Effect of Two Cleansing materials on hardness and surface

roughness of conventional and 3D printed Denture Base Materials

*Gehan El-olimy , ** Amel Salem

lecturer of dental materials, Faculty of Dentistry, Tanta University,*

Egypt

lecturer of Prosthodontic, Faculty of Dentistry, Tanta University, **

Egypt

Abstract

Aim the aim of this study was to compare the effects of two different
cleansing materials on hardness and surface roughness of conventional
heat cure (PMMA) and 3D printed . Materials &methods A total of 140
specimens were tested for surface hardness and surface roughness. The
samples of each denture base type (n.=70) were randomly divided into 7
subgroups each one is 10 samples. First subgroup was stored in distilled
water 2nd , 3rd & 4th subgroups were immersed for 18 , 36 &54 days
into corega denture cleanser respectively .5th , 6th & 7th subgroups were
immersed for 18 , 36 &54 days into Aloevera respectively. Results At
baseline , The roughness of the 3d printed resin was significantly lower
than the conventional (PMMA) and The hardness of the 3d printed resin
was significantly higher than the conventional (PMMA). Considering
the different types of cleaning gent, there were non significant difference
in hardness of 3d printed and conventional denture base resin comparing
Corega and Aloe vera. There were significant difference in roughness
of 3d printed nd conventional denture base resin comparing Corega and
.Aloe vera

Introduction

Edentulism is a highly prevalent condition globally (1)Complete dentures

are the most common treatment for the rehabilitation of complete
edentulism.(2).Poly methyl methacrylate will still be the well-
liked material of choice for the fabrication of complete
denture prostheses. (3) Enhancements in science and innovation have
given digital methods for denture base creation, including computer-aided
design/computer-aided manufacturing (CAD/CAM) . . The benefits of
computerized strategies are quicker denture creation and fewer stages in
the work interaction, which can decrease the chance of errors. With
computer-aided manufacturing (CAM), the denture could be fabricated
by subtractive or additive manufacturing. Additive manufacturing by 3D
printing includes adding layers of resin material, incrementally light-
activated, to construct the denture base. (4)There are currently new 3D-
printed materials from different dental producers for denture base
construction. While the mechanical properties of heat polymerized
(PMMA) have been researched and reported, the evidence of
performance of three-dimensionally printed resin is lacking (5) (6) Proper
denture hygiene is crucial to maintaining oral health.. Deficient cleaning
of removable dentures advances the aggregation and adhesion of denture
biofilm. It has been generally revealed that denture biofilm is a reservoir
for pioneering microorganisms that can cause Candida-related denture
stomatitis or even systemic infections.(7)(8) Denture cleaning material
may be chemical or natural denture cleaning material. Among the natural
denture cleanser, Aloe vera is successful, available, and economical one.
Aloe vera is the oldest therapeutic plant ever (9) It can be utilized as a
viable therapeutic plant against Candida albicans(10) ideal denture
cleansers should have antibiofilm activity without negative impacts on
the properties of the materials utilized for the fabrication of denture bases.
(11) Roughness presents on denture surfaces gives a favorable place to
retain biofilm and make its removal difficult.(12) Surface hardness and
surface roughness testing are routinely utilized for analyzing the surface
mechanical properties of denture base materials (13)(14) Because
cleanliness strategies have been shown to alter the mechanical properties
of acrylic resins, the aim of this study was to compare the effects of two
different cleansing materials on hardness and surface roughness of
conventional heat cure (PMMA) and 3D printed .

