SCIENCE
M. Arslana, S. Muratb, G. Alpc, A. Zaimoglud
Evaluation of flexural strength and surface properties of
prepolymerized CAD/CAM PMMA-based polymers used for
digital 3D complete dentures
Abstract
Purpose: The objectives of this in vitro study were to evalu-
ate the flexural strength (FS), surface roughness (Ra), and
hydrophobicity of polymethylmethacrylate (PMMA)-based
computer-aided design/computer-aided manufacturing
(CAD/CAM) polymers and to compare the properties of dif-
ferent CAD/CAM PMMA-based polymers with conventional
heat-polymerized PMMA following thermal cycling.
Materials and methods: Twenty rectangular-shaped speci-
mens (64 × 10 × 3.3 mm) were fabricated from three CAD/
CAM PMMA-based polymers (M-PM Disc [M], AvaDent
Puck Disc [A], and Pink CAD/CAM Disc Polident [P], and
one conventional heat-polymerized PMMA (Promolux [C]),
according to ISO 20795-1:2013 standards. The specimens
were divided into two subgroups (n = 10), a control and a
thermocycled group. The specimens in the thermocycled
group were subjected to 5000 thermal cycling procedures
(5 to 55°C; 30 s dwell times). The Ra value was measured
using a profilometer. Contact angle (CA) was assessed using
the sessile drop method to evaluate surface hydrophobicity.
In addition, the FS of the specimens was tested in a universal
testing machine at a crosshead speed of 1.0 mm/min. Sur-
face texture of the materials was assessed using scanning
a Mustafa Arslan, Prosthodontics, Istanbul Aydin University, Turkey
b Dr. Sema Murat, Besevler Ankara University, Turkey
International Journal of Computerized Dentistry 2018;21(1):31–40
Mustafa Arslan
electron microscope (SEM). The data were analyzed using
two-way analysis of variance (ANOVA), followed by Tukey’s
HSD post-hoc test (ž < 0.05).
Results: CAD/CAM PMMA-based polymers showed sig-
nificantly higher FS than conventional heat-polymerized
PMMA for each group (P  <  0.001). CAD/CAM PMMA-
based polymer [P] showed the highest FS, whereas conven-
tional PMMA [C] showed the lowest FS before and after
thermal cycling (P < 0.001). There were no significant dif-
ferences among the Ra values of the tested denture base
polymers in the control group (P > 0.05). In the thermocy-
cled group, the lowest Ra value was observed for CAD/
CAM PMMA-based polymer [M] (P  <  0.001), whereas
CAD/CAM PMMA-based polymers [A] and [P], and con-
ventional PMMA [C] had similar Ra values (P > 0.05). Con-
ventional PMMA [C] had a significantly lower CA and con-
sequently lower hydrophobicity compared to the CAD/
CAM polymers in the control group (P  <  0.001). In the
thermocycled group, CAD/CAM PMMA-based polymer [A]
and conventional PMMA [C] had significantly higher CA,
and consequently higher hydrophobicity when compared to
CAD/CAM polymers [M] and [P] (P < 0.001). However, no
significant differences were found among the other mater-
ials (P > 0.05).
c Dr. Gulce Alp, Prosthodontics, Okan University, Turkey
d Prof. Ali Zaimoglu, Prosthodontics, Istanbul Aydin University,
Turkey
31
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Conclusions: The FS and hydrophobicity of the CAD/
CAM PMMA-based polymers were higher than the con-
ventional heat-polymerized PMMA, whereas the CAD/
CAM PMMA-based polymers had similar Ra values to the
conventional PMMA. Thermocycling had a significant
effect on FS and hydrophobicity except for the Ra of den-
ture base materials.
Keywords: CAD/CAM, digital complete dentures, flexural
strength (FS), hydrophobicity, PMMA, surface roughness (Ra)
Introduction
Computer-aided design/computer aided manufacturing
(CAD/CAM) has a wide range of applications in dentistry
due to its advanced data acquisition and production capa-
bility. CAD/CAM technology is routinely used for the fabri-
cation of inlays, onlays, full crown restorations, fixed and
removable partial prostheses, fixed and removable
implant-supported prostheses, and maxillofacial prosthe-
ses.1
In recent years, CAD/CAM technology has become an
