|Year : 2013 | Volume
| Issue : 4 | Page : 150-153
Effect of 3 types of antifungal agents on hardness of 2 different commercially available tissue conditioners: An in-vitro study
Vijeta Jadhav, M Mitha Shetty, N Kalavathy, Roshan Kumar
Department of Prosthodontics, D.A.P.M.R.V. Dental College, Bengaluru, Karnataka, India
|Date of Web Publication||22-Jan-2014|
D.A.P.M.R.V. Dental College, J.P. Nagar 1st Phase, Bengaluru - 560 078, Karnataka
Objectives: The primary objective of the following study is to evaluate and secondary objective is to compare the hardness of two different tissue conditioners before and after the addition of three types of antifungal agents. Materials and Methods: Two types of tissue conditioners: viscogel and coe-soft were manipulated with three types of antifungal agents (fluconazole, clotrimazole, neem) and placed in the metal mold as per the manufacturer's instructions. A total of 240 samples were fabricated and divided into two groups of 120 samples each and were grouped as, T1 - Viscogel., T2 - Coe-soft. These were subjected to hardness test on 1 st , 7 th 14 th days with the Shore-A-Durometer equipment. Results: Tissue conditioners showed an increase in hardness values with the use of antifungal agents in all the groups. Conclusion: The study can be concluded that hardness of Viscogel was statistically significant when mixed with fluconazole and compared with coe-soft as on 1 st day, 7 th day and 14 th day.
Keywords: Clotrimazole, coe-soft, fluconazole, neem, Shore-A-Durometer, Viscogel
|How to cite this article:|
Jadhav V, Shetty M M, Kalavathy N, Kumar R. Effect of 3 types of antifungal agents on hardness of 2 different commercially available tissue conditioners: An in-vitro study. SRM J Res Dent Sci 2013;4:150-3
|How to cite this URL:|
Jadhav V, Shetty M M, Kalavathy N, Kumar R. Effect of 3 types of antifungal agents on hardness of 2 different commercially available tissue conditioners: An in-vitro study. SRM J Res Dent Sci [serial online] 2013 [cited 2020 Jun 1];4:150-3. Available from: http://www.srmjrds.in/text.asp?2013/4/4/150/125590
| Introduction|| |
Tissue conditioning materials were introduced about 50 years ago.  These are soft, resilient, temporary relining materials which by reducing and evenly distributing stresses on the mucosa of the basal seat, have a rehabilitating effect on unhealthy tissue and allow the condition to return to normal health.  Denture stomatitis affects 65% of healthy adult mouths.  Candida albicans is considered as a primary etiologic agent for denture stomatitis even though other factors such as stress, vitamin deficiency, ill-fitting dentures also can cause denture stomatitis.  The aim of the antifungal therapy (denture cleaning, disinfection and topical medication) prior to the construction of a new prosthesis is the reduction of acute candidal overgrowth to levels that can be controlled by the host's defenses.  The incorporation of antifungal agents into tissue conditioners was shown to be effective and viable. ,,, Many of the studies were done on the properties of tissue conditioner modified with nystatin antifungal agent. Nevertheless, this association between tissue conditioner and antifungal agents can modify the physical and mechanical properties of the tissue conditioning materials.  Neem leaf and its constituents have been demonstrated to exhibit immunomodulatory, anti-inflammatory, antihyperglycaemic, antiulcer, antimalarial, antifungal, antibacterial, antiviral, antioxidant, antimutagenic and anticarcinogenic properties. 
| Materials and Methods|| |
A rectangular metal mold of dimension 65 mm length, 10 mm width and 2.5 mm thickness, according to ADA specification no. 12 was fabricated. Tissue conditioner was manipulated and placed in the metal mold as per the manufacturer's instructions. The respective antifungal agents were also added to the tissue conditioner powder at the time of manipulation. The control group (G) was manipulated without antifungal agents. A total of 240 samples were fabricated in this manner. They were divided into 2 groups of 120 samples each which were as follows: Group T1 - Viscogel, Group T2 - Coe-soft. These groups were further subdivided into 4 groups of 30 samples each as shown in [Table 1]. Each of the above groups was further divided into three groups of 10 samples each to evaluate the hardness at 1 day, 7 days and 14 days. These groups were identified as per [Table 2] for the T1 group and [Table 3] for the T2 group.
| Results|| |
A total of 240 samples were fabricated. These samples were divided as follows for the hardness test in each group. Descriptive statistical analysis was carried out in the present study. Results on continuous measurements were presented on mean ± standard deviation (Min-Max) and results on categorical measurements were presented in number (%) [Table 4]. Significance was assessed at 5% level of significance. The following assumptions on data were made [Table 5].
|Table 4: Comparison of effect of 3 types of antifungal agents with 2 different commercially available tissue conditioners based on hardness|
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Assumptions: (1) Dependent variables should be normally distributed, (2) samples drawn from the population should be random and cases of the samples should be independent.
