Treatment of Denture Stomatitis Using Modified Tissue Conditioners: A Systematic Review.

The most common sequela of wearing removable dentures is denture stomatitis. This review article uses a Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) format to collect data regarding articles that report on the treatment of denture stomatitis using tissue conditioners modified with antifungal drugs, inorganic compound, and phytomedicines. Their advantages, disadvantages, and mechanism of action are discussed.

Comparison of Mechanical Properties of Three Tissue Conditioners: An Evaluation In Vitro Study.

Introduction: Tissue conditioners have been widely used in various clinical applications in dentistry, such as treating inflamed alveolar ridges, temporarily relining partial and complete dentures, and the acquisition of functional impressions for denture fabrication. This study aimed to investigate the mechanical properties of the most prevalent tissue conditioner materials on the market, including Tissue Conditioners (TC), Visco Gel (VG), and FITT (F). Materials and Methods: The three tissue conditioners, TC, VG, and F, were assessed based on the parameters mentioned above. The following tests were performed based on the ISO 10139-1 and ISO 10139-2 requirements: Shore A hardness, denture plate adhesion, sorption, water solubility, and contraction after 1 and 3 days in water. Additional tests are described in the literature, such as ethanol content and gelling time. The tests were carried out by storing the materials in water at 37 °C for 7 days. Results: The gel times of all tested materials exceeded 5 min (TC = 300 [s], VG = 350 [s]). In vitro, phthalate-free materials exhibited higher dissolution in water after 14 days (VG = -260.78 ± 11.31 µg/mm2) compared to F (-76.12 ± 7.11 µg/mm2) and experienced faster hardening when stored in distilled water (F = 33.4 ± 0.30 Sh. A, VG = 59.2 ± 0.60 Sh. A). They also showed greater contractions. The connection of all materials to the prosthesis plate was consistent at 0.11 MPa. The highest counterbalance after 3 days was observed in TC = 3.53 ± 1.12%. Conclusions: Materials containing plasticizers that are not phthalates have worse mechanical properties than products containing these substances. Since phthalates are not allowed to be used indefinitely in medical devices, additional research is necessary, especially in vivo, to develop safe materials with superior functional properties to newer-generation alternatives. In vitro results often do not agree fully with those of in vivo outcomes.

Antibacterial and antifungal impacts of combined silver, zinc oxide, and chitosan nanoparticles within tissue conditioners of complete dentures in vitro.

BACKGROUND: Tissue conditioners are suitable places for colonization of microorganisms. A combination of tissue conditioners with antibacterial and antifungal materials inhibits the growth of microorganisms. AIMS: Here, we aimed to investigate the antibacterial and antifungal effects of silver (Ag), zinc oxide (ZnO), and chitosan nanoparticles on tissue conditioners in complete dentures. METHODS: The growth of four microorganisms in six different concentrations of Ag, ZnO, and chitosan nanoparticles was investigated after 24 and 48 h. Nanoparticles were synthesized using optical sequestration and approved by scanning electron microscope, x-ray diffraction, and infrared (FT-IR) methods. Nanoparticles were combined at 0.5, 0.25, and 0.25 ratios (chitosan, Ag, and ZnO, respectively) with 0.625, 1.25, 2.5, 5, 10, and 20 mass percentages. Tissue conditioners with nanoparticles were entered to test tubes containing microorganisms, and the growth rate was measured using the turbidity method by spectrophotometer after 24 and 48 h of incubation at 37 °C. RESULTS: Growth inhibition of Candida albicans occurred at 2.5% concentration. However, the growth inhibition of Streptococcus mutans, Enterococcus faecalis, and Pseudomonas aeruginosa occurred at 5% after both 24 and 48 h. Also, the optimum nanoparticle concentration for Candida albicans was found to be 1.25% for both timings. On the other hand, the optimum nanoparticle concentration for Streptococcus mutans, Enterococcus faecalis, and Pseudomonas aeruginosa was 2.5% for both time scales. CONCLUSIONS: The combination of Ag, ZnO, and chitosan nanoparticles inhibited the growth of fungi and bacteria in tissue conditioners. These nanoparticles inhibited the growth of fungi more effectively than bacteria.

