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 Table of Contents  
ORIGINAL ARTICLE
Year : 2018  |  Volume : 11  |  Issue : 2  |  Page : 170-174

Comparison of effectiveness of silver zeolite as an antimicrobial agent in acrylic and silicone soft liners in complete denture patients: An in vivo study


1 Department of Prosthodontics and Crown and Bridge, KLE V K institute of Dental Sciences, KLE Academy of Higher Education and Research, Belgaum, Karnataka, India
2 Department of Microbiology, JNMC, KLE Academy of Higher Education and Research, Belgaum, Karnataka, India

Date of Web Publication18-May-2018

Correspondence Address:
Dr. Bishakha Singh
Department of Prosthodontics and Crown and Bridge, KLE V K Intitute of Dental Sciences, Belagavi, Karnaraka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/kleuhsj.kleuhsj_243_17

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  Abstract 


BACKGROUND: Soft liners (SLs) are easily colonized and infected by Candida species and bacteria, leading to denture-induced stomatitis. Hence, it is essential that the SLs be taken care of. To serve such a purpose, antimicrobial zeolites have been incorporated. Limited in vitro evidence suggests that silver zeolite (SZ) is a potentially effective antimicrobial agent. Hence, this study aims to analyze and compare the antimicrobial effectiveness of SZ when added to two different types of SLs in vivo for 28 days in complete denture patients.
MATERIALS AND METHODS: This study was undertaken to determine the efficacy of SZ as an antimicrobial agent when incorporated in acrylic soft liners (ASLs) and silicone soft liners (SSLs). A total of 32 edentulous patients were selected and were divided into two groups. Group 1 consisted of 16 patients, wherein SSL was used, and Group 2 consisted of 16 patients with ASL. The reduction of colony-forming units (CFUs) was seen in both the groups after an interval of 28 days.
RESULTS: There was a greater reduction noted when SZ was incorporated in SSLs after 28 days. Group 1 showed a mean reduction of CFU from 4.60 to 1.98, whereas Group 2 showed a mean reduction from 4.73 to 3.39. Thus, SZ was effective in both the SLs.
CONCLUSION: SZ showed a significant reduction in CFU in both the SLs. Hence, this in vivo study concluded that incorporation of SZ is effective as an antimicrobial agent when added to SLs.

Keywords: Acrylic soft liner, antimicrobial, Candida, denture-induced stomatitis, silicone soft liner, silver zeolite


How to cite this article:
Singh B, Bembalagi M, Nagmoti JM, Patil R, Patil A. Comparison of effectiveness of silver zeolite as an antimicrobial agent in acrylic and silicone soft liners in complete denture patients: An in vivo study. Indian J Health Sci Biomed Res 2018;11:170-4

How to cite this URL:
Singh B, Bembalagi M, Nagmoti JM, Patil R, Patil A. Comparison of effectiveness of silver zeolite as an antimicrobial agent in acrylic and silicone soft liners in complete denture patients: An in vivo study. Indian J Health Sci Biomed Res [serial online] 2018 [cited 2020 Feb 25];11:170-4. Available from: http://www.ijournalhs.org/text.asp?2018/11/2/170/232688




  Introduction Top


Soft liners (SLs) are used in the management of abused tissue, underlying ill-fitting dentures, functional impression and tissue conditioning during implant healing, and the relining of maxillofacial prosthesis. However, these are easily colonized and infected by Candida species and bacteria, leading to denture-induced stomatitis. Hence, it is essential that the SLs be taken care of.[1],[2],[3],[4] To serve such a purpose, antimicrobial zeolites have been incorporated. Zeolites are aluminum silicate crystalline structures that present void spaces measuring 3–10 Š in their structure. Antimicrobial cations, such as silver and zinc, may be lodged within the void spaces of the zeolites and be exchanged over time with other cations from their environment. Limited in vitro evidence suggests that silver zeolite (SZ) is a potentially effective antimicrobial agent.In vitro studies have shown favorable long-term antimicrobial effects of SLs containing SZ on Candida albicans and the bacteria Staphylococcus aureus and Pseudomonas aeruginosa. Few studies have been published on this topic because the changes in SL materials in the mouth over time are more rapid when compared to in vitro immersion of the same in water, isotonic saline, artificial saliva, or denture cleansers.In vitro studies possess limitations in their capacity to simulate the oral environment, and moreover, the in vivo effect of SZ as antimicrobial activity is unknown.[5],[6]

Hence, the purpose of the study is to analyze and compare the antimicrobial effectiveness of SZ when added to two different types of SLs in vivo for 28 days in complete denture patients.


  Materials and Methods Top


A total of 32 patients in the age group of 45–75 years, attending to the Department of Prosthodontics and Crown and Bridge, KLE Vishwanath Katti Institute of Dental Sciences, Belgaum, were included in the study. Two groups were formed, with 16 patients in each group. Group 1 composed of denture wearer patients where silicone soft liners (SSLs) were used and Group 2 composed of denture wearer patients where acrylic soft liners (ASLs) were used.

