Zakład Protetyki Stomatologicznej Pomorskiej Akademii Medycznej w Szczecinie al. Powstańców Wlkp. 72, 70-111 Szczecin
Kierownik: dr hab. n. med. Bogumiła Frączak
1 Katedra Immunologii i Mikrobiologii Akademii Rolniczej w Szczecinie ul. Doktora Judyma 24, 71-466 Szczecin
Kierownik: dr hab. Danuta Czarnomysy-Furowicz
Streszczenie
Przedłużająca się długość życia ludzkiego i dynamiczny rozwój lecznictwa protetycznego sprawiły, że coraz więcej ludzi i przez coraz dłuższy czas użytkuje protezy ruchome.
Materiały stosowane do wykonania tych protez stanowią potencjalny czynnik patogenny dla błony śluzowej jamy ustnej będącej w kontakcie z tym materiałem. U 20–70%
pacjentów użytkujących ruchome protezy występują sto-matopatie protetyczne. W przedstawionej pracy oceniano i porównano adhezję płytki bakteryjnej do powierzchni najczęściej stosowanych materiałów na protezy ruchome, tj.
tworzywa akrylowego Vertex R.S., stopu metalu stosowa-nego na protezy szkieletowe oraz materiału, który stanowi alternatywę do żywicy akrylowej i metalu-żywicy acetalo-wej Acetal Pressing D. Z tych materiałów wykonano próbki, które umieszczono w pożywkach z czterema podstawowymi kulturami bakterii oraz grzybami Candida albicans i oce-niano przyleganie płytki bakteryjnej do poszczególnych tworzyw. Taka ocena ułatwia wybór właściwego materiału protetycznego, który pozwala na wykonanie uzupełnienia funkcjonalnego, estetycznego, a jednocześnie uwzględnia-jąca profi laktykę stomatopatii protetycznych.
H a s ł a: adhezja – płytka bakteryjna – tworzywa protety-czne – stomatopatia protetyczna.
Summary
Increased life span of humans and dynamic develop-ment of prosthetic treatdevelop-ment has caused that increased number of people are using removable dentures for longer periods of time. The materials used to make those pros-thesis are becoming a potential pathogen factor for oral mucosa being in contact with this material. Prosthetic stomatopathy occurs in 20% to 70% of the patients who are using removable dentures. The present paper evalu-ates and compares adhesion of bacterial plague to the most common materials used for removable dentures i.e.
acrylic material Vertex R.S., metal alloy used for frame prosthesis and a material which is an alternate to acrylic resin and acetal metal-resin Acetal Pressing D. Samples were made from the above mentioned materials and placed in mediums with four basic bacteria cultures and fungus Candida albicans (fungus) as the adhesion of bacterial plague to individual materials was evaluated. Such an evaluation facilitates choice of appropriate prosthetic material, allowing to make prosthetic restoration that is functional and aesthetic at the same time taking into ac-count prosthetic stomatopathy prevention.
K e y w o r d s: adhesion – bacterial plaque – prosthetics materials – prosthetic stomatopathy.
Introduction
Continuous progress in the area of materials science and increasing expectations of both doctors and patients cause that the manufacturers of stomatological materials to introduce more perfect and modern products on the market.
Amongst others while making prosthesis synthetic materials and metal alloys are being used. The most commonly used materials for prosthesis derive from polymethyl metacrylate which belongs to the group of acrylic mases [1].
The dental prosthesis should be constructed and fi t in such a way that it does not become a iatrogenic factor, but it fulfi ls its therapeutic and preventive role. Making of a good prosthesis without good base material is impossible.
Physicochemical properties of materials used for prosthesis as well as their reactions in the oral cavity should be taken into consideration. Dentists are particularly interested in the accumulation of dental plaque on the prosthesis surface, as well as allergenic properties of prosthetic materials. The in-teraction of prosthetic restoration with a denture foundation might cause prosthetic stomatopathy. One of the three major factors causing the occurrence of prosthetic stomatopathy is mycotic infection, affecting 70 to 100% of prosthesis users [2]. Adhesion ability of yeast like fungi to the surface of oral mucosa and prosthesis plays a signifi cant role in the pathogenesis of fungi infection. Intensifi cation of fungi in-fection symptoms depend on the extend of prosthesis plaque sediment and on the concentration of mycotic cells on the prosthesis surface. Mycotic infections are caused mainly by fungi from Candida albicans genus which show the larg-est adhesion degree to the epithelium cells. The ability to adhere to the surface of the oral mucosa is the fi rst, basic factor for a mycotic infection in a human.
Prosthesis presence and its traumatic effect on oral mu-cosa create conditions which are favourable for the growth and reproduction of Candida albicans on the surface of oral mucosa as well as on the mucous contact part of the prosthesis. Oral-throat colonisation of Candida albicans can be a potential source of regional and general dissemination.
Dimorphism is a characteristic feature of those yeast-like-fungi. Candida species exist in yeast form (yeast-like,
bud-ding, blastospore) or mycelium (fi mbriated, pseudofi mbriated or false fi mbriated, mycelium) and both forms are in vitro and in vivo research [3].
The purpose for this research was to determine which from the basic prosthetics materials in vitro show the small-est adhesion of prosthesis plaque.