An In Vivo Study to Compare Location of Neutral Zone Recorded with Two Materials.

AIM: To establish a relationship between the crest of the alveolar ridge and neutral zone and to compare its location recorded by two different material. METHODS AND MATERIALS: Thirty subjects were selected, and the location of the neutral zone was compared with the mandibular alveolar ridge crest. For each subject neutral zone was recorded by two different recording materials-Low fusing impression compound and tissue conditioner. After neutral zone recording, the relation between mandibular ridge crest and neutral zone location examined radiographically. The data so collected were checked for normality, descriptive statistics and the Mann-Whitney U test was used. RESULTS: Position of neutral zone was found towards lingual in the posterior, labial side in anterior and almost near to the alveolar ridge crest in premolar region. The thermoplastic flow of the material effects the position of neutral zone but no significant difference was noted in the positions of neutral zone recorded by the two materials in relation to the alveolar ridge crest. CONCLUSION: Location of the neutral zone is not affected by the material used in recording it. CLINICAL SIGNIFICANCE: The location of the neutral zone varies from subject to subject and mainly depends upon their musculature and can be recorded accurately by using correct technique irrespective of the materials used.

In-vitro antifungal efficacy of tissue conditioner-chitosan composites as potential treatment therapy for denture stomatitis.

Tissue conditioners are commonly used to improve the adaptation of ill-fitting dentures. These materials are easily colonized by Candida albicans (C. albicans), resulting in "denture stomatitis". Chitosan and its derivative possess inherent antifungal activity. This study aims to formulate a chitosan-based tissue conditioner and assess its anti-fungal efficacy against C. albicans over time. A chitosan oligosaccharide (COS) was synthesized from commercially purchased chitosan and was characterized by Fourier Transform Infrared spectroscopy (FTIR) and X-ray diffraction analysis (XRD). The minimum inhibitory concentration (MIC) of COS and commercial chitosan against C. abicans was evaluated using broth micro-dilution assay (n = 3). Next, it was incorporated into tissue conditioners and two experimental groups i.e. tissue conditioner modified by chitosan (TC-CH) and tissue conditioner modified by COS (TC-COS) were prepared. The in-vitro antifungal activity of experimental group was compared with a control group (chitosan-free tissue conditioner) by counting numbers of colony forming units (CFUs) (n = 3). The antifungal potential of experimental formulations over time in a simulated oral environment was also evaluated using a spectrophotometry (n = 3). A potent in-vitro antifungal activity against C. albicans was observed. The minimum inhibitory concentration (MIC) of pure commercial chitosan and COS was 0.625 mg/ml and 0.3125 mg/ml respectively. Compared to the control group, experimental groups showed a reduction in number of CFUs of C. albicans density. Once immersed in saliva, the TC-CH retained its inhibitory effect for 24 h, while TC-COS exhibited improved inhibition until the third day, beyond which a gradual reduction in the inhibitory effect was observed. Experimental formulations showed a reduction in C. albicans density compared to the control group. Thus, a novel combination of chitosan and tissue conditioners is a promising alternative for prevention and treatment of denture stomatitis.

Antifungal Efficacy and the Mechanical Properties of Soft Liners against Candida albicans after the Incorporation of Garlic and Neem: An In vitro Study.

OBJECTIVES: To evaluate the in vitro growth inhibition of Candida albicans, in the soft-liner material and Shore A hardness from resin-based denture soft lining materials modified by neem or garlic incorporation. MATERIALS AND METHODS: Resin discs were prepared with poly methyl methacrylate (PMMA) and soft liners incorporated with varying concentrations of neem or garlic. For antifungal activity, resin discs were placed on agar plates inoculated with C. albicans and were evaluated after 2, 4, and 7 days using the streaking method. The hardness of the PMMA was evaluated with the use of Shore A at 2, 4, and 7 days. Data were statistically processed by SPSS software (IBM Company, Chicago, USA) using Kruskal-Wallis test, and post hoc comparisons were done using Dunn's test. P <0.05 was considered statistically significant. RESULTS: Neem and garlic added to PMMA soft liner had an inhibitory effect on C. albicans. Both the neem and garlic when added showed positive results against C. albicans when compared to the control group. The soft liner hardness increased statistically by time but not for the different plant extract concentrations. CONCLUSIONS: Within the limitations of this in vitro study, it was found that neem and garlic can be used as an additive to tissue conditioner to reduce the adherence of C. albicans without significantly affecting the hardness of the heat-polymerized acrylic resin.

