NANOTECHNOLOGY IN PROSTHODONTICS

INTRODUCTION
Prosthodontics is an important branch of dentistry. The main purposes of oral prosthesis are
to restore function, facial appearance and maintain the patient’s health.

In recent years, nanomaterials have captured more and more attention because of their
unique structure and properties. Researchers started studying and using various nanomaterials not
only in medical field but also in dentistry particularly in prosthodontics.

Nanomaterials are mainly used in ceramic, resin, and metals providing a huge space for the
improvement and innovation of dental material.

The term “nano” is derived from the Greek word “dwarf.” One nanometer is one-billionth or
−9
10 of a meter. Single hair strand has a thickness of 100,000 nm. Nanotechnology is translated as
“the science of the small”.

Nanotechnology is the production of functional materials and structures in the range of 0.1–
100 nm, the nanoscale, by various physical or chemical methods. It is formulated on the basic
principle of constructing functional structures by controlling atoms and molecules on an individual
basis. At nanoscale, quantum physics becomes significant and the behavior of surfaces begins to
govern the characteristics of bulk materials. All properties, including electrical, optical, and magnetic
ones, are altered.

Various nanoparticles are incorporated in the acrylic resin, tissue conditioner, dental
composites, dental adhesives, dental cements, dental porcelain, maxillofacial prosthesis, and
implants to improve their antimicrobial and mechanical properties

Various nanomaterials used in prosthodontics are as follows:

1. Nanoparticles in Denture Base Resins (Polymethyl Methacrylate)—

PMMA
2. Silver Nanoparticles in Tissue Conditioners
3. Nanoparticles in Impression Materials
4. Nanoceramics
5. Luting Cements and Nanoparticles
6. Dental Adhesives
7. Silver Nanoparticles in Maxillofacial Prosthesis
8. Silver Nanoparticles in Dental Implants

A. Nanoparticles in Denture Base Resins (Polymethyl Methacrylate)—

PMMA

Most of the oral prosthesis are made up of polymethyl methacrylate (PMMA).Its overall
performance is satisfactory; it is widely used for fabrication of oral prosthesis like removable
partial denture, complete dentures, and maxillofacial prosthesis. It has been shown by
researchers that PMMA denture base material may act as reservoir for many
microorganisms and has the potential to support biofilm formation. The porous surface of
denture base material (PMMA) and irregularities on anatomical surface of the prosthesis
favor the accumulation of various microorganisms. This leads to candidiasis or denture
stomatitis.

DENTURE STOMATITIS OR CANDIDIASIS

Candida species are human fungal pathogens. They are responsible of initiating a variety of
recurring diseases in the oral mucosae. Candida albicans has been shown to be most
opportunistic pathogen causing infection in the oral cavity and to be able to colonize acrylic
materials.
Candida species form biofilm on acrylic denture surfaces. This biofilm is a network of yeasts,
pseudohyphae, and hyphae surrounded by an extracellular matrix and logged into
irregularities of anatomical surface of acrylic prosthesis. Tissue invasion by these species
causes infection of the oral mucosa.
C. albicans can induce a chronic inflammatory response in the oral mucosa, described as
denture stomatitis. Denture-induced stomatitis is an inflammatory reaction of the denture-
bearing mucosa that affects approximately 60–70% of complete denture wearers.
Methods for prevention of this such as the incorporation of antimicrobial agents into the
denture base resin and into tissue conditioners have been developed. Incorporation of
nanoparticles into the acrylic resin denture base material is mainly in the form of silver and
platinum nanoparticles as an effective antimicrobial agent. Some researchers showed that
the addition of metal nanoparticles such as TiO2, Fe2O3, and silver to PMMA materials could
increase the surface hydrophobicity. Other nanoparticles such as ZrO2, TiO2, and carbon
nanotubes have been used to improve the performance of PMMA, and the results showed
that desired mechanical property enhancement can be achieved in those composites with
small amounts of nanoparticles added.
B. Silver Nanoparticles in Tissue Conditioners

Relining the ill-fitting denture with a tissue conditioner allows tissues to return to normal
health. Tissue conditioners are used in the treatment of chronic soreness from complete
dentures. Tissue conditioners are degradable with time and susceptible to microbial
colonization mainly C. albicans. Incorporation of AgNPs in the tissue conditioners could help
in the reduction of microbial colonization.
Zeolites have been incorporated by many researchers into tissue conditioner to make it
antimicrobial. Zeolites are aluminum silicate crystalline structures having void spaces
measuring 3–10 angstroms. Antimicrobial cations, such as silver and zinc, may be lodged
within the void spaces of the zeolites. As this ion availability occurs, the free cations come
into contact with the microorganisms, suppressing their development by inactivating
microbial enzymes, interrupting RNA replication, and blocking their respiration by an
oxidative process. Tissue conditioners containing (silver zeolite) SZ have been proved that
they have antibacterial effects. They showed that silver zeolite continuously releases a small
amount of silver ions into water resulting in antimicrobial activity which is not harmful to
cells.

