| Title |
Denture Fabrication Method Alters Candida albicans Adherence |
| Clinical Question |
For patients who wear complete dentures, does denture fabrication method (conventional compression molding, injection molding, CAD/CAM milling, CAD/CAM printing) affect adherence of Candida albicans? |
| Clinical Bottom Line |
Denture fabrication methods do affect adherence of Candida albicans. In vitro studies demonstrate that injection molded and milled CAD/CAM materials exhibit decreased adherence compared to compression molded materials. While adherence is a multifactorial process, material choice does impact Candida adherence due to physical characteristics such as surface roughness, porosity and hydrophobicity. A lack of evidence exists regarding printed CAD/CAM materials. |
| Best Evidence |
|
| PubMed ID |
Author / Year |
Patient Group |
Study type
(level of evidence) |
| 29962017 | Murat/2019 | 40 samples/material | Laboratory study | | Key results | Three milled PMMA CAD/CAM samples (18.30, 22.44, 60.28 mean cell/ field) exhibited a statistically significant decrease in adherence of Candida albicans as compared to heat polymerized PMMA samples (279.06 mean cell/field), p<0.05. | | 28280761 | Aslanimehr/ 2017 | 20 samples/ material | Laboratory study | | Key results | Injection molded Polymethyl methacrylate (PMMA) samples (6x10^3 mean cfu/mL) exhibited a statistically significant decrease in adherence of Candida albicans as compared to compression molded PMMA samples (8.3x10^3 mean cfu/mL), p<0.001. | | 29142649 | Al-Fouzan/2017 | 10 samples/material | Laboratory study | | Key results | In three out of four candida species, milled PMMA CAD/CAM samples (1.1x10^3, 2.1x10^3, 1.2x10^3 mean cfu/mL) exhibited a statistically significant decrease in adherence of Candida albicans as compared to compression molded PMMA samples (2.3x10^3, 5.4x10^3, 2.0x10^3 mean cfu/mL), p<0.05. | |
| Evidence Search |
"candida"[MeSH Terms] OR "candida"[All Fields] OR "candidas"[All Fields] OR "candidae"[All Fields]) AND ("dentural"[All Fields] OR "denture s"[All Fields] OR "dentures"[MeSH Terms] OR "dentures"[All Fields] OR "denture"[All Fields]) AND ("adherance"[All Fields] OR "adhere"[All Fields] OR "adhered"[All Fields] OR "adherence"[All Fields] OR "adherences"[All Fields] OR "adherent"[All Fields] OR "adherents"[All Fields] OR "adherer"[All Fields] OR "adherers"[All Fields] OR "adheres"[All Fields] OR "adhering"[All Fields]) AND ("inject"[All Fields] OR "injectability"[All Fields] OR "injectant"[All Fields] OR "injectants"[All Fields] OR "injectate"[All Fields] OR "injectates"[All Fields] OR "injected"[All Fields] OR "injectible"[All Fields] OR "injectibles"[All Fields] OR "injecting"[All Fields] OR "injections"[MeSH Terms] OR "injections"[All Fields] OR "injectable"[All Fields] OR "injectables"[All Fields] OR "injection"[All Fields] OR "injects"[All Fields]) AND ("fungi"[MeSH Terms] OR "fungi"[All Fields] OR "mold"[All Fields] OR "molds"[All Fields] OR "mould"[All Fields] OR "molded"[All Fields] OR "molding"[All Fields] OR "moldings"[All Fields] OR "moulded"[All Fields] OR "moulding"[All Fields] OR "mouldings"[All Fields] OR "moulds"[All Fields]
"candida"[MeSH Terms] OR "candida"[All Fields] OR "candidas"[All Fields] OR "candidae"[All Fields]) AND ("adherance"[All Fields] OR "adhere"[All Fields] OR "adhered"[All Fields] OR "adherence"[All Fields] OR "adherences"[All Fields] OR "adherent"[All Fields] OR "adherents"[All Fields] OR "adherer"[All Fields] OR "adherers"[All Fields] OR "adheres"[All Fields] OR "adhering"[All Fields]) AND ("computer aided design"[MeSH Terms] OR ("computer aided"[All Fields] AND "design"[All Fields]) OR "computer aided design"[All Fields] OR ("cad"[All Fields] AND "cam"[All Fields]) OR "cad cam"[All Fields]
|
Comments on
The Evidence |
Validity: All studies were controlled in vitro designs which tested Candida adherence to PMMA fabricated through various methods. Each study found statistically significant findings comparing their samples through equal experimental treatment of samples and analysis. The study by Murat also revealed in vitro that with a simulated pellicle layer, there was no difference in adherence between any samples. This demonstrates that clinical studies are needed to assess adherence in vivo.
Perspective: No single study compared all fabrication methods concurrently. Due to differences in study design, inter-study direct comparison becomes difficult. Regardless, these findings demonstrate that material choice does impact Candida adherence in vitro. No information was found regarding this topic in vivo, which would provide more direct clinical applicability as adherence is multifactorial. |
| Applicability |
Overall, these studies inform the practitioner in treatment planning dentures for the edentulous patient. Candida albicans contribution to denture stomatitis must be considered, especially in higher risk patients. Milled CAD/CAM and injection molded materials may help reduce denture stomatitis formation due to decreased adherence of Candida compared to conventionally compressed heat cured PMMA. No studies have compared adherence of injection molding to CAD/ CAM materials directly. A literature search did not retrieve any studies regarding printed CAD/CAM materials. Furthermore, Candida adherence and biofilm formation are multifactorial processes affected by pellicle formation, host resistance, hydrophobicity, surface roughness and porosity, Candida species, etc. In-vitro studies are limited in their direct clinical application. In vivo studies are needed to explore the relationship of Candida albicans/ denture stomatitis and patients treated with varying denture fabrication. |
| Specialty |
(General Dentistry) (Prosthodontics) |
| Keywords |
Candida albicans, PMMA, denture, denture stomatitis
|
| ID# |
3438 |
| Date of submission |
11/20/2020 |
| E-mail |
nealb@uthscsa.edu |
| Author |
Benjamin Neal, DMD |
| Co-author(s) |
Kara Dunegan, DDS |
| Co-author(s) e-mail |
dunegan@uthscsa.edu |
| Faculty mentor |
Robert Taft, DDS, FACP |
| Faculty mentor e-mail |
taftr@uthscsa.edu |
| |
|
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?) |
| None available | |
 |
Comments and Evidence-Based Updates on the CAT
(FOR PRACTICING DENTISTS', FACULTY, RESIDENTS and/or STUDENTS COMMENTS ON PUBLISHED CATs) |
| None available | |