Role of antifungal medicaments added to tissue conditioners: A systematic review.

PURPOSE: The aim of this review is to investigate the current state of knowledge on the incorporation of antifungal agents into the tissue conditioners for the treatment of denture induced stomatitis. STUDY SELECTION: Studies reporting the incorporation of antifungal/antimicrobial agents in to tissue conditioners were included in the review. In order to search the studies on the topic "incorporation of antifungal agents in tissue conditioners for the treatment of denture induced stomatitis" ISI web of science, PubMed/MEDLINE, and Google-Scholar databases were searched from 1970 up to and including July 2015 using various keywords such as antifungal agents, tissue conditioners, Candida albicans, denture stomatitis, etc. RESULTS: Various studies reported the efficacy and effectiveness of adding conventional organic antifungal medicines (nystatin, azole group derivatives and chlorhexidine, antimicrobials/antifungals other than organic (silver zeolite, silver nano-particles, photo-catalysts and metallic oxides) and natural and herbal antimicrobials (tea tree oil, lemongrass essential oil and origanum oil) into various tissue conditioners. The review literature reported that incorporation of antifungal agents into tissue conditioners is effective with minimal or no effects on physical and mechanical properties of tissue conditioners. CONCLUSIONS: Incorporation of different antifungal medicaments to commercially available tissue conditioners can be recommended for the management of denture induced stomatitis.

An in-needle extraction technique in determination of organic compounds released from dental tissue conditioners incubated in artificial saliva.

The use of an in-needle technique for direct isolation of analytes from real liquid samples is a new proposal. The in-needle technique has been relatively seldom used for direct sampling of liquid matrix through the needle. In this work the in-needle technique has been applied for the determination of compounds evolved to artificial saliva from dental prosthetic materials. It has been shown that results from the experiment with in-needle device were at least comparable with those obtained with using well known solid phase extraction (SPE). It is worth to mention that in-needle extraction offers some advantages: lower consumption of solvent, shorter step-preparation time and reduced costs. The compounds released from prosthetic materials may affect the stability of tissue conditioners and limit their long-term use in the oral cavity. Examined soft dental materials have been found to be stable as minor amount of various species have been emitted from them. Results of the stability tests of soft dental materials with the use of in-needle device on sample preparation step enable their quick evaluation and estimations of their quality.

Effect of Sealant Application and Thermal Cycling on Bond Strength of Tissue Conditioners to Acrylic Resin

The aim of this study was to evaluate the effect of sealer application and thermal cycling on the bond strength between tissue conditioners and acrylic resin, and to observe the type of bond failure. Two hundred eighty-eight specimens (10x16x3 mm) were made of an acrylic resin (Lucitone 500, Dentsply) using a metal muffle. Specimens were divided into four groups according to the tissue conditioner (Coe-Comfort, GC or Dentusoft, Densell) used and whether or not a sealer (Eversoft Soft Liner Sealer, Myerson) was applied. Each of the four groups was subdivided into other six subgroups (n=12) to undergo thermocycling for 45, 90, 135, 180 or 210 cycles with a dwell time of 60 s, or to be left non thermocycled (control). Tensile bond strength was measured in a universal testing machine at a crosshead speed of 5 mm/min. Sealant application had no effect on the tensile bond strength of the relined acrylic resin, regardless of the tissue conditioner used (Coe-Comfort: p=0.306 and Dentusoft: p=0.1501). The number of thermal cycles had a significant effect on the tensile bond strength of the relined acrylic resin (Coe-Comfort: p=0.002 and Dentusoft: p<0.001). Both tissue conditioners presented similar bond strength to acrylic resin. For both tissue conditioners, sealer coatings had no influence on bond strength, while different numbers of thermal cycles affected that mechanical property.