Sample size was calculated as:

A-error = 5% power of that = 90%

η =2 s2 (z1−α/2 + z1−β) 2/d2

z1−α/2 = 1.96 z1−β=0.842

Inclusion criteria

  1. Patients between age 45 and 75 years of age
  2. Patients with healthy oral mucosa
  3. Patients with ill-fitting denture requiring SL.


Exclusion criteria

  1. Immunocompromised patients
  2. Patients on antimicrobial treatments
  3. Diabetes
  4. Any form of oral diseases.


Materials used in the study

  • Zeomic ® AJ10N (SZ)
  • Mollosil (SSL); LOT number 180603
  • GC SL (ASL); LOT number 1601071
  • <
  • Blood agar.


Methodology

Preparation of metal die

A ring-shaped metal die of dimension 15 mm (inner diameter) × 1.5 mm thickness was fabricated.[5]

Preparation of specimens

This ring was seated on a glass slab and addition silicone of putty consistency was manipulated and placed in the lumen of the ring, which was covered by another glass slab for 10 min [Figure 1].
Figure 1: Materials used in the study

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Determination of minimum inhibitory concentration of silver zeolite

The antimicrobial effect of SZ was calculated by determining the minimum inhibitory concentration (MIC) by broth dilution method. MIC was done against C. albicans and Gram-negative and Gram-positive bacteria.

A ring-shaped metal die of dimension 15 mm (inner diameter) × 1.5 mm thickness was fabricated. This ring was seated on a glass slab and additional silicone of putty consistency was manipulated in the inner diameter of ring, which was covered by another glass slab for 10 min. After 10 min, the set putty block was secured to the palatal region of the maxillary cast using cyanoacrylate. Heat-curing resin was packed into the mold space and the maxillary prosthesis was retrieved after curing. The intaglio surface of prosthesis containing the putty block was replaced by a layer of SL (Group 1 – SSL and Group 2 – ASL) according to the manufacturer's instructions [Figure 2] and [Figure 3].
Figure 2: Replacement of putty block with silicone soft liner

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Figure 3: Replacement of putty block with acrylic soft liner

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The prosthesis was inserted and was allowed to set in the patient's mouth for 10 min and the excess material was trimmed away. The patients were instructed to wear the prosthesis during the day and stored in cold water at night.

After 28 days, the SL without SZ was scrapped and the sample was collected and was sent for microbiological evaluation. This space was replaced by a new layer of SL with SZ (0.1 g of SZ to the powder of SL). The patient was given this prosthesis and was asked to report after 28 days for another sample collection.

Microbiological evaluation

The sample was stored in a sterile container having normal saline and transported immediately to the microbiology laboratory for culture to identify the presence of C. albicans and Gram-negative and Gram-positive bacteria. The specimen was first vortexed for 20 min in 10 ml of saline. Then, 10 ml of this was inoculated onto blood agar to produce lawn culture. The culture media is incubated at 37°C in carbon dioxide jar for 18–24 h. At the end of the incubation period, two to three predominant bacterial colonies were noted. Semiquantitation of these microorganisms was done by counting the number of colonies on the culture media multiplied by 100 to report the number of colony-forming units (CFUs) per ml of culture media. Later, plates were incubated at 5% carbon dioxide. The colony was kept in a carbon dioxide incubator for 48 h and the count was done. The count was multiplied with dilution factor to quantify the number of CFUs.


  Results Top


In the present study, distributions of male and females in the two study groups were such that Group 1 consisted of 10 males and 6 females and Group 2 consisted of 9 males and 7 females [Table 1] and [Graph 1].
Table 1: Distribution of male and females in two study groups (1, 2)

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Comparison of the two study groups (1, 2) with pretest and posttest log CFU count was done by independent t-test. The results showed that pretest in Group 1 had 4.60 ± 1.00 CFU and in Group 2, it was 4.73 ± 1.55, while in the posttest, Group 1 CFU was 1.98 ± 1.86 and in Group 2, CFU was 3.39 ± 1.73 [Table 2] and [Graph 2].
Table 2: Comparison of two study groups (1, 2) with pre- and post-test log colony-forming units counts by independent t-test

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Comparison of pretest and posttest log CFU counts in the two study groups (1, 2) was done by dependent t-test. The results showed that Group 1 pretest CFU was 4.60 and posttest it was 1.98. In Group 2, pretest CFU was 4.73 ± 1.55 and posttest it was 3.39 ± 1.73 [Table 3] and [Graph 3].
Table 3: Comparison of pre- and post-test log colony-forming units counts in the two study groups (1, 2) by dependent test

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The results of the present study showed that there was more CFU in SSL when compared to ASL.

The reduction in the growth of microorganism in Group 1 was about 57% and in Group 2 the reduction was about 29%.


