Original Article

Comparative study on the microbial adhesion to acetal resin

and metallic removable partial denture
MA Al-Akhali, bds*, MW El-Kerdawy, phd**, ZA Ibraheim, phd, NA Abbas, phd
*Graduate Student, **Assistant Professor, Professor, Department of Prosthodontics, Faculty of Oral and Dental Medicine, Associate Professor,
Medical Microbiology and Immunology, Faculty of Medicine, Cairo University, Cairo, Egypt.

Abstract
Since the fitting surface of the denture base promotes colonization of micro-organisms, it is important to know how the different types of
denture base prevent or promote the colonization of micro-organisms. This study aimed to compare the adhesion of micro-organisms to the
fitting surface of acetal resin, metallic removable partial denture (RPD) bases, and mucosa beneath them using the same environmental condition in patient class III mod 1 Kennedy classification. Seven partially edentulous patients, having lower bilateral posterior bounded saddles
and a RPD constructed from two bounded base saddles, one from acetal resin and the other from cobaltchromium (CoCr) metal were
selected. The fitting surfaces of the denture bases and mucosa beneath them were swabbed before and after insertion at 1 week, 2 weeks, and
4 weeks follow-up periods. Microbial adhesion was determined by counting the colony forming units (CFU) of the micro-organisms in the
collected specimens. The mucosa under the acetal denture base retained more micro-organisms than the mucosa under the metallic denture
base, and the colonization of micro-organisms increased by time on mucosa and on a denture base made either by metal or acetal resin.
The study recommended the use of CoCr as denture base in short span bounded saddle in patients highly susceptible to infection.
Keywords: Acetal resin, CoCr metal, denture base, micro-organisms

INTRODUCTION
The materials used to make the denture base are fast becoming a reservoir of micro-organisms and act as a potential
pathogenic factor contributing to the health of the patient.
Continuous progress in the area of materials science and
increasing expectations of both doctors and patients cause
the manufacturers of stomatological materials to introduce
more perfect and modern products to the market. The dental
prosthesis should be constructed and fit in such a way that
rather than becoming an iatrogenic factor, it should fulfill its
therapeutic and preventive role.1
Several types of polymers and metal alloys that have been
used in the removable partial denture (RPD) construction,
are becoming a potential pathogenic factor with oral mucosa
being in contact with this material.2 Metallic alloy such
as titanium,3 precious and nonprecious metal alloy,4 and
Correspondence: Dr. MA Al-Akhali, Graduate Student, Department of
Prosthodontics, Faculty of Oral and Dental Medicine, Cairo University,
Cairo, Egypt.
E-mail: dent.majed@yahoo.com
Received: 17.09.2011
Accepted: 19.12.2011
doi: 10.1016/S0975-962X(12)60002-1
2012 Indian Journal of Dentistry. Published by Elsevier Ltd.

nonmetallic alloy such as acrylic denture base, nylon,5 lucitone 199,6 and acetal resin,79 are some to of the materials
commonly used. Base metal alloys, such as cobaltchromium
(CoCr) and nickelchromium (NiCr), have been widely
used in the fabrication of fixed and RPD frameworks.4 Acetal
resin (polyoxymethylene) is a polycrystalline structure; it is
an injection-molded resin and has been introduced as
an alternative to the conventional polymethyl methacrylate
(PMMA). Acetal resins are formed by the polymerization of
formaldehyde, which has been shown to have good physical,
mechanical, and biological prorerties.10,11
Among the properties required of the materials used in
denture construction, are those related to the surface, viz.
roughness, free surface energy, surface tension, wettability,
hydrophobicity, hydrophilicity, electrostatic interactions, and
microhardness. All of them are of clinical importance since
they may affect plaque accumulation and staining. The higher
the surface free energy, the higher will be the adhesion of
micro-organisms and alternatively the more hydrophobic the
surface, the less cell adherence is expected.12 The presence of
saliva is known to change this scenario. The nature of the substratum may influence the formation and the composition of
the salivary pellicle, which may then become more relevant
than the surface properties of the dental material itself.13
1

Al-Akhali, et al

The oral deposits and micro-organisms that adhere to a

dental appliance brings about several undesirable, unpleasant,
and unesthetic effects.14 Micro-organisms may also serve as
reservoirs for disseminated infections with gastrointestinal
and pleuropulmonary involvement.15

MATERIALS AND METHOD

The two bounded edentulous spaces were equal.

