David R. Radford

Denture Plaque and Adherence of Candida Albicans To Denture-Base Materials in Vivo and in Vitro

The aim of this paper is to review our understanding of the mechanisms and clinical significance of adhesion of C. albicans to denture-base materials in relation to denture plaque and denture-related stomatitis. Earlier reports in the literature of a 65% prevalence level of denture-related stomatitis seem to be exaggerated. More recent studies indicate that denture-related stomatitis is considerably less common, particularly in normal healthy subjects. The etiology of the condition is discussed in this review, and although much of the literature supports the view that the condition is strongly associated with C. albicans, this is not always so. In some subjects, the cause appears to be related to a non-specific plaque. This review also considers the role of denture plaque in the pathogenesis of denture-related stomatitis, the sequential development of denture plaque, and its colonization by Candida organisms. Designing controlled in vivo studies is difficult, and as a consequence, many investigators have had to resort to in vitro studies. The majority of these studies have attempted to investigate the hydrophobicity of C. albicans, relating the surface free-energy of denture-base materials, particularly acrylic resin, to that of the organism. Surprisingly little work has been directed at surface roughness and how it affects retention of organisms. Further, no attention has been paid to the properties and character of the surface, other than average surface roughness, as it affects adhesion. A comparison of results from in vitro studies on the effect on adhesion of pre-coating the surfaces of denture-base materials with saliva has produced equivocal conclusions. This is largely due to little standardization of experimental protocols between studies, particularly in the collection and handling of the saliva used. In conclusion, the review strongly supports the suggestion that adherence of C. albicans to denture-base materials in vitro is related to the hydrophobicity of the organism. The clinical significance of the observation and the mechanisms for the development and maturation of denture plaque are yet to be understood. There is a clear need for further investigation of other factors that may moderate the adhesion of organisms and subsequent colonization of denture-base materials.

ADHERENCE OF CANDIDA ALBICANS TO DENTURE-BASE MATERIALS WITH DIFFERENT SURFACE FINISHES

OBJECTIVES To assess the in vitro adherence of Candida albicans to heat-cured hard and soft denture-base materials with varying surface roughness, and to observe the effect of a mixed salivary pellicle on candidal adhesion to these surfaces. METHODS In vitro adhesion assays on heat-cured acrylic resin (Trevalon), Molloplast B and Novus using the type strain of C. albicans (NCPF 3153A). Surfaces for the assays were prepared using clinically appropriate rotary instruments. Unstimulated, pooled and clarified whole saliva was used to assess its effect on adhesion. RESULTS Significantly greater adhesion of C. albicans to rough rather than smooth surfaces was found (P < 0.001), as well as increased adhesion to the machined soft lining materials compared with acrylic. Pre-coating denture-base materials with saliva reduced candidal adhesion on all materials. CONCLUSIONS Rough surfaces on denture-base materials promote the adhesion of C. albicans in vitro. However, saliva reduces adhesion of C. albicans and thus diminishes the effect of surface roughness and free surface energy differences between materials.

Emended description of Actinomyces naeslundii and descriptions of Actinomyces oris sp. nov. and Actinomyces johnsonii sp. nov., previously identified as Actinomyces naeslundii genospecies 1, 2 and WVA 963

Actinomyces naeslundii is an important early colonizer in the oral biofilm and consists of three genospecies (1, 2 and WVA 963) which cannot be readily differentiated using conventional phenotypic testing or on the basis of 16S rRNA gene sequencing. We have investigated a representative collection of type and reference strains and clinical and oral isolates (n=115) and determined the partial gene sequences of six housekeeping genes (atpA, rpoB, pgi, metG, gltA and gyrA). These sequences identified the three genospecies and differentiated them from Actinomyces viscosus isolated from rodents. The partial sequences of atpA and metG gave best separation of the three genospecies. A. naeslundii genospecies 1 and 2 formed two distinct clusters, well separated from both genospecies WVA 963 and A. viscosus. Analysis of the same genes in other oral Actinomyces species (Actinomyces gerencseriae, A. israelii, A. meyeri, A. odontolyticus and A. georgiae) indicated that, when sequence data were obtained, these species each exhibited <90 % similarity with the A. naeslundii genospecies. Based on these data, we propose the name Actinomyces oris sp. nov. (type strain ATCC 27044T =CCUG 34288T) for A. naeslundii genospecies 2 and Actinomyces johnsonii sp. nov. (type strain ATCC 49338T =CCUG 34287T) for A. naeslundii genospecies WVA 963. A. naeslundii genospecies 1 should remain as A. naeslundii sensu stricto, with the type strain ATCC 12104T =NCTC 10301T =CCUG 2238T.