alternative to conventional methods in the fabrication of
complete dentures. Clinical and laboratory protocols include
the combined use of manual and digital procedures. How-
ever, fabrication of CAD/CAM digital dentures shortens the
number of clinical appointment procedures from five to
two.1-4
With the recent increased interest in complete dentures
fabricated using computer-aided technology, a range of
CAD/CAM polymethylmethacrylate (PMMA)-based poly-
mers has been introduced by manufacturers. Currently, the
fabrication of CAD/CAM digital dentures is accessible to
practitioners from five manufacturers: AvaDent (Global Den-
tal Science LLC), Dentca (Dentca Inc), Ceramill Full Denture
System (Amann Girrbach AG), Wieland Digital Denture (Ivo-
clar Vivadent Inc), and the Baltic Denture System (BDS)
(Merz Dental GmbH). CAD/CAM PMMA-based polymers
that are utilized for the fabrication of the denture base pro-
vide a superior fit and strength in comparison to the conven-
tionally processed base. Also, CAD/CAM PMMA-based pol-
ymers undergo no polymerization shrinkage due to the
milling of blanks, and contain less residual monomer. They
are also more hydrophobic than conventionally processed
acrylic resin, which results in a more bio-hygienic den-
ture.1,3-6 Moreover, highly crossed-linked PMMA-based
blanks are industrially polymerized under standardized condi-
32
tions at a high temperature and pressure to improve their
mechanical properties.7-10
Denture base polymers should possess adequate mechan-
ical properties to prevent denture fracture for successful den-
ture construction and patient satisfaction. Dentures are sub-
jected to flexural stress during mastication, which creates
internal stresses that cause cyclic deformation of denture
base polymer, resulting in crack formation and eventually
fracture of the denture. Therefore, high flexural strength (FS)
is crucial to denture wearing success, as alveolar resorption is
a gradual, irregular process that leaves tissue-born prosthe-
ses unevenly supported.11,12
In addition to mechanical properties, surface roughness
(Ra) and surface free energy are other important factors for
denture base materials that affect bacterial plaque retention,
discoloration, oral health, and patient satisfaction.13-15 Previ-
ous studies13,14,16-21 have indicated that surfaces with a
lower surface free energy (hydrophobic) and a lower rough-
ness delay plaque accumulation on polymeric materials.
Denture base materials are routinely exposed to thermal
stresses that cause degradation of the surface and weaken
the mechanical properties of materials during consumption
of hot and cold foods and beverages in the oral cavity.22-24
Thermal stresses may increase the water absorption of the
material by increasing the distance between the polymer
chains.25 An increase in temperature causes the water mole-
cules to diffuse into the base materials quicker.26 Thus, dif-
fused water in the polymer acts as a plasticizer, allowing the
chains to easily slide under chewing forces. This phenome-
non has a negative impact on the mechanical properties of
polymers. In addition, the effect of thermal cycling on the
surface properties of denture base polymer has not been
thoroughly investigated.
Moreover, no published information regarding the sur-
face and mechanical properties of CAD/CAM PMMA-based
polymers is available to date. Therefore, the aim of the pres-
ent study was to evaluate the FS, Ra, and hydrophobicity of
CAD/CAM PMMA-based polymers before and after thermal
cycling.
For the present study, three null hypotheses were
addressed:
1. The FS of CAD/CAM PMMA-based polymers is not dif-
ferent from a conventional heat-polymerized PMMA.
2. Ra and hydrophobicity of CAD/CAM PMMA-based poly-
mers are not different from conventional heat-polymer-
ized PMMA.
3. Thermal cycling does not affect the mechanical and sur-
face properties of denture base resins.
International Journal of Computerized Dentistry 2018;21(1):31–40