MATERIALS AND METHODS

Two types of denture base resins were studied in this research

1- conventional heat cure PMMA (Acrostone; Acrostone Dental

Manufacturer, Egypt)
 2- Resin for 3D printing (NextDent Denture 3D+ , Soesterberg،
Netherlands)

Also two kinds of denture cleansers were studied in this research

Aloe Vera 100% gel concentrate ( Vital care of No., LTD, Dist. -1
America ) ingredients: water, propylene glycol, phenoxyethanol,
carbomer, polysorbate 20, aminomethyl propanol, chorphenesin,
.fragrance, tetrasodium EDTA, aloebarbadensis, leaf juice

2- Corega. (Corega Denture Cleanser Tabs, GSK, Egypt). Corega

cleansers contain four active ingredients which work in parallel to
maintain denture hygiene Potassium caroate, Tetra acetyl ethylene
diamine (TAED), Sodium carbonate peroxide, and Sodium lauryl
sulfoacetate

Samples preparation

A total of 140 specimens of dimensions 3 mm thickness ,10 mm width ,

10 mm length were tested for surface hardness and surface roughness.
All denture base samples were constructed according to the
manufacturers’ instructions The heat-polymerized acrylic samples were
constructed utilizing the compression molding method. A square wax
pattern blocks were prepared using a custom made metallic mold A
square templates made of wax were invested with gypsum.in denture
flasks Short-cycle polymerization in a water bath at 72°C for 1.5 h,
followed by 30 min boiling in 100°C water was performed . After curing
& bench cooling,the specimens were deflasked. ..

A square block was designed by ( Meshmixer Autodesk, California,

USA) and saved as a standard tessellation language (STL) file; the 3D-
printed samples were printed according to the obtained STL file. Using
the STL, the 3D printing was conducted using (Epax 3d , North Carolina,
.USA)

All specimens were finished with no. 120, 200, 800 silicone carbide
grinding papers and polished with 1000 grade abrasive waterproof paper,
rinsed with tap water, and air dried. Specimens were polished using a
slurry of water and pumice with brush wheel followed by a slurry of tin
oxide with a cloth wheel. All samples were polished with only one
operator , to guarantee nearly the same pressure of the polishing tools on
the samples.

Soaking procedures

All the specimens were stored in distilled water at room temperature for
2 days . The samples of each denture base type (n.=70) were randomly
divided into 7 subgroups each one is 10 samples. Each subgroup was
soaked into the same container

First subgroup was stored in distilled water

2nd , 3rd & 4th subgroups were immersed for 18 , 36 &54 days into
. corega denture cleanser respectively

5th , 6th & 7th subgroups were immersed for 18 , 36 &54 days into
.Aloevera respectively

:The cleansers preparation

Corega solutions were prepared according to the manufacturer’s

instruction , by dropping one corega tablet into 200 mL of warm water
(40 °C)

Aloe Vera solutions were prepared by dissolving properly 2.5 gm of

aloevera gel in 200 mL warm water

After 5 minute soaking , the resin samples were removed from the
cleansing solution, and Rinsed thoroughly with running water The
sessions of soaking was repeated 10 times daily Between the immersion
procedures the specimens were saved in distilled water, at room
temperature. The 18 ,36 & 54 days simulating 6, 12, 18 months of
.cleansing by the patient respectively

Assessment

Surface Micro-hardness of the specimens was determined using Digital

Display Vickers Micro-hardness Tester (Model HVS-50, Laizhou Huayin
Testing Instrument Co., Ltd. China) with a Vickers diamond indenter and
a 20X objective lens. A load of 100g was applied to the surface of the
specimens for 15 seconds. Three indentations, which were equally placed
over a circle and not closer than 0.5 mm to the adjacent indentations,
were made on the surface of each specimen. The diagonals length of the
indentations were measured by built in scaled microscope and Vickers
values were converted into micro-hardness values. Five measurements
were taken for each pair and the mean used for statistical analysis.

For the determination of surface roughness values, Surface Profile Gage

(Positector, SPG, Deflesko Corporation, New York, USA) was used. It is
a hand-held electronic instrument that measures the peak-to-valley height
of the surface profile of the surfaces. It consists of PosiTector body and
built-in probe. The gage is turned on and its probe is carefully applied to
the surface to be measured. Five readings were taken for each specimen
and then averaged. The mean of the examined specimens was taken as
the surface roughness of the material.

Results

All tests were performed using a confidence level of 95% (α=.05).