The opposing dentition had a complete set of teeth, free
from systemic diseases such as diabetes mellitus, acquired
immunodeficiency syndrome (AIDS), anemia, etc. leading
to increased microbial adhesion.
Patient maintained good oral hygiene, and was free from
caries and periodontal diseases.
All participants gave a prior informed consent before enrolment, and the study was approved by the local ethical committee.

Tested Materials
Sampling
Mandibular RPD class III mod 1 were constructed from two
bounded base saddles such as the split mouth design. One
side was acetal resin denture base (Bio Dentaplast, bredent
GmbH, Senden/Witzighausen. Germany), and the contralateral side was CoCr metal denture base (Biosil F, DeguDent
A Densply Company, GmbH, Germany).
Patients
Seven partially edentulous patients were selected from the
outpatient clinic of the Prosthodontic Department, Faculty
of Oral and Dental Medicine, Cairo University. They fulfilled
the following criteria:
The selected patients had lower class III mod 1 Kennedy
classification.

Swabs were collected as follows:

From the mucosa of the edentulous spaces, before denture insertion.
From the fitting surfaces of both the acetal resin denture
base and metallic denture base, as well as from mucosa
beneath them 1 week, 2 weeks, and 4 weeks after denture
insertion (Figure 1).
Sample Processing
Samples were serially diluted to 101, 102, and 103. Around
100 L of each dilution were spread onto the surface of
blood agar (Oxoid Ltd., Cambridge, UK). Bacterial counts
in different samples were calculated (using plate counting

Figure 1 Swabs were taken from: (A) mucosa under acetal resin, (B) mucosa under metal, (C) acetal resin tting surface, (D) metal tting surface.

Indian Journal of Dentistry 2012/Volume 3/Issue 1

Comparative study on the microbial adhesion to acetal resin and metallic removable partial denture

method) by counting the colony forming units (CFUs) on

the blood agar plates (Beta Lab., Cairo, Egypt).
Statistical Analysis
Statistical analysis was performed with SPSS 16.0
(Statistical Package for Scientific Studies SPSS, Inc.,
Chicago, IL, USA) for Windows. Data were presented as
mean and standard deviation (SD) values. Paired t-test was
used to compare between the two types of partial dentures.
Repeated measures analysis of variance (ANOVA) was used
for studying the changes by time within each group. The
significance level was set at p 0.05.

RESULTS
The results obtained are as listed in the Tables 13.

DISCUSSION
A successful partial denture must meet important criteria:
function, comfort, cost, and built-in performance, in addition to easy cleanliness and ability to prevent the adhesion of
micro-organisms on its surface, as it has been demonstrated

by the majority of studies worldwide.2,3,16 The present study

showed that the colonization of micro-organisms on the
mucosa under the acetal resin denture base was more than
the colonization under the CoCr denture base, which may
be due to the role of surface properties such as surface
free energy, surface roughness, role of saliva, bacteria and
Candida interaction, and temporal changes. Microbial adhesion is a very complicated process affected by many factors,
including the shear rates which result in higher microbial
detachment forces.12,17
In the present study, microbial colonization to the CoCr
denture base was more than the colonization to the acetal
resin denture base. These results agreed with many authors,
who found that among the different materials researched
minimal adhesion to acetal resin was shown by Candida
albicans, almost 10 times smaller in relation to all other
bacterial strains evaluated. Furthermore, metal materials
showed greater adhesion, particularly with samples polished
mechanically, as the coarse surfaces create good retention
for micro-organisms.1,18,19 However, the adhesion of certain
micro-organisms regardless of the polishing method was
large; it might be related to an affinity of those microorganisms with some components of the metal alloy and the
acceleration of biocorrosion by providing retentive niches.1,20
To sum up, these metallic alloys should therefore be eliminated to the greatest extend.