A scanning electronmicroscopy investigation of the structure of colonies of different morphologies produced by phenotypic switching of Candida-albicans

Variant colony formation by Candida albicans has been described and the phenomenon of phenotypic switching has been studied extensively. Whereas the microstructure of non-variant colonies has been investigated by scanning electronmicroscopy (SEM), the relationship between switched variant colonies and microstructure has not been described. The object of this study was to investigate and compared by SEM the microstructure of the normal colony type and five common variant colony types of C. albicans and to determine whether a pattern of dimorphic growth could account for the characteristic colony morphologies. A general relationship between colony type and structure was observed; smooth colonies consisted entirely of blastospores whereas regular, irregular-wrinkled and semi-rough colonies consisted of different proportion of true hyphae and blastospores. Regular extreme-jagged shaped colonies consisted of an almost pure culture of pseudohyphae, and colonies producing aerial hyphae were composed of pseudo- and true hyphae, as well as blastospores. These results show a clear relationship between colony morphology and development of particular cell types.

The effects of surface machining on heat cured acrylic resin and two soft denture base materials: a scanning electron microscope and confocal microscope evaluation

STATEMENT OF PROBLEM Rough surfaces promote the adhesion and colonization of denture plaque, therefore it is important to know the character of the surface left by rotary instruments on denture base materials. As a single microscopic technique can introduce artifact, complementary microscope techniques need to be used. PURPOSE This study investigated the surface characteristics of the machined surfaces of heat-cured acrylic resin, Molloplast B and Novus. MATERIAL AND METHODS Scanning electron microscopy and confocal microscopy were used to investigate surfaces that had been prepared with appropriate clinical rotary instruments. Thirty samples of each material were prepared with steel and tungsten carbide burs, Molloplast stones, and Arbor bands. An analysis of variance, with the Scheffe multiple comparison of means test, was used to compare average surface roughness of the individual surfaces. RESULTS The tungsten carbide bur produced a smoother nongrooved surface than the steel bur on acrylic resin. The roughest surfaces were produced on the soft lining materials by the Arbor band and Molloplast stone. CONCLUSIONS The confocal microscope is a valuable complementary instrument to scanning electron microscopy and provides surface roughness data by using a noncontact method. Each type of rotary instrument produces its own characteristic surface on denture base materials.

Shuttleworthia satelles gen. nov., sp. nov., isolated from the human oral cavity

Nine strains of anaerobic, non-spore-forming, gram-positive bacilli, isolated from the human oral cavity and provisionally identified as belonging to the genus Eubacterium, were subjected to a comprehensive range of phenotypic and genetic tests. Biochemically, they were found to comprise a homogeneous group, and phylogenetic analysis of their 16S rRNA sequences indicated that they constitute a unique branch within the Clostridium-Bacillus subphylum of the phylum Firmicutes. All of the isolates displayed an unusual colonial morphology after extended incubation. This resembled a contaminated culture in that small, secondary colonies were seen to arise around and from within the primary colony form, and a third, independent, colony type was also seen. However, inspection of the colonies by Gram-staining and scanning electron microscopy together with protein profile analysis and 16S rRNA gene sequence comparison of the two independent colony types revealed that only a single organism was present. A new genus, Shuttleworthia, and the species Shuttleworthia satelles gen. nov., sp. nov., are proposed. The cells are saccharolytic, and acetate, butyrate and lactate are produced as end products of glucose fermentation. Aesculin is hydrolysed and indole is produced. The G+C content of the DNA of the type strain is 51 mol%. The type strain is strain DSM 14600T (= CCUG 45864T = VPI D143K-13T).

The future of teaching of complete denture construction to undergraduates in the UK: is a replacement denture technique the answer?

Due to changes in the amount of curriculum time available for teaching complete denture construction to undergraduate students, course content requires reconsideration and possible modification. The idea that a replica complete denture technique may offer some advantages is explored. A review of the relevant literature fails to support many of the claimed benefits of this technique such as relative ease of adaptation by the elderly to new dentures. This article suggests that the replica denture technique should be considered as no more than an alternative method of making dentures. The relative demerits of the technique are discussed. A modification of the replica block technique to include important aspects of conventional complete denture courses is described. It is suggested that, because less clinical time is required, it may be a suitable way of introducing students to complete denture construction and educating them to a level which would encourage some to take further postgraduate study and would allow all graduates to treat routine cases or diagnose, treatment plan and refer to clinical dental technicians.