At baseline , The hardness of the 3d printed resin was (44.26 ±1.2),

which was significantly higher than the conventional (PMMA)
.(42.62±0.6). (t-test)

At baseline , The roughness of the 3d printed resin was (0.143± 0.05)

µm, which was significantly lower than the conventional (PMMA)
.(0.204±0.037) µm. (t-test)

Considering the different types of cleaning gent, There were non

significant difference in hardness of 3d printed denture base resin
comparing Corega and Aloe vera at 18 days, 36 days and 54 days (t-
test) .Also , There were non significant difference in hardness of
conventional acrylic resin comparing Corega and Aloe vera at 18 days, 36
days and 54 days (t-test)

There were significant difference in roughness of 3d printed resin

comparing Corega and Aloe vera at 18 days, 36 days and 54 days (t-test)
Also , There were non significant difference in roughness of
conventional acrylic resin comparing Corega and Aloe vera at 18
days ,while there were significant difference at 36 days and 54 days
comparing Corega and Aloe vera (t-test)
Roughness ( µm)
Time Resin type Corega Aloe vera P value
cleaning cleaning
material material

Base line conventiona

l PMMA 0.204±0.037
Group I
At 18 days conventiona 0.202±0.036 0.207±0.038 0.7
l PMMA
Group I
At 36 days conventiona 0.229±0.04 0.210±0.04 0.000*
l PMMA
Group I
At 54 days conventiona 0.265±0.026 0.235±0.05 0.006*
l PMMA
Group I
Base line 3D printed 0.143± 0.05
resin
At 18 days 3D printed 0.235±0.029 0.183±0.045 0.007*
resin
At 36 days 3D printed 0.240±0.04 0.185±0.06 0.000*
resin
At 54 days 3D printed 0.255±0.011 0.024*
0.224±0.035
resin
Table (1) Roughness values ( µm) of conventional heat cure acrylic resin and 3d printed resin
at base line and after immersion in Corega and Aloevera cleaning materials for different
periods

Hardness
Time Resin type Corega Aloe vera P value
cleaning cleaning
material material

Base line conventional

PMMA 42.62 ± 0.68
Group I
At 18 days conventional 42.48±1.23 42.04±1.09 0.4
PMMA
 Group I
At 36 days conventional 41.57±0.90 41.78±0.63 0.5
PMMA
Group I
At 54 days conventional 41.06±0.91 41.19±1.12 0.7
PMMA
Group I
Base line 3D printed 44.26 ± 1.26
resin
At 18 days 3D printed 44.19±0.89 43.86±0.90 0.4
resin
At 36 days 3D printed 42.44±1.23 42.00±1.07 0.3
resin
At 54 days 3D printed 41.76±0.91 0.5
41.55±0.73
resin
Table (2) Hardness values of conventional heat cure acrylic resin and 3d printed resin at
base line and after immersion in Corega and Aloevera cleaning materials for different
periods.

Discussion

This study compared the hardness and roughness of conventional denture

base acrylic resin and 3d printed denture base resin. In addition to
comparing the effect of Corega and Aloe vera cleaning agent on the
hardness and roughness of conventional acrylic resin denture base and 3d
printed denture base resin.
Poly (methyl methacrylate) (PMMA) resin has been widely used as a denture base
material due to its desirable properties of excellent aesthetics, low water sorption and
solubility, relative lack of toxicity, ability to repair, and simple processing techniques
(15) Many attempts have been made to overcome the drawbacks associated with the
conventional method of denture fabrication and to improve the properties of
polymethylmethacrylate (PMMA) material (16) The digital denture is one of the
recent improvements . The digital path of denture fabrication involves the digitization
of the information captured from the patient utilizing specific software .(17) Once the
denture is digitally designed, it is saved as a Standard Tessellation Language (STL)
file. Following that, the denture is manufactured using either an additive three
dimensional (3D-printing) or subtractive (computerized numerical controlled milling)
technique(18,19). Milling is popular for manufacturing dentures, but 3D-printing
provides significant advantages. It is more economical; it does not involve the wear of
rotary tools, or the waste of raw materials, and permits the simultaneous
manufacturing of multiple products(20,21).

