RESEARCH AND EDUCATION

Inhibition of denture plaque by TiO2 coating on denture base

resins in the mouth
Tomokuni Obata, DDS, PhD,a Takayuki Ueda, DDS, PhD,b and Kaoru Sakurai, DDS, PhDc

Denture plaque may cause ABSTRACT

denture stomatitis and/or aspi- Statement of problem. Information is lacking about antiadhesion effect of titanium dioxide (TiO2)
ration pneumonia.1 Denture coating on denture base resins in the mouth.
cleaning tends to be inadequate
Purpose. The purpose of this clinical study was to investigate the antiadhesion effect of TiO2
in the elderly and people
coating on denture base resins.
requiring nursing care, result-
ing in excessive denture plaque Material and methods. Ten healthy dentate participants (mean 27 ±2 years of age) participated in
accumulation.2,3 this study. Disks and palatal appliances were made with denture base resin. They were divided into
2 groups: a TiO2-coated group and an uncoated group. A primer and a top coat containing TiO2
The high photocatalytic
were applied to the surfaces of the resin by means of an air spray. In the denture plaque staining
and superhydrophilic effects of test, resin disks were fixed to the retainer, placed in each participant’s mouth for 3 days, and stained
titanium dioxide (TiO2) have with a dental plaque-disclosing solution. The staining rate was calculated. The resin disks and
been reported, and when palatal appliances were used to measure the total number of microbes. The resin specimens
applied to dentures, they can were placed in each participant’s mouth for either 3 or 7 days and swabbed to count the total
be cleaned simply by rinsing in number of microbes. The chewing gum adherence test was performed both subjectively and
water.4-7 Two methods have objectively. Subjectively, each participant wearing a palatal appliance rated adherence using a
visual analog scale. The objective test was performed with a chewing gum adhesion test. The
been proposed for the appli-
staining rate, the total number of microbes, and the visual analog scale values were statistically
cation of TiO2 to the denture analyzed using the Wilcoxon signed rank test, and the adhesive force was statistically analyzed
base. One method is to mix using a Student t test.
TiO2 with resin.8-10 This
Results. In the denture plaque staining test, the measurement of microbes, and the resin chewing
approach causes weakening gum adherence test results, significant differences were observed between the TiO2-coated groups
and color change (whitening) and the uncoated groups.
of the denture base. A prefer-
Conclusions. TiO2 coating of the denture base acrylic resin inhibited the adhesion of microbes,
able option is to use the TiO2
denture plaque, and highly adhesive food. (J Prosthet Dent 2017;-:---)
coating method. Here, the
photocatalytic effect may be
applied to the denture without changing the mechanical TiO2 coating. Moreover, Amano et al6 reported that
properties or color of the denture base. durability of TiO2 coating with a primer against 100 000
The spray method with primer for TiO2 coating was brushstrokes could be achieved. Mori et al7 reported that
4-7,11 4
previously used. Kado et al showed that bolus TiO2 coating increased resin gloss without causing color
adhesion can be reduced by TiO2 coating. Arai et al5 change.
observed that adhesion of Streptococcus sanguinis and Based on experiments in animals, Tsuji et al11
Candida albicans to the denture base can be inhibited by reported that the TiO2 coating of denture base acrylic

a
Postgraduate student, Department of Removable Prosthodontics and Gerodontology, Tokyo Dental College, Tokyo, Japan.
b
Associate Professor, Department of Removable Prosthodontics and Gerodontology, Tokyo Dental College, Tokyo, Japan.
c
Professor, Chair, Department of Removable Prosthodontics and Gerodontology, Tokyo Dental College, Tokyo, Japan.