Table 1 Tested denture base polymers
Material name Code Polymer type
Promolux [C] Conventional PMMA
M-PM Disc [M] CAD/CAM PMMA-based polymer
AvaDent Puck Disc [A] CAD/CAM PMMA-based polymer
Polident Pink CAD/CAM Disc [P] CAD/CAM PMMA-based polymer
Materials and methods
Three commercially available CAD/CAM PMMA-based poly-
mers along with one conventional heat-polymerized PMMA
were assessed. Table 1 lists the four denture base resins used,
the manufacturers, and the material information.
Specimen preparation
The specimens of each group (n = 20) were prepared accord-
ing to ISO 20795-1:2013 (E) (Dentistry-Base polymers – Part
1: Denture base polymers),27 and divided into two subgroups
(n = 10), a control and a thermocycled group. In order to pre-
pare heat-polymerized conventional PMMA specimens, uni-
form, rectangular, prism-shaped wax (Cavex Holland BV, RW
Haarlem, Netherlands) specimens (64(ı) × 10(w) × 3.3(h) mm)
were fabricated using a metal matrix. A standard resin den-
ture-making technology was applied according to the manu-
facturer’s instructions.
To prepare standard specimens from CAD/CAM PMMA-
based polymers, the virtual design of rectangular prisms with
the dimensions of 64(ı) × 10(w) × 25(h) mm were made with
the help of a computer program (Yenadent CAM 5.1;
Yenadent Ltd, Istanbul, Turkey) and then converted into a
stereolithography (.stl) file. Thereafter, rectangular prism
sheets from blanks were milled (Yenadent D14; Yenadent
Ltd). After the milling process, CAD/CAM polymer sheets
were sectioned using a precision cutter (Secotom 10 isomet;
Struers A/S, Ballerup, Denmark) to obtain 20 standard speci-
mens for each CAD/CAM PMMA-based polymer.
All specimens were polished with silicon carbide papers
(grits 120, 400, 600, and 800) to the final dimension. A digi-
tal caliper (IP54; Shan) was used to measure the final dimen-
sions of the specimens. All specimens were immersed in
water at 37ºC for 48 ± 2 h prior to the thermal cycling pro-
cedure. Specimens in the thermocycled group were subject-
International Journal of Computerized Dentistry 2018;21(1):31–40
SCIENCE
Manufacturer
Merz Dental GmbH
Merz Dental GmbH
AvaDent Global Dental
Science LLC
Polident d.o.o
ed to a thermal cycling protocol (5000 cycles, 5°C to 55°C,
5  min/cycle) by using a thermal cycler (MTE-101; MOD
Dental; Esetron Smart Robotecnologies, Ankara, Turkey) to
simulate a clinical aging process.
Flexural strength (FS) testing
For the determination of FS (MPa), a three-point bending
test was conducted using a universal testing machine (Lloyd
LRX; Lloyd Instruments Ltd, Fareham, UK), with the Nexy-
gen software computer program (Nexygen  MT; Lloyd
Instruments). After mounting the specimens in the testing
device apparatus with 50 mm distance between two verti-
cal supports, the vertical load was applied midway between
the supports with a 5  mm/min crosshead speed until the
specimen was fractured, and the maximum load at fracture
was recorded. The FS data (Ɛ) were calculated according to
the following formula: Ɛ = 3Fd/2wh2, where F is the applied
load (N) at the highest point of the load–deflection curve,
d is the span length (50.0 mm), w is the measured width of
the test specimen, and h is the measured thickness of the
test specimen. Immediately after flexural testing, fracture
pieces were recovered and used to determine Ra and hydro-
phobicity.
Surface roughness measurement
Ra (μm) was determined at three spots on each specimen
(one in the central position, and two at the margins) by using
a profilometric contact surface measurement device (Perth-
ometer M2; Mahr GmbH, Gottingen, Germany) with a
measurement length of 5.5 mm and 0.5 mm/s, in order to
obtain the general surface characteristics of the specimens.
Ten specimens were used for each material and for each
group. Three readings were conducted for each specimen,
and a mean value was calculated.
33
SCIENCE