Long-term dimensional stability and reproduction of surface detail of four polyvinyl siloxane duplicating materials

OBJECTIVES Duplicating materials must routinely accurately reproduce the details of dental casts and thus contribute significantly to the close adaptation and success of a removable prosthesis or fixed indirect restoration. It is important to establish the long-term dimensional stability of polyvinyl siloxane materials (PVS) as they are widely used in dental technology and over the duration of a course of treatment, are stored under dental laboratory conditions. The dimensional stability of four PVS duplicating materials was investigated over a 13-week period. MATERIALS AND METHODS Forty PVS duplicate moulds of a partially dentate maxillary arch were produced from four materials (Elite double 8, Gemini transparent, C & J pourable silicone and Z Dupe). Three dimensions were measured in triplicate at baseline 1, 5, 9 and 13 weeks using computerised image analysis. Half of the specimens were measured following storage at room temperature (21+/-2 degrees C) and half at 37 degrees C to represent storage in hot climates. Specimens for scanning electron microscopy were prepared by duplicating a rugosity standard. RESULTS At room temperature two materials Elite Double 8 and Z Dupe showed no statistically significant dimensional change, the other two materials showed a slight increase of dimensions. Specimens stored at 37 degrees C showed greater differences in dimensions with Z Dupe showing statistically significant shrinkage. SEM investigation showed no surface deterioration of two materials. CONCLUSIONS None of the materials showed a change in dimension greater than 2% and the four PVS materials showed good dimensional stability over the time period of the study.

The influence of handling technique on the strength of phosphate-bonded investments

OBJECTIVES This study examined the influence of six handling techniques on the strength of four phosphate-bonded investment (PBI) materials. The size and distribution of pores produced by the handling techniques were investigated and their effect on room temperature strength determined. METHODS Specimens were tested for strength using four point bend at a cross-head speed of 1 mm min-1. The fracture surface of randomly selected specimens was viewed through a light microscope to determine the pore size. A three-parameter Weibull distribution was used to describe strength giving values of Weibull modulus and characteristic strength. RESULTS The handling technique that produced the smallest pore size resulted in the highest strength. Significant differences in strength (90% confidence level) were found between most handling techniques. The reduction of pore size by mechanical spatulation and setting under pressure was found to be the most effective method of increasing the strength of PBI. SIGNIFICANCE Previous studies have related handling technique to the inclusion of air bubbles in dental investments but have not reported any consequent effect on strength. PBI materials are used in production of a range of dental appliances with a variety of different material forming processes and are required to withstand the loads applied without fracture or distortion to ensure accuracy of fit of these prostheses. The use of a handling technique that reduces pore size can significantly increase the strength of PBIs, thereby decreasing the possibility of die fracture or degradation.

Investigation of retentive force reduction and wear of the locator attachment system with different implant angulations.

PURPOSE To evaluate the effect of cyclic disengagement on the retentive force and wear patterns of pairs of three Locator inserts (blue, pink, and clear) in vitro. MATERIALS AND METHODS Implant analogs (Astra Tech) were positioned into aluminum blocks parallel to each other and perpendicular to the horizontal plane, with one analog angulated mesially by 10 degrees (0/10), or with two implant analogs each angulated mesially by 5 degrees (5/5). Ninety Locator attachments, in 15 pairs of each standard retention strength (blue, pink, and clear), underwent 2,500 cycles of testing, lubricated with artificial saliva. Data were analyzed after 6, 12, and 18 months of simulated clinical use (720, 1,440, or 2,160 cycles). The wear patterns of the Locator inserts were examined before and after the cyclic dislodgments using scanning electron microscopy. RESULTS There were significant differences in retentive force between clear, blue, and pink inserts at baseline, with the clear insert being the most retentive in the 0/10 model. The lowest percentage reduction in retentive force from baseline to 2,160 cycles was the pink insert in the 0/10 model, and the highest was the blue insert in the 5/5 angled model. CONCLUSION A rapid decrease in retentive force was observed in all three models after 720 cycles for all three inserts. The most retentive combination was the clear insert in the 0/10 model, and the least retentive was the blue insert in the 0/10 model. After 2,160 cycles, there was a significant reduction in retentive force of 59% to 70%. However, the values of retention were still higher than those claimed by the manufacturer.