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Clinical Implications
TiO2 coating of the denture base acrylic resin
applied by spray inhibited the adhesion of
microbes, denture plaque, and adhesive food.
Coating a denture may improve ease of denture
cleaning. This is importance for older people
and those requiring nursing care.
resin did not irritate the oral mucosa or cause skin
sensitization. These inhibitory effects against the adhe-
sion of the bolus, S sanguinis, and C albicans are in vitro
results. Before the clinical application of TiO2 coating, the
adhesion inhibitory effect against nonspecific microbes
and denture plaque must be confirmed by placing resin
in the mouth. Therefore, the purpose of this study was to
evaluate the antiadhesion effects of TiO2 coating on
denture base acrylic resin in the mouth. The null hy-
pothesis was that no significant difference would be
found between TiO2-coated resin specimens and un-
coated resin specimens concerning microbial adhesion.
MATERIAL AND METHODS
To evaluate the antiadhesion effects of TiO2 coating on
denture base acrylic resin in the mouth, 3 tests were
performed: a denture plaque-staining test, a total mi-
crobial measurement test, and a chewing gum adherence
test. The participants were 10 healthy dentulous adults
without dental caries or periodontal disease. This study
was approved by the Ethics Committee of Tokyo Dental
College (no. 471). Acrylic resin (Procast DSP A2 and
Acron No. 3; GC Corp) specimens for the experiment
were polished using a series of abrasive paper (up to
#1000 grit). In the uncoated group, the surface of the
resin specimens was polished until buffing. In the TiO2-
coated group, the resin specimens were coated with TiO2
by using the following method. A primer (Paltitan
PTI5603S; Nihon Parkerizing Co Ltd) was sprayed for 2
seconds, using an air brush (Super Airbrush Advance;
WAVE), and was allowed to dry at 70 C for 10 minutes.
Then, a top coat containing a TiO2 coating material
(Paltitan PTI5603S; Nihon Parkerizing) was sprayed for 2
seconds and was allowed to dry at 70 C for an additional
10 minutes. The TiO2 crystals of the Paltitan used in this
experiment were anatase type and 5 to 10 nm in
diameter.
A retainer for the denture plaque staining test
was prepared by pressing 1-mm-thick polyethylene-
terephthalate (Splint Square; Yamahachi Dental Mfg
Co) to the participant’s maxillary cast. The white denture
base resin disks, 5 mm in radius and 1 mm in thickness,
were prepared using a denture base acrylic resin (Procast
DSP A2; GC Corp). These were placed at the buccal areas
THE JOURNAL OF PROSTHETIC DENTISTRY
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of left and right maxillary premolars and molars on the
retainer. Two disks in each group (4 disks in total) were
placed on each retainer, using an autopolymerizing resin
(Unifast III; GC Corp) (Fig. 1A, B). The disks were divided
into 2 groups: TiO2-coated group and uncoated group.
The disks on the retainer were placed in the mouth of
each participant for 3 days. Participants were instructed
to remove the retainer and immerse it in water when
eating, brushing, and sleeping. After 3 days, the disks
were stained with a dental plaque-disclosing solution
(GUM Red-Cote #802; Sunstar Americas Inc) and pho-
tographed using a digital camera (D3100; Nikon Corp).
From the images obtained, the percentage of the stained
area relative to the disk area (staining area rate) was
calculated by using image analysis software (Image J;
National Institutes of Health). In a preliminary experi-
ment, disks before and after placement in the mouth
were stained with the dental plaque-disclosing solution,
allowing the threshold of analyzing staining to be
determined.
For the total microbial measurement, 2 types of resin
specimens were prepared: disk and palatal appliances.
These resin specimens were made with an acrylic resin
(Acron No. 3; GC Corp). The disks were divided into 2
groups: a TiO2-coated group and an uncoated group.
Disks were attached to the retainer in the same location
as in the denture plaque staining test. Palatal resin ap-
pliances were fabricated by waxing the participant’s
maxillary cast, investing, and polymerizing. Single-arm
clasps made of 0.9-mm cobalt-chrome alloy (Fine co-
balt clasp wire; Yamahachi Dental Mfg Co) were applied
to left and right of maxillary last molars. The mucosal
surfaces of the palatal resin appliances were divided into
2 sides of the median line (broken line), and the 2 sides
were randomly allocated to the TiO2-coated and un-
coated groups by block randomization method (Fig. 1C).
Either the disk or palatal resin appliance was placed in
the participant’s mouth. The participants were instructed
to remove the resin specimen and immerse it in water
while eating, brushing, and sleeping. This test was per-
formed 4 times in each participant for the 2 types of resin
specimens (disk and palatal appliance) and for 2 dura-
tions (3 and 7 days). The types and durations were
selected at random by block randomization method, and
the interval between each test was at least 2 weeks. After
the placement period, microbes were sampled by rubbing
1 cm length in the center of the specimen using a ster-
ilized swab with 3 back-and-forth strokes under a 0.196-
N load. The used swab was then inserted into the
disposable cup with pure water. The total number of oral
microbes in the cup was counted on the surface of the
resin specimen by using a bacterial counter (DU-
AA01NP-H; Panasonic Healthcare). The device was
developed by applying the dielectrophoretic impedance
measurement method, consisting of dielectrophoresis
Obata et al
- 2017 3

Figure 1. Experimental resin specimens and retainer. A, B, Retainer prepared by pressing 1-mm-thick polyethylene terephthalate to participant’s
maxillary cast. C, Palatal resin appliance.