C. Nanoparticles in Impression Materials

1. Physical properties of polyvinylsiloxane impression materials were improved by the

addition of nanosized silica. The fumed silica was effective in increasing the viscosity,
tensile strength, and maximum % strain.

2. Irreversible hydrocolloid, i.e., alginate impression powders can be mixed with water that
contains silver hydrosol nanoparticles to make an alginate impression. This will reduce
microbial cross-contamination by bacteria, yeasts, fungi, and viruses to the stone model
from the infected impression.

3. Nanofillers are added to vinyl poly siloxanes, thus producing novel addition silicone
impression materials. This material is claimed to have better properties such as flow and
improved hydrophilic properties that helps in avoiding voids in the impression and
model as well.

D. Nanoceramics

At present, ceramic dental crown mainly includes alumina and zirconia ceramic.
Nanoceramic refers to the ceramic material with nanoscale dimensions in the
microstructures phase. Compared with the conventional ceramics, nanoceramics have a
unique property.
Ceramic is brittle material; Compared to the conventional ceramics, nanoceramic has the
superior mechanical properties, such as strength and hardness.
The hardness, toughness, and strength of nanoceramics are four to five times higher
than those of the traditional materials.
 Incorporation of silver and platinum nanoparticles in dental porcelain and concluded
that the addition of silver nanoparticles and platinum nanoparticles enhanced the
mechanical properties of porcelain. The incorporation of silver and platinum
nanoparticles increased Young’s modulus and the fracture toughness of ceramics. Silver
nanoparticles increased the fracture toughness more than platinum nanoparticles.

E. Luting Cements and Nanoparticles

Antibacterial activity of luting cement is advisable when luting crowns, bridges, inlay,
onlay, and veneers.
Silver nanoparticles are used in luting cements because of their advantage that they
show antibacterial activity due to their higher surface-area-to-volume ratio. Resin
composite cement incorporated with silver-containing materials had a long-term
inhibitory effect against S. mutans and favorable mechanical properties.

F. Dental adhesives

Dental adhesives are the materials used to increase adhesion or cohesion between two
substances or between a material and tooth structure.
Silane is added to dental adhesives in order to increase the cohesive strength.
Since the adhesive liquid is not very viscous, the filler particles tend to settle out during
storage which leads to inconsistency in their performance. To overcome this
disadvantage, discrete silane-treated nanoparticles of silica or zirconia in the size range
of 5–7 nm are added to dental adhesives.

G. Silver Nanoparticles in Maxillofacial Prosthesis

Maxillofacial prostheses are used to restore lost facial parts. Candida albicans infection
remains a problem for maxillofacial prostheses made of silicone, as the microorganism
causes degradation of the material and infection of the tissue.
The intaglio or anatomical surface of maxillofacial prostheses is exposed salivary and
nasal secretions. That is why these prostheses are susceptible to biofilm formation and
colonization by microorganisms, with subsequent degradation of the prosthesis.
The coating of silicone materials with AgNPs could be of great use to prevent fungal
infection for patients with maxillofacial prostheses.
silicone prosthetic materials coated with AgNPs showed antifungal properties without
appreciable adverse effects on human dermal fibroblast cells.

H. Silver Nanoparticles in Dental Implants

Due to the interaction of the implant surface with bone and gingival and also, partial
exposition of implant to the oral cavity that includes bacteria, fabricating a coating
material with both antimicrobial activity and biocompatibility is important and leads to
implant success.
 Nanoparticles have also been used as coatings to the implant surface to improve
osseointegration.
Coating of bioinert nanomaterials like zirconium and aluminum over titanium implant
surfaces may change the physical properties and enhance the osteogenic potential of
implants.
It has been also reported that materials such as titanium nanotubes are able to increase
the density of osteoblast cells on the implant that may lead to better implant stability
Al2O3 nanoparticles help in osseointegration and in the healing process around dental
implant. It helps in new bone formation with haversian canals, osteoblast, and osteocyte
and also improves mechanical properties of dental implants.
After implantation, titanium surfaces are prone to bacterial colonization that could lead
to bacterial infection, inflammation, and finally lead to implant failure. Silver
nanoparticles (AgNPs) are known as antibacterial agents, and their integration to
titanium surfaces decreases the risk of implant failure.