowns) were recorded tooth wise. Caries history was described with the sum of decayed, missing, and filled teeth (DMF). Caries was assessed using the International Caries Detection and Assessment System (ICDAS). The score of 4 was used as the cut off point for visible decay. Present need for restorative treatment was calculated by summing the decayed (D) and fractured (Fr) teeth. Need for restorative treatment was dichotomized to low [(D + Fr) ≤ 1] and high [(D + Fr) > 1]. RESULTS: Altogether, 7.8% of the study population had indirect restorations. The prevalence of indirect restorations did not differ within DMF (p = 0.925), but it was higher among the subjects with a low need for restorative treatment (p < 0.001). CONCLUSIONS: Indirect restorations were rare in the adult population and found mainly among the subjects with a low need for restorative treatment. CLINICAL RELEVANCE: The results of the study can encourage dentists to consider more often indirect restorations for subjects with a need for restorative treatment.

Missing Teeth and Prosthetic Treatment in Patients Treated at College of Dentistry, University of Dammam.

The percentage of completely and partially edentulous patients and their prosthetic treatment at the Department of Substitutive Dental Sciences (SDS), College of Dentistry, University of Dammam, were investigated. Panoramic radiographs and medical records of adult patients (n = 479, mean age 45.9 years, and range 25-96 years) treated in 2011-2014 were examined. 6% of the patients were completely edentulous, 8% had single jaw edentulousness, and 74% were partially edentulous. Edentulousness was significantly correlated with age and the number of missing teeth was significantly higher among males (p < 0.026). Diabetes was significantly associated with complete edentulousness, single edentulous jaw (p value 0.015), and partial edentulousness (p value 0.023). Kennedy class III was the most frequent class of partial edentulousness in single and/or both jaws (p = 0.000). Patients having class I and/or class II were treated most often with removable partial dentures (RPD) (p = 0.000), while patients having class III were treated with fixed partial dentures (FPD). It was found that complete edentulousness increases in older age and the number of missing teeth was significantly higher among males. Kennedy class III was most common in both upper and lower jaw and was treated more often with FPD than with RPD.

PMMA denture base material enhancement: a review of fiber, filler, and nanofiller addition.

This paper reviews acrylic denture base resin enhancement during the past few decades. Specific attention is given to the effect of fiber, filler, and nanofiller addition on poly(methyl methacrylate) (PMMA) properties. The review is based on scientific reviews, papers, and abstracts, as well as studies concerning the effect of additives, fibers, fillers, and reinforcement materials on PMMA, published between 1974 and 2016. Many studies have reported improvement of PMMA denture base material with the addition of fillers, fibers, nanofiller, and hybrid reinforcement. However, most of the studies were limited to in vitro investigations without bioactivity and clinical implications. Considering the findings of the review, there is no ideal denture base material, but the properties of PMMA could be improved with some modifications, especially with silanized nanoparticle addition and a hybrid reinforcement system.