the effects of material and thermal cycling on mechanical

155
and surface properties, and to assess the interaction between
145 d the two factors. Post-hoc analysis (Tukey’s HSD post-hoc
135 h
test) was carried out to determine the differences between
Mean flexural strength (MPa)

b,c
c
125 f materials evaluated. Statistical significance was set at
a
115 g P < 0.05.
e
105
108.95 ± 5.36

122.47 ± 5.54

114.52 ± 5.81

118.32 ± 4.66

106.78 ± 3.37

125.85 ± 3.92
133.43 ± 5.9
95
Results
98.83 ± 6.33

85

75 The mean FS and mean standard deviation (SD) values of

65 denture base materials are shown in Figure 1. The two-way
C M A P
ANOVA indicated that both material and thermal cycling
„ Before thermal cycling „ After thermal cycling
influenced FS, but there was no significant interaction
Fig 1 Comparison of mean FS values of four denture base between the two main factors (P < 0.05). Tukey’s test deter-
polymers before and after thermal cycling. Different single mined that CAD/CAM PMMA-based polymer [P] showed
letters denote statistical difference (* indicates significant the highest FS, whereas conventional PMMA [C] showed the
difference between two groups).
lowest FS in the control group (P < 0.001). The FS of CAD/
CAM PMMA-based polymers [A] and [M] was significantly
higher (P  <  0.001) than that of conventional PMMA [C];
however, no significant differences (P > 0.05) were observed
Contact angle (CA) measurement
between CAD/CAM PMMA-based polymers [M] and [A]. In
For the evaluation of surface hydrophobicity, water contact the thermocycled group, CAD/CAM PMMA-based polymer
angles (CAs) were measured using an automated CA meas- [P] showed the highest FS, whereas conventional PMMA [C]
urement device equipped with a video camera and an image showed the lowest (P  <  0.001). The FS of CAD/CAM
analyzer (OCA 15 Plus; Dataphysics Instruments GmbH, PMMA-based polymer [M] was significantly higher
Filderstadt, Germany). All specimens were cleaned ultrasoni- (P  <  0.001) than that of CAD/CAM PMMA-based poly-
cally with sterile water for 20 min to remove any contami- mer  [A] and conventional PMMA [C]. Besides, the FS of
nants. Thereafter, the specimens were dried in an oven at CAD/CAM PMMA-based polymer [A] was higher (P < 0.001)
30°C for 15 min and used for physicochemical characteriza- than that of conventional PMMA [C]. Moreover, the FS of all
tion utilizing the sessile drop method. For each specimen, denture base polymers decreased significantly following
three drops of deionized water (12 μm) were analyzed on thermal cycling (P < 0.001).
10 specimens (30 measurements in total per each material), Figure 2 shows the mean and SD of Ra values of denture
and the left and the right CA of each drop was averaged. base polymers before and after thermal cycling. The two-
way ANOVA indicated that material and thermal cycling had
no significant effect (P > 0.05); however, there was a signifi-
Microscopic evaluation
cant interaction between material and thermal cycling
Two specimens randomly selected from each tested group (P < 0.001). In the control group, no significant differences
were gold sputtered and subjected to microscopic surface (P > 0.05) were found among all the materials for Ra value.
analysis using a scanning electron microscope (SEM) (x5000 The highest mean Ra was found for conventional PMMA [C],
magnification) (FEI Nova Nanosem 430) to assess the surface whereas the lowest Ra was found for CAD/CAM PMMA-
topography of the specimens. based polymer [M]. In the thermocycled group, the Ra value
of CAD/CAM PMMA-based polymer [M] was significantly
lower (P < 0.001) than that of CAD/CAM PMMA-based pol-
Statistical analysis
ymers [A] and [P]. However, no significant differences
Data analyses were performed with IBM SPSS Statistics 22 (P > 0.05) were found among other denture base polymers.
software (IBM SPSS Inc, Chicago, IL, USA). A two-way The highest mean Ra value was found for CAD/CAM PMMA-
analysis of variance (ANOVA) was conducted to determine based polymer [P], while the lowest Ra value was found for

34 International Journal of Computerized Dentistry 2018;21(1):31–40

 SCIENCE

140
0.4
120

Mean contact angle (degree)

a c
Mean surface roughness (Ra)

c,d 100 b b
d d
0.3 a e e
c
80
a
a,b c
d
60

73.97 ± 3.53

83.35 ± 4.37

81.03 ± 3.29

77.21 ± 3.01

92.95 ± 2.65

83.52 ± 2.6

76.16 ± 3.3
b

82.39 ± 3
0.2
40
0.22 ± 0.07

0.29 ± 0.09

0.22 ± 0.06

0.24 ± 0.04

0.26 ± 0.09

0.32 ± 0.08
0.18 ± 0.04
0.21 ± 0.07

20

0.1 0
C M A P C M A P
„ Before thermal cycling „ After thermal cycling „ Before thermal cycling „ After thermal cycling