Os objetivos deste estudo foram avaliar o efeito da aplicação de selante e a ciclagem térmica na resistência de união entre condicionadores de tecido e resina acrílica e observar o padrão de fratura. Duzentos e oitenta e oito espécimes (10×16×3 mm) de resina acrílica (Lucitone 500, Dentsply) foram confeccionados utilizando-se uma mufla metálica. Os espécimens foram divididos em quatro grupos de acordo com o condicionador de tecido (Coe-Comfort, GC ou Dentusoft, Densell) e com o uso ou não de selante (Eversoft Soft Liner Sealer, Myerson). Cada um dos quatro grupos foi subdividido em seis grupos para a realização de 45, 90, 135, 180 ou 210 ciclos térmicos, ou ausência de termociclagem (controle). Resistência de união por tração foi mensurada em uma máquina universal de ensaios com velocidade de 5 mm/min. A aplicação de selante não afetou a resistência de união por tração da resina acrílica reembasada, independentemente do condicionador de tecido utilizado (Coe-Comfort: p=0,306 e Dentusoft: p=0,1501). O número de ciclos térmicos apresentou efeito significativo na resistência de união por tração da resina acrílica reembasada (Coe-Comfort: p=0,002 e Dentusoft: p<0,001). Ambos os condicionadores de tecidos apresentaram resistência de união semelhante à resina acrílica. Para ambos os condicionadores de tecidos, a aplicação de selante não apresentou influência na resistência de união, enquanto que diferentes números de ciclos térmicos afetaram essa propriedade mecânica.

Resilient liners: a review.

Resilient liners when used intelligently are an excellent adjunct in removable prosthodontics. However, currently they have to be best considered as temporary expedients because none of the advocated permanent liners have life expectancy comparable to resin denture base. This article reviews the literature regarding their composition, functions, gelation characteristics, bond strength and influence on denture bases. It also presents their drawbacks and attempts made to extend their longevity. A Medline search was completed for the period from 1986 to 2007, along with a manual search, to identify pertinent English peer-reviewed articles and textbooks.

Efeito da desmineralização óssea superficial na migração, adesão e diferenciação de pré-osteoblastos / The effect of surface bone demineralization on the migration, adhesion and differentiation of pre-osteoblasts

Resultados de pesquisas prévias tem encontrado potencial aumentado para a consolidação de enxertos ósseos mediante desmineralização do material enxertado e/ou das superfícies de consolidação. Entretanto há carência de embasamento apoiado em evidências biológicas do benefício de tal procedimento. Para testar esta hipótese, o tecido ósseo da calvária de cobaias (Cavia porcellus) foi exposto ao condicionamento por ácido cítrico durante 15, 30, 90 e 180 segundos (grupos teste). Quarenta e cinco discos ósseos de três milímetros de diâmetro foram removidos dos animais, dos quais 36 foram condicionados com ácido cítrico pH 1 a 50% e nove não receberam condicionamento (grupo controle). Sobre nove discos de cada grupo foram cultivados pré-osteoblastos MC3T3-E1 durante 24, 48 e 72 horas (três discos de cada grupo em cada tempo). Análises da morfologia celular, do número de células aderidas sobre as superfícies e da área de cobertura destas superfícies por préosteoblastos foram realizadas à microscopia eletrônica de varredura. Observou-se aumento do número de células aderidas às superfícies com o tempo, independentemente de haver condicionamento ou de seu tempo de aplicação. Entretanto, essa diferença só foi estatisticamente significante intragrupos (p<0,05) e quando comparados os períodos de 24 e 72 horas de incubação. A área de cobertura das superfícies por células aumentou significantemente com o tempo somente nos grupos teste, também entre os períodos de incubação de 24 e 72 horas (p<0,01). O grupo controle apresentou-se com 50% ou menos de área de cobertura superficial em relação aos demais. A duração de aplicação do ácido não interferiu significantemente nesse parâmetro de avaliação, mas nos grupos 15 e 30, a área de recobrimento ósseo mais do que triplicou às 72 horas em relação às 24 horas (p<0,01), com cerca de 70% das superfícies cobertas por células, contra 30% no grupo controle. Conclui-se que a desmineralização óssea...