Analysis of variance (ANOVA) was used to find the significance of study parameters between three or more groups, post-hoc Tukey test were used to find the pair wise significance.
ANOVA: F test for K population means
To test the hypothesis that K samples from K Populations with the same mean.
The mathematical model that describes the relationship between the response and treatment for the one-way ANOVA is given by
Yij = μ + τi + ∈ij
Where Yij represents the jth observation (j = 1, 2, ...n i) on the ith treatment (i = 1, 2, ..., k levels)
It is assumed that populations were normally distributed and have equal variance. It was also assumed that samples were independent of each other.
The Statistical software namely SAS 9.2, SPSS 15.0, Stata 10.1, MedCalc 9.0.1, Systat 12.0 and R environment version 2.11.1 were used for the analysis of the data and Microsoft word and Excel were used to generate graphs, tables etc.
| Discussion|| |
Acrylic or silicone soft liners act as shock absorber and are used as a therapeutic measure for patients who cannot tolerate stresses induced by dentures. These materials are often used in management of edentulous patients who suffer from chronic pain, traumatized oral mucosa due to prolonged contact between the rigid denture base materials and the underlying tissues.  However, despite their vast clinical benefits, the most challenging factor in the use of long and short-term soft liners is their tendency to support the growth of C. albicans due to material porosity, water absorption and diffusion of nutrient materials. This is further complicated by the difficulty of cleaning most of the liners with routine mechanical or chemical methods. Therefore, prevention of the growth of C. albicans has focused on the use of antifungal medications.  The Candida-associated denture stomatitis is a common condition characterized by generalized inflammation of the palatal mucosa covered by the denture. It is a harmless form of oral candidiasis and is associated with a quantitative increase of yeasts on the mucosa and the tissue surface of the denture base. 
Usually a mixture of Candida species such as Candida albicans, Candida tropicalis, Candida krusei, Candida guilliermondii, Candida parapsilosis, Candidaglabrata can be isolated from oral candidal lesions. Candida albicans, however, has been claimed to be the principal pathogen that has a main role in the development of oral candidiasis. ,,
Although denture induced candidiasis could be treated by various treatment modalities directed toward the oral mucosa, other treatment modalities are directed toward the denture base. ,
A number of effective antifungal agents have been administered, either topically or systemically, for management of oral candidiasis. Amphotericin B and nystatin are common topical antifungal agents, whereas azoles such as fluconazole and ketoconazole are available as systemic antifungal treatment. 
Schneid showed that chlorhexidine, clotrimazole, fluconazole and nystatin can be released from the tissue conditioner matrix, demonstrating in-vitro growth inhibition of C. albicans by these agents. This study has also proved that these four antifungal drugs can alter the mechanical and physical properties of the tissue conditioner.
A study which demonstrated that clotrimazole at 1.0% concentration by weight when incorporated into silicone samples was effective in inhibiting in-vitro growth of the fungus for 5 months at room temperature, but the effect of long-term water storage was not tested. Increasing the concentration of the clotrimazole did not increase the degree of fungal inhibition. They recommended that 1.0% concentration by weight should be used in any clinical application of this method, without endangering the mechanical and physical properties of the material. ,
An in-vitro study showed the Effect of Clotrimazole incorporation into Silicone soft Liner on fungal colonization showed that Candidal colonization on soft liners is important in the development of pathogenesis, such as denture stomatitis. It has been reported that combining anti-fungal agents into soft liners might be used in treatment and prevention of denture stomatitis and concluded that the addition of clotrimazole significantly reduced the C. albicans growth to the surface of the silicone soft liner. The samples continued to inhibit the fungal growth when they were washed daily with wet cotton for 2 months. ,
Other factors can also cause change in hardness of tissue conditioners like material contamination, porosity associated with technique, improper mixing of powder and liquid of tissue conditioners, temperature of mixing vessels etc. , Therefore, many more studies are required to evaluate and to compare hardness of tissue conditioners before and after adding antifungal agents for the clinical practice.
The main limitation of the study was that the clinical conditions were not simulated.
| Conclusion|| |
Within the limitations of the study, it was concluded that:
- The hardness values of Viscogel with antifungal agents showed an increase in hardness than without the use of antifungal agents.