Material and methods
At the Department of Dental Prosthetics Pomeranian Medical University in Szczecin laboratory samples were prepared. Those samples were prepared according to the pro-cedures, size 20 mm × 20 mm. Metal samples were divided into 2 groups: polished mechanically and polished electro-galvanically. Research of 5 micro-organism test species were conducted at the Faculty of Immunology and Microbiology, Academy of Agriculture. Those micro-organisms were: Sta-phylococcus aureus, Enterococcus hirae, Escherichia coli, Pseudomonas aeruginosa and Candida albicans. Model strains were inoculated on appropriate mediums. After 18 hours the strains were suspended in isotonic salt solution.
One sterile plate made of prosthetic material was placed in each solution with the micro-organisms. Plates suspended in isotonic salt solution were a control sample. Plates with a bacteria and yeast solutions as well as the control samples were incubated for 60 minutes at 37°C, shaking the sus-pension every 15 minutes. After the incubation the plates were rinsed 3 times with NaCl solution. Plates taken out and dried were placed against the culture medium for 1 minute. The culture was incubated for 24 hours at 37°C, the colonies that grew at the pressured area were counted. The test was repeated 3 times. The research evaluated adhesion and number of colonies on different materials.
Results
As table 1 results bacteria Staphylococcus auresu and Enterococcus hirae exert the biggest adhesion to chrome-cobalt alloy polished mechanically. However, Escherica coli
T a b l e 1. Number of colonies grown on the studied prosthetic materials T a b e l a 1. Liczba wyrosłych kolonii na badanych materiałach protetycznych
Bacteria species Gatunek bakterii
Number of colonies / Liczba wyrosłych kolonii
acrylic material tworzywo akrylowe
acetal epoxy żywica acetalowa
chrome-cobalt alloy / stop chromo-kobaltowy polished mechanically
polerowany mechanicznie
polished electrogalvanically polerowany elektrogalwanicznie
Staphylococcus aureus 165 136 214 141 183 192 191 243 267 193 157 182
Enterococcus hirae 187 211 191 93 118 123 312 262 371 297 288 265
Escherichia coli 396 318 341 33 34 38 45 47 67 23 39 66
Pseudomonas aeruginosa 397 416 404 184 136 131 380 415 430 326 398 459
Candida albicans 27 22 26 7 5 9 15 11 23 17 14 19
Control / Kontrola 0 0 0 0 0 0 0 0 0 0 0 0
Fig. 1. Adhesion of Candida albicans to acrylic material Vertex R.S.
magnifi ed 40 times
Ryc. 1. Adhezja Candida albicans do tworzywa akrylowego Vertex R.S.
w pow. ×40
Fig. 2. Adhesion of Candida albicans to acetal epoxy magnifi ed 40 times Ryc. 2. Adhezja Candida albicans do żywicy w pow. ×40
Fig. 3. Adhesion of Candida albicans to chrome-cobalt alloy magnifi ed 40 times
Ryc. 3. Adhezja Candida albicans do stopu chromo-kobaltowego w pow. ×40
Disscusion
Available literature makes it known that bacterial and fungal adhesion to the prosthetic materials is a complicated phenomenon and depends on such factors as, coarseness of those materials, their ability to attract water and the of proteins in saliva, which facilitate adhesion of micro-or-ganisms [4]. Proliferation of Candida albicans takes place mainly inside of bacterial plaque, seldom in infl amed oral mucosa [5, 6, 7]. In microscopic research numerous research-ers state that an acrylic surface is irregular and the plate along with Candida albicans cells penetrates all concavi-ties (fi g. 1) [8, 9]. From the research of Glantz et al. [10]
it arises that acrylic has smaller surface potential, but it absorbs water which causes a signifi cant increase of adhe-sion strength and adsorption of a relatively large amount of prosthesis plaque. Verran and Maryan [11] investigated the retention of Candida albicans to acrylic and to silicon.
There was no difference in yeast adhesion to both smooth surfaces. Coarse surfaces however create good retention for micro-organisms and therefore should be eliminated to the greatest extend.
The results of in vitro research reveal that signifi cant differences for individual bacteria can be asserted: E. coli showed 10 times higher adhesion to acrylic material than to acetal epoxy and metal alloy. As far as Staphylococcus aureus and Enterococcus hirae the highest adhesion was found with metal. The smallest adhesion to the materials researched was shown by Candida albicans, almost 10 times smaller in relation to all bacterial strains evaluated, with the smallest adhesion being to acetal (fi g. 2). In case of acrylic material Vertex R.S. large bacterial adhesion is probably associated with its manufacturing technology and material structure itself. In case of metal larger adhesion was found with samples polished mechanically (fi g. 3). Adhesion of certain bacteria strains regardless of the polishing method was large, it might be related to an affi nity of those bac-teria with some components of the metal alloy, this would however require further detailed research.
References
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2. Mierzwińska-Nastalska E., Spiechowicz E., Rusiniak-Kubik K., Sko-pińska-Różewska E.: Prevention of fungi infection of oral cavity and its immunology consequences. Protet. Stom. 1997, 47, 1, 4–9.
3. Rieth H.: Infections caused by yeast-like-fungi. PZWL, Warszawa 1983.
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R O C Z N I K I P O M O R S K I E J A K A D E M I I M E D Y C Z N E J W S Z C Z E C I N I E 2007, 53, 2, 72–82
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