Fig 2 Comparison of mean Ra values of four denture base Fig 3 Comparison of mean CA values of four denture base
polymers before and after thermal cycling. Different single polymers before and after thermal cycling. Different single
letters denote statistical difference (*indicates no significant letters denote statistical difference (*indicates significant
difference between two groups). difference between two groups).

CAD/CAM PMMA-based polymer [M] (P < 0.001). Tukey’s significant differences (P < 0.001) between the control and
test revealed no significant differences (P > 0.05) between thermocycled groups for each polymer. The CA of all the
the control and the thermocycled groups for each polymer. materials in the thermocycled group, apart from convention-
Conventional PMMA [C] and CAD/CAM PMMA-based al PMMA [C], was found to be significantly lower (P < 0.001)
polymer [M] showed reduced Ra values, whereas CAD/CAM than those of the control group. On the other hand, thermal
PMMA-based polymers [A] and [P] showed increased Ra val- cycling increased the CA of conventional PMMA significantly
ues following thermal cycling (P > 0.05). (P < 0.001).
The mean CA values are presented in Figure 3. The two- Representative SEM images of conventional PMMA [C],
way ANOVA indicated that material influenced the CA of and CAD/CAM PMMA-based polymers [M], [A], and [P]
denture base polymers; in addition, there was a significant specimens before (Fig 4) and after thermal cycling are pre-
interaction between the material and thermal cycling sented in Figure 5.
(P < 0.05). Tukey’s test determined that the lowest hydro-
phobicity, characterized by the lowest CA, was calculated for
conventional PMMA [C] in the control group. Conventional Discussion
PMMA [C] had significantly lower (P < 0.001) CA, and con-
sequently lower hydrophobicity when compared to CAD/ Based on the results obtained, the first null hypothesis that
CAM PMMA-based polymers [M], [P], and [A]. However, no suggested that CAD/CAM PMMA-based polymers exhibit
significant differences (P > 0.05) were found between CAD/ FS in the same range as conventional heat-polymerized
CAM PMMA-based polymers [M] and [P]. The CA of CAD/ PMMA is rejected. On the other hand, the results obtained
CAM PMMA-based polymer [A] was also found to be sig- revealed that CAD/CAM PMMA-based polymers showed a
nificantly higher (P  <  0.001) than that of conventional statistically insignificant difference in Ra when compared to
PMMA [C] and CAD/CAM PMMA-based polymers [M] and conventional heat-polymerized PMMA; thus the second null
[P]. In the thermocycled group, CAD/CAM PMMA-based hypothesis is accepted. It was also observed that significant
polymers [A] and [P] had significantly higher (P < 0.001) CA, differences (P < 0.001) occurred in FS and hydrophobicity
and consequently higher hydrophobicity when compared to except for Ra of denture base materials before and after ther-
CAD/CAM PMMA-based polymers [M] and [P]. However, mal cycling. Therefore, the hypothesis suggesting that ther-
no significant differences (P > 0.05) were found among other mal cycling would not affect the FS, Ra or hydrophobicity of
denture base polymers. Furthermore, there were statistically denture base materials is partially rejected.