Table 1 Comparison between the two types of partial denture regarding bacterial counts (log10 values of colony forming unit).
Period

Site

1 wk after insertion

Mucosa**
Denture***
Mucosa
Denture
Mucosa
Denture

2 wk after insertion
4 wk after insertion

Acetal denture bacterial count

(mean SD)

Metal denture bacterial count

(mean SD)

p value*

6.57 0.01
6.46 0.17
6.60 0.01
6.49 0.15
6.66 0.01
6.58 0.14

6.42 0.02
6.54 0.14
6.51 0.02
6.56 0.13
6.59 0.02
6.62 0.14

<0.001
0.012
0.001
0.007
0.002
0.001

*Signicant at p 0.05, **mucosal swab beneath the acetal denture base showed statistically signicantly higher mean CFU counts than mucosal swab beneath the metal
denture base after 1 wk, 2 wk, and 4 wk, ***denture swab of the tting surface of the metal denture base showed statistically signicantly higher mean CFU counts than the
tting surface of the acetal denture base after 1 wk, 2 wk, and 4 wk. CFU: colony forming unit, SD: standard deviation.

Table 2 Comparison between the two types of denture bases regarding increase in bacterial count (%)* in mucosal samples by time.
Period

Acetal denture base**

% increase in CFU (mean SD)

Metal denture base

% increase in CFU (mean SD)

p value***

7.14 0.32
7.59 0.56
8.69 0.60

4.73 0.33
6.20 0.34
7.55 0.42

<0.001
0.001
0.001

1 wk after insertion
2 wk after insertion
4 wk after insertion

CFU (before)
100, **the tting surface of the acetal denture base showed statistically signicantly higher mean % increase in
*The percentage change was calculated as: CFU (after)
CFU (before)
CFU counts than the tting surface of the metal denture base, ***signicant at p 0.05. CFU: colony forming unit, SD: standard deviation.

Table 3 Comparison between the two types of denture bases regarding increase in bacterial count (%)* in denture base samples by time.
Period

Acetal denture % increase

in CFU (mean SD)

Metal denture % increase

in CFU (mean SD)

p value**

0.59 0.25
1.95 0.51

0.46 0.01
1.26 0.07

0.366
0.078

2 wk after insertion
4 wk after insertion

CFU (before)
100, **signicant at p 0.05, there was no statistically signicant difference in the mean % increase of CFU counts
*The percentage change was calculated as: CFU (after)
CFU (before)
between the tting surfaces of the acetal and metal denture bases. CFU: colony forming unit, SD: standard deviation.

Indian Journal of Dentistry 2012/Volume 3/Issue 1

Al-Akhali, et al

The acetal resin may have anionic surface charge which

facilitates adsorption of salivary defense molecules such as
histatins and defensins. Charged acrylic resins were shown to
have a dose-related anti-microbial activity.21 A better understanding of the surface properties of both micro-organisms
and biomaterials is crucial in elucidating the mechanism of
adhesion of micro-organisms to the polymeric biomaterials.22
As demonstrated by the majority of studies worldwide,1,21
the present study demonstrates significant increase of microbial colonization to denture base and mucosa by time. On the
contrary, Katsikogianni et al stated that higher shear rates
result in higher detachment forces that result in decreasing
the number of attached bacteria, while making the biofilm
denser and thinner.17

CONCLUSION
Within the limitations of this study, it can be concluded that
the mucosa under the acetal denture base retains more microorganisms than the mucosa under the metallic denture base.
However, the fitting surface of the metallic denture base
retains more micro-organisms than the fitting surface of the
acetal resin denture base. This difference is not statistically
significant; the adhesion of micro-organisms on mucosa and
denture base of either the metal or acetal denture increases
by time.
Under the conditions of this study we recommend metallic denture base for patients complaining of gastrointestinal
or pleuropulmonary diseases to avoid disseminated infections. Edentulous patients with RPD should clean the
mucosa under the denture base as well as the denture itself
properly. The study recommended the use of CoCr as denture base in short span bounded saddle in patients highly susceptible to infection. Multiple factors such as surface free
energy, surface roughness, role of saliva, shear rates, wettability, and surface charge affecting microbial colonization
and temporal changes such as the rehabilitation material
chosen in clinical situations has to be further investigated.

ACKNOWLEDGMENT
I would like to thank Hi-Tech dental lab and all staff members of the Microbiology Department who participated in
this work.

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