Denture hygiene and disinfection have been recommended as an essential practice for
preventing cross-contamination and the maintenance of a healthy oral mucosa .(22,23)
Several agents are indicated for denture disinfection and maintaining the health of
denture, classified into mechanical and chemical agents (24). A disinfection method
should be effective without detrimental effects on the properties of materials used for
fabrication of denture base(25). Properties that are mainly affected by denture
cleansers are hardness and surface roughness, hardness, and these are very important
for long-term success of any prosthesis(22)

Hardness is a measure of the resistance to localized plastic deformation induced by

either mechanical indentation or abrasion(26). Hardness influences the surface
characteristics of denture base material as it facilitates the prosthesis finishing and
maximizes its resistance to abrasion and scratching during service and cleansing(27)
Dentures made of a material with low surface hardness can be damaged by
mechanical brushing, causing plaque retention and pigmentations, which can decrease
the life of dentures(26).

The surface roughness of the denture base is a contributing factor for the
accumulation of plaque,the adherence of Candida albicans and bacterial
colonization(28). Because there is no mention of roughness measurement in the
International Standards Organization ISO 1567 for denture base resins, surface
roughness tester was used for roughness measurements by measuring peak to valley
height and computing the numeric values representing the roughness of the profile as
Ra. The Ra value describes the overall roughness of a surface and is defined as the
arithmetic mean value of all absolute distances of the roughness profiles from the
center line within the measuring length.
During clinical use of dentures, several disinfection solutions may be
used for denture cleaning and stomatitis control, It appears that different
materials acted differently once exposed to various cleaning agent.(29)

The null hypothesis that no difference of hardness and roughness would

be found among conventional acrylic resin denture base and 3d printed
denture base resin was rejected because statistical differences were
observed among these materials. The results of this study demonstrated
that the 3D printed resin in this study (NextDent Denture 3D+ ) presented
lower initial surface roughness values and higher initial surface hardness
compared to those of the heat-cured PMMA . Previous studies that
assessed the mechanical properties of 3D printing denture base materials
and compared them with conventional heat-cured PMMA used for
denture bases are scanty.

The higher surface hardness of the 3D printed resin in this study (Epax
3d), compared to the heat cured PMMA, may be attributed to less human
error in the automated processing and the resin’s compositional effects on
mechanical properties. The hardness between the 3D printed and
conventional heat-cured PMMA in this study were similar to the findings
in a study by Vladimir Prpi et al., which compared the hardness of three
brands of conventional heat-polymerized, three brands of CAD/CAM,
one 3D-printed, and one polyamide material fabricated denture base
resins.(6) In their study, the authors reported a varying range of hardness
among heat-cured PMMA. One of heat-cured PMMA was significantly
lower than the 3D-printed as in this study; however, another heat-cured
PMMA was higher than the 3D-printed. Therefore, different resin brands
may contribute to differences in mechanical properties such as hardness.

The surface roughness between the 3D printed and conventional heat-

cured PMMA in this study were similar to the findings in a study by
Fernandez et al, (30) . They reported that, the 3D printed specimens
demonstrated lower surface roughness than conventionally produced after
polishing.

The second null hypothesis that both disinfection solutions were used in
this study could be used without adverse effects on the surface hardness
of the conventional heat cured (PMMA) and 3D printed denture base was
accepted. Because The hardness of the conventional heat cured (PMMA)
 and 3D printed denture base resin specimens were not affected by either
Corega or Aloe vera . These findings were similar to the findings in a
study by Machado et al (31) which evaluated the effect of chemical
disinfection solutions on hardness of conventional heat cured (PMMA).

While the third null hypothesis that both disinfection solutions Corega
and Aloe vera could be used without adverse effects on the surface
roughness of the conventional heat cured (PMMA) and 3D printed
denture base was rejected. Because . Corega created more surface
roughness than Alovera of both denture base samples.

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