International Journal of Computerized Dentistry 2018;21(1):31–40 35

SCIENCE
a b
c d
CAD/CAM PMMA-based polymers showed significantly
higher (P < 0.001) FS than conventional PMMA before and
after thermal cycling. According to the findings of this study,
the polymerization technique that was used to produce
CAD/CAM PMMA-based polymer blanks might facilitate
higher mechanical properties than for conventional heat-po-
lymerized PMMA. Similarly, a recent study9 found that heat
polymerization under a high pressure of 250 MPa at a high
temperature of 180ºC increased the FS of commercially avail-
able dental resin composites. It is likely that polymerization
under high pressure/high temperature resulted in a reduction
of the number and size of defects, which led to an increase in
FS.28 Moreover, polymerization under a high-pressure/
high-temperature technique increased the degree of poly-
merization and reduced residual monomer, which subse-
quently improved the strength of prepolymerized blank
materials.7-10 On the contrary, Murakami et al11 reported
that polymerization under a high pressure of 500  MPa
decreased the FS and elastic modulus of PMMA denture base
resin. In this scenario, a reduction in FS might have been due
to the high pressure, which created interfacial stress on the
36
Fig 4a to d SEM images (×5000
magnification) of denture base resins
before thermal cycling. (a) Conventional
PMMA [C]; (b) CAD/CAM PMMA-
based polymer [M]; (c) CAD/CAM
PMMA-based polymer [A]; (d) CAD/
CAM PMMA-based polymer [P].
border between filler and matrix that could have caused the
formation of microcracks on the tensile bottom surface of the
specimens. Further studies should focus on the effects of
high-pressure/high-temperature conditions on the mechani-
cal properties of polymers.
The CAD/CAM PMMA-based polymers investigated in
the current study exhibited the highest strength even after
thermal cycling. Although the mechanical properties of com-
mercially available CAD/CAM PMMA-based polymers have
not been reported in the literature, this was in agreement
with that claimed by manufacturers, that the FS of CAD/
CAM PMMA-based polymers [P] (114  MPa) and [M]
(91.5/96.6  MPa) were higher than those of previously
reported values for conventional heat-polymerized PMMA
(generally ranging between 70 to 90 MPa).7,29,30,31 Accord-
ing to the findings of this study, all the tested denture base
resins passed the requirement of ISO 20795-1:2013 17
regarding FS before and after thermal cycling (> 65 MPa).
In the present in vitro study, thermal cycling was chosen
to simulate the clinical oral environment in terms of tempera-
ture and moisture, which cause thermal stress. According to
International Journal of Computerized Dentistry 2018;21(1):31–40

