Comparative Evaluation of Two Antifungal Agents Incorporated in Auto Polymerising Denture Base Resin, Heat Polymerising Denture Base Resin and Permanent Silicone Soft Liner-An In-Vitro Study

Introduction: Denture-induced candidiasis is a common disease in elderly denture wearers with Candida albicans as the principal causative agent. The problem is aggravated for elderly patients with limited motor skills who fail to follow a strict antifungal drug regime. To overcome this and to avoid the formation of biofilm on denture base resins, several attempts to incorporate antifungal agents/antiseptics into denture base resins, denture reliners and tissue conditioners have been reported. No study has been done to incorporate any herbal extract into polymeric systems and shows its elution and to compare it with commercially available antifungal drug. Aim: To evaluate the leaching of fluconazole and herbal neem extract incorporated into auto polymerising acrylic resin, heat polymerising acrylic resin and permanent silicone soft liner over a period of 21 days. And comparatively evaluate the effect of the leached antifungal agents on the growth of Candida albicans in-vitro. Materials and Methods: A total of 60 samples; 20 each of auto polymerising acrylic resin, heat polymerising acrylic resin and permanent silicone soft liner, (10 samples in each group incorporated with 10% w/w herbal neem extract and the other 10 with 10% w/w fluconazole), were fabricated using a stainless steel die of specific dimensions (50 +/- 1 mm in diameter and 1.0 +/- 0.05 mm thickness), as per the American Dental Association (ADA) specification no. 12. They were subsequently checked for leaching of the antifungal agents over a time period of three weeks at the intervals of 2,14 and 21 days using the High Performance Liquid Chromatography (HPLC) apparatus. The eluates were also checked for their anti-candidal activity by measuring the zones of inhibition of each agent in all the three test groups. Results: Fluconazole exhibited significantly better elution profile and antifungal activity against Candida albicans as compared to herbal neem extract. Amongst the materials tested, permanent silicone soft liner exhibited significantly higher elution and better antifungal activity in terms of colony inhibition of Candida albicans followed by auto polymerising acrylic resin and heat polymerising acrylic resin. Conclusion: 1) Fluconazole was established to be more potent than herbal neem extract against Candida albicans; 2) Permanent silicone soft liner was established to be the most effective polymeric system for sustained release of antifungal agents up to 21 days.