Results of previous research has found increased potential for the consolidation of bone grafts by demineralization of the graft material and / or areas of consolidation. However there is a lack of foundation supported by biological evidence of benefits from such procedures. To test this hypothesis, the bone tissue of the calvaria of guinea pigs (Cavia porcellus) were exposed to conditioning by citric acid for 15, 30, 90 and 180 seconds (test group). Forty-five bone disks measuring three millimeters in diameter were removed from the animals, of which 36 were conditioned with citric acid pH 1 to 50% and nine did not receive conditioning (control group). About nine disks in each group were pre-cultured with MC3T3- E1 osteoblasts for 24, 48 and 72 hours (three discs of each group at each time point). Analysis of cell morphology, number of cells attached on the surface and the coverage area of these surfaces by pre-osteoblasts were performed on scanning electron microscopy. There was na increase in the number of cells attached to surfaces over time, regardless of conditioning or application time. However, this difference was not statistically significant intra-group (p <0.05) when comparing the periods of 24 and 72 hours of incubation. The coverage area of the surfaces of cells increased significantly with time only in the test groups, also among the incubation periods of 24 and 72 hours (p <0.01). The control group presented with 50% or less of surface area coverage compared to the other. The duration of application of the acid did not affect significantly this parameter of evaluation, but in groups 15 and 30, the bonearea covered more than tripled from 24 to 72 hours (p <0.01), with about 70 % of the area covered by cells, versus 30% in the control group. It was concluded that bone demineralization in the studied conditioning times provides a substrate on which cells acquire pre-osteoblastic morphology compatible with...

Avaliação in vitro de três condicionadores de tecido, submetidos a testes de penetração / In vitro evaluation of three temporary tissue conditioners, submitted to penetration tests

Introdução e Objetivo: O objetivo do estudo foi avaliar a existência de alterações na resiliência de quatro diferentes condicionadores de tecido: Coe Comfort (CC), Ufi-Gel (UG), Sofreliner S (SS) e Sofreliner MS (SMS), associados aos seus respectivos selantes de superfície em diferentes intervalos de tempo. Material e Método: Foram confeccionadas 160 cápsulas de resina acrílica que, após seu acabamento, foram preenchidas com os condicionadores de tecidos. Para o Grupo CC, não houve tratamento da superfície interna das cápsulas, sendo o material preparado conforme as indicações do fabricante e acomodado nas cápsulas e para os condicionadores de tecido UG, SS e SMS realizou-se o tratamento interno das cápsulas. Após a obtenção dos corpos de prova, estes foram submetidos a testes de penetração, os testes foram realizados nos intervalos de 1h, 24hs, 30, 60 dias. Resultados: Avaliou-se o efeito do fator tempo na resiliência destes materiais e foi observado que o CC foi o condicionador que mais perdeu essa característica com o passar do tempo, comprovando que seu uso está limitado apenas por curto período. Já os condicionadores UG, SS e SMS, apesar de terem uma pequena deficiência na resiliência na primeira hora, demonstraram-se mais estáveis após todos os testes ao final de 60 dias. Conclusão: Condicionadores de tecidos a base de silicona permanecem com as características iniciais por até 60 dias, enquanto condicionadores de tecido a base de resina acrílica perdem progressivamente sua viscoelasticidade.

Introduction and Objective: The aim of this study was to evaluate resilience changes of four tissue conditioners: Coe Comfort (CC), Ufi-Gel (UG), Sofreliner S (SS) and Sofreliner MS (SMS), associated to their respective surface sealers at different times. Material and Method: 160 capsules of acrylic resin were made and then finished prior to the filling with the tissue conditioners. For the CC group the capsules were not treated and were filled with the material. For the conditioners UG, SS and SMS, the capsules were internally treated prior to the material insertion. All the materials were used following the manufacturer?s instructions. The test were carried out after 1h, 24h, 30 days and 60 days. Results: The effect of time at the materials resilience was evaluated and observed that CC loses more resilience than UG, SS and SMS what proofs his use in a short period. UG, SS and SMS despite bad results in a first moment, shows better results after 60 days. Conclusion: Were concluded that silicon based materials are more stable than acrylic resin based materials.