- There was an increase in hardness values for coe-soft with addition of antifungal agents than without the addition of antifungal agents.
- A significant increase was shown in hardness values of Viscogel when compared to coe-soft before and after addition of antifungal agents at 1 st , 7 th and 14 th day intervals.
- On comparing the hardness values between antifungal agents with Viscogel, there was a significant increase in addition of fluconazole, followed by clotrimazole and a least value shown with neem.
- The hardness values between antifungal agents with coe-soft showed a significant increase in value with fluconazole when compared to clotrimazole and neem.
| References|| |
|1.||Chase WW. Tissue conditioning utilizing dynamic adaptive stress. J Prosthet Dent 1961;11:804-15. |
|2.||Starcke EN Jr, Marcroft KR, Fischer TE, Sweeney WT. Physical properties of tissue-conditioning materials as used in functional impressions. J Prosthet Dent 1972;27:111-9. |
|3.||Zegarelli DJ. Fungal infections of the oral cavity. Otolaryngol Clin North Am 1993;26:1069-89. |
|4.||Aldana L, Marker VA, Kolstad R, Iacopino AM. Effects of Candida treatment regimens on the physical properties of denture resins. Int J Prosthodont 1994;7:473-8. |
|5.||Urban VM, de Souza RF, Arrais CA, Borsato KT, Vaz LG. Effect of the association of nystatin with a tissue conditioner on its ultimate tensile strength. J Prosthodont 2006;15:295-9. |
|6.||Carter GM, Kerr MA, Shepherd MG. The rational management of oral candidosis associated with dentures. N Z Dent J 1986;82:81-4. |
|7.||Truhlar MR, Shay K, Sohnle P. Use of a new assay technique for quantification of antifungal activity of nystatin incorporated in denture liners. J Prosthet Dent 1994;71:517-24. |
|8.||Addy M. In vitro studies into the use of denture base and soft liner materials as carriers for drugs in the mouth. J Oral Rehabil 1981;8:131-42. |
|9.||Patel MP, Cruchley AT, Coleman DC, Swai H, Braden M, Williams DM. A polymeric system for the intra-oral delivery of an anti-fungal agent. Biomaterials 2001;22:2319-24. |
|10.||Subapriya R, Nagini S. Medicinal properties of neem leaves: A review. Curr Med Chem Anticancer Agents 2005;5:149-6. |
|11.||Vojdani M, Zibaei M, Kaaledi A. An In-vitro study of the effect of clotrimazole incorporation into silicone soft liner on fungal colonization. Shiraz Univ Dent J 2009;9:1. |
|12.||Hickey JE, Zarb GA, Bolender CJ. Boucher′s Prosthodontic Treatment for Edentulous Patients. 12 th ed. St. Louis: Mosby; 2004. p. 200-3. |
|13.||Qudah S, Harrison A, Huggett R. Soft lining materials in prosthetic dentistry: A review. Int J Prosthodont 1990;3:477-83. |
|14.||Epstein JB. Antifungal therapy in oropharyngeal mycotic infections. Oral Surg Oral Med Oral Pathol 1990;69:32-41. |
|15.||Veg RG. A modified chew in and functional impression technique. J Prosthet Dent 1964;14:2.214-20. |
|16.||Bultz-Jorgensen F. The significance of Candida aldicans in denture stomatits. Scand J Dent Res 1974;82:51. |
|17.||Douglass WH. Dental materials as carriers for therapy. Dent Update 1977;4:395. |
|18.||Lamb DJ, Martin MV. An in vitro and in vivo study of the effect of incorporation of chlorhexidine into autopolymerizing acrylic resin plates upon the growth of Candida albicans. Biomaterials 1983;4:205-9. |
|19.||Budtz-Jörgensen E, Theilade E. Regional variations in viable bacterial and yeast counts of 1-week-old denture plaque in denture-induced stomatitis. Scand J Dent Res 1983;91:288-95. |
|20.||Dootz Er, Koran A, Craig RG. Comparison of the physical properties of 11 soft denture liners. J Prosthet Dent 1992;67:707-12. |
|21.||De Mot B, De Clercq M, Rousseeuw P. Visco-elastic properties of four currently used tissue conditioners. J Oral Rehabil 1984;11:419-27. |
|22.||Okita N, Orstavik D, Orstavik J, Ostby K. In vivo and in vitro studies on soft denture materials: Microbial adhesion and tests for antibacterial activity. Dent Mater 1991;7:155-60. |
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]