a b
Fig 5a to d SEM images (×5000
magnification) of denture base resins
after thermal cycling. (a) Conventional
PMMA [C]; (b) CAD/CAM PMMA-
based polymer [M]; (c) CAD/CAM
PMMA-based polymer [A]; (d) CAD/
c d
CAM PMMA-based polymer [P].
our findings, the FS of all denture base polymers decreased
significantly following thermal cycling (5000 cycles). This
finding is in agreement with several studies,10,23,24,32,33 which
reported that the FS of denture base resins reduced signifi-
cantly after thermal cycling. The results of the present study
did not accord with those of Ayaz et al,29 who showed that
thermal cycling did not cause a significant adverse effect on
the FS of PMMA base resins. In the present study, it was
observed that Ra values of CAD/CAM PMMA-based poly-
mers were insignificantly lower than conventional heat-po-
lymerized PMMA in the control group. In addition, this study
demonstrated that the roughness of all resin specimens was
at – or slightly higher than – the threshold value of 0.2 μm, as
reported by Bollen et al.15 Although several previous studies
have investigated the effect of thermal cycling on the surface
and mechanical properties of restorative materials with differ-
ent polymer structures, only a limited number of stud-
ies24,29,32,33-35 have examined the effect of thermal cycling
on the surface properties of denture base resins. Ayaz et al29
reported that thermal cycling caused an increase in Ra in den-
ture resin materials without statistically significant differences.
International Journal of Computerized Dentistry 2018;21(1):31–40
SCIENCE
Conversely, Lira et al34 reported that thermal cycling signifi-
cantly affected the Ra of microwaved resins, and microwaved
resins showed lower values of roughness after thermal cycling.
In the present study, it was observed that CAD/CAM PMMA-
based polymer [M] and conventional PMMA [C] showed
reduced Ra values, whereas CAD/CAM PMMA-based poly-
mers [A] and [P] showed increased Ra values after thermal
cycling. However, according to the results of the present
study, changes in roughness values were not statistically sig-
nificant. The results of the present study coincided with those
of Ayaz et al29 and Wieckiewicz et al,35 who found that 5000
cycles of thermal cycling did not cause statistically significant
changes in Ra values of denture base resins. Inconsistent
results among different studies can be explained by variations
in the water solubility, surface hardness, microstructures, and
chemical configurations of the resins studied.36
According to the results obtained from the SEM observa-
tions, conventional PMMA exhibited more porous surface
with multi dots and surface irregularities than CAD/CAM
PMMA-based polymers. This finding was supported by the
Ra results, which indicated that conventional heat-polymer-
37
SCIENCE
ized PMMA [C] showed a rougher surface than the CAD/
CAM PMMA-based polymers, without statistical signifi-
cance. Additionally, CAD/CAM PMMA-based polymer [M]
showed a more homogeneous surface as well as randomly
located micropores and pits than the other denture base
polymers. Scratch lines made by the abrasive polishing papers
were also observed in all the polymers. Moreover, on SEM
evaluation, the denture base polymers showed surface char-
acteristics after thermal cycling similar to untreated speci-
mens.
Surface free energy is another important factor that
affects bacterial adhesion and biofilm formation on material
surfaces, and CA measurement is a reliable technique used to
assess the surface free energy of materials.13,16,37 In princi-
ple, materials having lower surface free energy (hydropho-
bic) exhibit a higher value of water CA.37 Previous stud-
ies13,15,16,19-21 have indicated a negative correlation between
solid hydrophobicity and the number of adhered cells (or
biofilm). In the present study, the highest CA values were
determined for CAD/CAM PMMA-based polymers, while
the lowest CA values were determined for conventional
PMMA (P < 0.001). These results suggest that CAD/CAM
PMMA-based polymers showed more hydrophobic proper-
ties, causing less bacterial adhesion than conventional
PMMA. This might be due to the presence of less residual
monomer as a result of the production of the corresponding
CAD/CAM PMMA-based polymers under high pressure and
temperature, or the polarity of the molecules in the polymer
matrix.36,38 Additionally, it was observed that the CAD/CAM
PMMA-based polymers showed a significantly lower
(P < 0.001) CA following thermal cycling. Thermal cycling
reduced the hydrophobicity of the CAD/CAM PMMA-based
polymers, whereas it increased the hydrophobicity of con-
ventional PMMA. It is likely that the thermal cycling process
actually reduced the residual unpolymerized components of
conventional PMMA, which probably enhanced the hydro-
phobic properties.
One weakness of the present study was that the experi-
mental design had limitations regarding accurately replicat-
ing clinical conditions. The researchers also failed to simulate
repetitive mechanical stressing, which includes repeated
loads during mastication. Apart from this, a long-term clinical
prospective study designed to evaluate whether there is a
clinical significance between the properties and long-term
use of materials would contribute to current knowledge.
Assessment of microhardness, water solubility, and residual
monomer content of materials after thermal cycling was not
within the scope of the present research. Therefore, surface
38
hardness, solubility properties of polymers, and the effects of
the polymerization methods used in the production of the
materials need to be examined in more detail to clarify the
influence of aging procedures on the surface and mechanical
properties of denture base resins.
Conclusion
Within the limitations of this in vitro study, the following
conclusions are drawn:
• CAD/CAM PMMA-based polymers showed significantly
higher FS than that of conventional PMMA before and
after thermal cycling. Thermal cycling resulted in
decreased FS for all denture base polymers.
• There were no significant differences (P < 0.001) in Ra of
the tested denture base polymers before thermal cycling.
Thermal cycling did not have a significant effect on the Ra
of denture base polymers.
• Conventional PMMA had a significantly lower CA and con-
sequently lower hydrophobicity than CAD/CAM PMMA-
based polymers before thermal cycling. Thermal cycling
resulted in a significant decrease in the hydrophobicity of
CAD/CAM PMMA-based polymers and a significant
increase in the hydrophobicity of conventional PMMA.
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Address
Dr. Sema Murat
Besevler Ankara University, Faculty of Dentistry
Department of Prosthodontics, Ankara, Turkey
E-Mail: semamurat47@yahoo.com.tr
39
SCIENCE

Untersuchung der Biegefestigkeit und Oberflächeneigenschaften vorpolymerisierter

PMMA-basierter CAD/CAM-Kunststoffe für digitale Totalprothesen

Schlüsselwörter: CAD/CAM, digitale Totalprothese, Biegefestigkeit, Hydrophobizität, PMMA, Rauheit