  Discussion Top


Wearing the denture for a prolonged duration than required giving minimum rest to the denture-bearing tissues leads to irritation of mucosa, eliminating it from blood supply causing resorption of the supporting alveolar bone. This results in loosening of the denture, necessitating the use of tissue conditioners and denture adhesives for improved retention. These soft denture lining materials are mostly recommended in edentulous people with atrophied or sharp alveolar ridges or who have thin atrophied mucosa. Antimicrobial activity is one of the most parameters for successful use of SL. Zeolites are aluminum silicate crystalline structures which have void spaces measuring 3–10 Š in their structure.[5] The efficacy of antimicrobial zeolites against fungi and aerobic and anaerobic bacteria has been confirmed. Thus, in the present study, we have assessed the antimicrobial activity of SZ in two different SL, namely SSL (mollosil) and ASL (GC SL).

First, we found in the present study that the mean CFU in ASL was more as compared to SSL. This is in accordance with the study done by Kang et al. that reported ASL materials exhibited greater Candida adhesion than SSLs.[7]

Second, a significant reduction in the CFU in both the groups (1, 2) was seen after addition of SZ to SLs. The mean culture result for Group 1 showed reduction from 4.6 to 1.98. For Group 2, the mean culture reduced from 4.73 to 3.39.

Addition of SZ led to a reduction in the growth of microbes, which was also reported in an in vitro study done by Nikawa et al. It showed that SZ, when incorporated into SL, reported to control the denture plaque effectively. Another study done by Saravanan et al. showed two-third reduction in microbial growth in ASL incorporated with SZ.[8] Nevertheless, in our study, we found one-third reduction in microbial count in ASL. Literature search did not yield any study that evaluated the effect of SZ in SSL; therefore, a comparison cannot be drawn with other studies. However, Group 1 (SSL with SZ) percentage reduction in growth of bacteria is 57%.

In this study, the antimicrobial effect of SZ was noted for 28 days. This is in accordance with a previous in vitro study done by Matssura et al. who concluded that SLs containing SZ have shown antimicrobial effect for 4 weeks. Another study done by Abe et al. also concluded that the antimicrobial effects of samples containing SZ against all tested microbes except for P. aeruginosa and the Streptococcus milleri group are not influenced by saliva immersion for 28 days. An in vivo study by Malmstorm et al. also used 4-week time to evaluate surface integrity and softness of SL. This study also showed the efficacy of SZ in ASLs and SSLs over 28 days.

The limitations of the study were that the sample size used in the present study was small because of the strict inclusion and exclusion criteria. There is a scope of further research using a larger sample size and involving a wider research area and scale. Efficacy of SZ was studied in autopolymerized SL, that is, in ASL and SSLs. Efficacy of SZ as an antimicrobial should also be evaluated in heat cure as these may reflect greater or lesser susceptibility for candidal colonization. In the present study, the antimicrobial effect of SZ was considered. Further studies should evaluate other properties such as water sorption viscoelastic properties, color stability and surface roughness, tensile strength, and bond strength of SLs.


  Conclusion Top


The following conclusions are drawn from the study.

There was more CFU in ASL when compared to SSL. There was reduction in CFU in both the groups. On addition of SZ to both these SLs, SSL showed a marked reduction in CFU. Efficacy of SZ was effective over 28 days.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Bulad K, Taylor RL, Verran J, McCord JF. Colonization and penetration of denture soft lining materials by Candida albicans. Dent Mater 2004;20:167-75.  Back to cited text no. 1
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2.
Mack PJ. Denture soft lining materials: Clinical indications. Aust Dent J 1989;34:454-8.  Back to cited text no. 2
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3.
El-Hadary A, Drummond JL. Comparative study of water sorption, solubility, and tensile bond strength of two soft lining materials. J Prosthet Dent 2000;83:356-61.  Back to cited text no. 3
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4.
Saber-Sheikh K, Clarke RL, Braden M. Viscoelastic properties of some soft lining materials. II – Ageing characteristics. Biomaterials 1999;20:2055-62.  Back to cited text no. 4
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5.
Saengmee-Anupharb S, Srikhirin T, Thaweboon B, Thaweboon S, Amornsakchai T, Dechkunakorn S, et al. Antimicrobial effects of silver zeolite, silver zirconium phosphate silicate and silver zirconium phosphate against oral microorganisms. Asian Pac J Trop Biomed 2013;3:47-52.  Back to cited text no. 5
[PUBMED]    
6.
Hotta M, Nakajima H, Yamamoto K, Aono M. Antibacterial temporary filling materials: The effect of adding various ratios of Ag-Zn-Zeolite. J Oral Rehabil 1998;25:485-9.  Back to cited text no. 6
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7.
Kang SH, Lee HJ, Hong SH, Kim KH, Kwon TY. Influence of surface characteristics on the adhesion of Candida albicans to various denture lining materials. Acta Odontol Scand 2013;71:241-8.  Back to cited text no. 7
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8.
Saravanan M, Kumar A, Padmanabhan TV, Banu F. Viscoelastic properties and antimicrobial effects of soft liners with silver zeolite in complete dental prosthesis wearers: An in vivo study. Int J Prosthodont 2015;28:265-9.  Back to cited text no. 8
[PUBMED]    


    Figures

  [Figure 1], [Figure 2], [Figure 3]
 
 
    Tables

  [Table 1], [Table 2], [Table 3]


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