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.

Relationships between bone mass and micro-architecture at the mandible and iliac bone in edentulous subjects: a dual X-ray absorptiometry, computerised tomography and microcomputed tomography study.

OBJECTIVES: To compare bone volume, bone mineral density, cortical thickness and bone micro-architecture in a series of paired mandibular and iliac bone samples analysed by various imagery techniques to see whether relationships exist between the various techniques and between mandibular and iliac bone. MATERIALS AND METHODS: Bone samples from the mandible and ilium were harvested in 20 cadavers and analysed by dual energy X-ray absorptiometry (DXA), computerised tomography (CT) on a conventional hospital machine and microCT. RESULTS: Significant correlations were found between Hounsfield density obtained by CT, and bone mass determined by microCT but not with DXA values. Cortical thickness measurements were well correlated between CT and microCT. No relationships were found between mandibular and iliac bone, when considering mineral density, cortical thickness, bone volume or micro-architecture. CONCLUSION: In clinical practice, CT remains the most appropriate routine means for bone qualitative and quantitative evaluation at the mandible. In this ex vivo study, these results confirm that mandibular bone status does not reflect the axial skeletal one and assist in the placement of implants with dental prostheses in old or osteoporotic patients.

Histomorphometric analysis of the osseointegration of four different implant surfaces in the femoral epiphyses of rabbits.

OBJECTIVES: The surface properties of titanium dental implants are key parameters for rapid and intimate bone-implant contact. The osseointegration of four implant surfaces was studied in the femoral epiphyses of rabbits. MATERIAL AND METHODS: Titanium implants were either grit-blasted with alumina or biphasic calcium phosphate (BCP) ceramic particles, coated with a thin octacalcium phosphate (OCP) layer, or prepared by large-grit sand blasting and acid-etched (SLA). After 2 and 8 weeks of implantation, the bone-implant contact and bone growth inside the chambers were compared. Scanning electron microscopy (SEM) and profilometry showed distinct microtopographies. RESULTS: The alumina-Ti, BCP-Ti and OCP-Ti groups had similar average surface roughness in the 1-2 mum range whereas the SLA surface was significantly higher with a roughness averaging 4.5 microm. Concerning the osseointegration, the study demonstrated a significantly greater bone-to-implant contact for both the SLA and OCP-Ti surfaces as compared with the grit-blasted surfaces, alumina- and BCP-Ti at both 2 and 8 weeks of healing. CONCLUSION: In this animal model, a biomimetic calcium phosphate coating gave similar osseointegration to the SLA surface. This biomimetic coating method may enhance the apposition of bone onto titanium dental implants.

Osteoblastic cell behavior on nanostructured metal implants.

AIMS: Surface modifications at the nanometric scale may promote protein adsorption, cell adhesion and thus favor the osseointegration of metal implants. The behavior of osteoblastic cells was studied on mirror-polished (Smooth-SS) and nanostructured (Nano-SS) stainless steel surfaces. MATERIALS & METHODS: The nanostructuration was obtained by anodization. The surfaces were characterized by scanning electron, atomic force microscopy (AFM) and X-ray photoelectron specytoscopy. Osteoblastic cells were cultured on these surfaces. RESULTS & DISCUSSION: AFM showed a regular array of pores on the Nano-SS. Osteoblastic cells spread more rapidly on Nano-SS surfaces than on Smooth-SS surfaces. Cell viability was similar on Smooth-SS and Nano-SS. Alkaline phosphatase activity increased with culture time whatever the substrate but was better enhanced at 21 days on the Nano-SS than on the Smooth-SS. CONCLUSION: This study shows that the nanostructuration of metal implants may improve the adhesion and differentiation of osteoblastic cells.

Osteoblastic cell behaviour on different titanium implant surfaces.

The osseointegration of oral implants is related to the early interactions between osteoblastic cells and titanium surfaces. The behaviour of osteoblastic MC3T3-E1 cells was compared on four different titanium surfaces: mirror-polished (Smooth-Ti), alumina grit-blasted (Alumina-Ti) or biphasic calcium phosphate ceramic grit-blasted (BCP-Ti) and a commercially available implant surface (SLA). Scanning electron microscopy and profilometry showed distinct microtopographies. The BCP-Ti group had higher average surface roughness (Ra=2.5 microm) than the other grit-blasted groups. Hydrophilicity and surfaces energies were determined on the different substrates by dynamic contact angle measurements. The most hydrophilic surface was the Alumina-Ti discs, while SLA was the most hydrophobic. The titanium surfaces were all oxidized as TiO2 and polluted by carbon contaminants, as determined by X-ray photoelectron spectroscopy. Alumina-Ti samples also exhibited aluminium peaks as a result of the blasting. The BCP-Ti discs contained traces of calcium and phosphorus. MC3T3-E1 cells attached, spread and proliferated on the substrates. For both the SLA and BCP-Ti groups, the entire surface was covered with a layer of osteoblastic cells after 2 days. At high magnification, the cells exhibited cytoplasmic extensions and filopodia. Compared with plastic, cell viability was similar with the Smooth-Ti, slightly lower with the Alumina-Ti and superior with the SLA and BCP-Ti groups. Alkaline phosphatase activity increased with the culture time whatever the substrate. This study shows that BCP-blasting produces rough titanium implants without surface contaminants.

The safety and efficacy of an injectable bone substitute in dental sockets demonstrated in a human clinical trial.

This study is the first report of a clinical evaluation of an injectable bone substitute (IBS). This IBS was prepared by suspending biphasic calcium phosphate (BCP) particles with diameters ranging between 80 and 200 microm in a water-soluble cellulose polymer carrier phase. It was used for filling bone defects after tooth extractions in 11 patients. The first objective of the study was to investigate the safety of the filler material. The second objective was to investigate the efficacy of the material for filling human tooth sockets and preventing alveolar bone loss. Radiographic density measurements of the surgical sites gradually increased to those of the surrounding host bone. Three years after surgery, small biopsies of the implanted areas were harvested and analyzed by using micro-computed tomography, non-decalcified histology and histomorphometry. The BCP granules appeared in direct contact with mineralized bone tissue, thereby supporting bone growth. A gradual substitution of the filler by bone tissue was observed thus preserving the height of the alveolar bone crest.

[Non-invasive evaluation of an injectable bone substitute]. / Méthods non invasive d'évaluation d'un substitut osseux injectable.

Despite the increasing number of techniques for the preservation of bone ridges after dental avulsion, no precise evaluation of alveolar filling has been performed to date. The criteria of available measurement techniques (probes, retroalveolar or panoramic radiography, and lateral teleradiography) are not sufficiently reliable and precise. This study investigated the reliability of evaluation based on CT images in comparison with retroalveolar radiography (the most precise radiographic technique, providing standardised images), direct measurements, and images obtained in scanning electron microscopy. After a preliminary investigation ex vivo, a study was performed in vivo on three beagles. Mandibular premolars were extracted, and the corresponding alveoli were filled with an injectable bone substitute composed of a calcium phosphate mineral load associated with hydroxypropyl methylcellulose. Measurements performed on CT images relative to visual and automatic detection of density changes and studies of density curves provided better precision than those obtained by retroalveolar radiography.