Zusammenfassung
Ziel: Ziel dieser In-vitro-Studie war es, die Biegefestigkeit, die Rauheit (Ra) und die Hydrophobizität von PMMA-ba-
sierten CAD/CAM-Kunststoffen zu untersuchen. Zudem sollten die Eigenschaften verschiedener CAD/CAM-PM-
MA-Kunststoffe und konventionell heißpolymerisiertem PMMA nach Temperaturwechselbelastung verglichen wer-
den.
Material und Methode: Jeweils 20 quaderförmige Probekörper (64 × 10 × 3,3 mm) wurden aus drei verschiedenen
PMMA-basierten CAD/CAM-Kunststoffrohlingen (M-PM-Disc [M], AvaDent Puck [A] und Pink CAD/CAM-Disc
[P]) und einem konventionell heißpolymerisierten PMMA (Promolux [C]) gemäß ISO-Norm 20795-1:2013 herge-
stellt. Die Proben wurden zwei Untergruppen (n = 10), einer Gruppe mit Temperaturwechselbelastung (Thermocy-
cling) sowie einer Kontrollgruppe, zugeteilt, wobei die Proben der Belastungsgruppe 5.000 Temperaturzyklen
(5 bis 55 °C bei 30 s Haltezeit) unterworfen wurden. Für die Messung der Rauheit (Ra) kam ein Profilometer zum
Einsatz. Die Hydrophobizität wurde über den Kontaktwinkel mittels liegender Tropfen (Sessile-Drop-Technik)
bestimmt. Zusätzlich wurde in einer Universalprüfmaschine bei einer Traversengeschwindigkeit von 1,0 mm/min
die Biegefestigkeit der Proben getestet. Die Untersuchung der Oberflächenstruktur der Materialien erfolgte mithilfe
eines Rasterelektronenmikroskops. Die Daten wurden mittels zweifaktorieller Varianzanalyse und Tukey-Post-hoc-
Test ausgewertet (ž < 0,05).
Ergebnisse: PMMA-basierte CAD/CAM-Kunststoffe zeigten in jeder Gruppe eine signifikant höhere Biegefestigkeit
als konventionell heißpolymerisiertes PMMA (p < 0,001). Der CAD/CAM-PMMA-Kunststoff P wies vor und nach
der Temperaturwechselbelastung die höchste, konventionelles PMMA die geringste Biegefestigkeit auf (p < 0,001).
Bei den Ra-Werten der getesteten Prothesenkunststoffe fanden sich in der Kontrollgruppe keine signifikanten
Unterschiede (p  >  0,05). In der thermozyklisch belasteten Gruppe wurde der niedrigste R a-Wert für den CAD/
CAM-PMMA-Kunststoff M beobachtet (p < 0,001), während die CAD/CAM-PMMA-Kunststoffe A und P sowie
das konventionelle PMMA vergleichbare Ra-Werte zeigten (p > 0,05). In der Kontrollgruppe hatte konventionelles
PMMA einen signifikant kleineren Kontaktwinkel, war also hydrophiler als die CAD/CAM-Kunststoffe (p < 0,01). In
der Temperaturwechselbelastungsgruppe wiesen der CAD/CAM-Kunststoff A und konventionelles PMMA einen
signifikant größeren Kontaktwinkel auf, waren also hydrophober als die CAD/CAM-Kunststoffe M und P (p < 0,001).
Weitere signifikante Unterschiede zwischen einzelnen Materialien fanden sich hier nicht (p > 0,05).
Schlussfolgerung: Die Biegefestigkeit und die Hydrophobizität PMMA-basierter CAD/CAM-Kunststoffe waren höher
als die von konventionell heißpolymerisiertem PMMA, während die Ra-Werte von CAD/CAM-PMMA-Kunststoffen
und konventionell polymerisiertem PMMA vergleichbar waren. Eine Temperaturwechselbelastung wirkte sich signifi-
kant auf die Biegefestigkeit und die Hydrophobizität, nicht jedoch auf die Rauheit der Prothesenmaterialien aus.

40 International Journal of Computerized Dentistry 2018;21(1):31–40