100 * Table 1. Mean ±SD rate of staining area, number of total microbes, VAS
n=10 values, and adhesive force for uncoated and TiO2-coated dentures
90 *P<.05
Uncoated TiO2-coated
Staining Area Rate (%)

80 Parameter Mean ±SD Mean ±SD P

70 Rate of staining area (%) 81.5 0.1 17.1 10.9 <.001
60 Total microbes (log10[CFU/mL])
50 Surface of buccal disks 3-day placement 5.8 0.1 5.3 0.1 .005
Surface of buccal disks 7-day placement 6.5 0.1 5.7 0.3 .005
40
Mucosal surface of palatal plate 3-day 6.6 0.2 5.5 0.3 .005
30 placement
20 Mucosal surface of palatal plate 7-day 7.3 0.3 6.5 0.4 .005
placement
10
VAS value (mm) 17.8 30.8 79.8 32.9 .008
0 Adhesive force (N)
Uncoated TiO2-coated
Dry 18.8 8.7 5.1 4.9 .005
Group
Glycerin 17.2 7.1 3.7 2.9 .005
Figure 2. Comparison of rates of staining areas between uncoated Water 14.3 4.9 3.8 2.3 .005
group and TiO2-coated group. *Indicates significant differences
VAS, visual analog scale.
(Wilcoxon signed rank test).

then evaluated the feeling of adhesion of the gum to the

and impedance measurement.12 Measurements of the
bacterial counter ranged from 1.00×105 to 1.00×108
colony-forming units (CFU)/mL.
The surfaces of the resin disks were observed using
scanning electron microscopy (SU6600; Hitachi). In total,
6 types of disks were observed: polished using abrasive
paper (before primer coating), coated with the primer
(before TiO2 coating; without placing in the mouth),
TiO2-coated before placing in the mouth, TiO2-coated
after placing in the mouth for 3 days, uncoated (polished
until buffing) before placing in the mouth, and uncoated
after placing in the mouth for 3 days.
The chewing gum adherence test results were evalu-
ated subjectively and objectively. Subjective evaluation
was performed using the visual analog scale (VAS).13 The
palatal appliance was prepared using the same method as
described for the total microbial measurement. The palatal
appliance was divided into 2 groups: TiO2-coated and
uncoated groups. After the experimenter had inserted the
palatal appliance, the participant was instructed to chew
3 g of chewing gum (Lotte Xylitol gum Lime Mint; Lotte
Co Ltd) for 5 minutes and to answer the question: “Did the
gum adhere to the palatal appliance?” The participant
palatal appliance, using a 100-mm VAS. “Very much so”
as the worst condition was set at the left and “not at all” as
the best condition was set at the right. The participant was
instructed to mark their subjective evaluation on each
scale. The distance between the left end and the mark was
measured, and the distance measured was set as the VAS
value.
Objective evaluation was performed by the chewing
gum adhesion test.14 Resin specimens (2×2×2 cm) were
prepared using acrylic resin (Acron No. 3; GC Corp). The
resin specimens were divided into 2 groups: the TiO2-
coated group and the uncoated group. A pair of resin
specimens was attached to the upper and lower parts of
a pulling device (MV-100; Imada Co Ltd) with a digital
force gauge (DSN2-50N; Imada Co Ltd). After a volun-
teer had chewed 3 g of chewing gum (Lotte Xylitol gum
Lime Mint; Lotte Co, Ltd) for 5 minutes, saliva on the
chewing gum was removed with a wipe (Kimwipe;
Kimberly Clark Corp). The gum was then placed be-
tween the upper and lower resin specimens and com-
pressed until the distance between the resin specimens
had narrowed to 1 mm. The upper resin specimen was
then pulled at a crosshead speed of 100 mm/minute, and

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n=10 n=10
Total Microbes [log10(CFU/mL)]

Total Microbes [log10(CFU/mL)]

8 8
*P<.05 *P<.05

7 * 7 *

6 6

5 5

4 4
Uncoated TiO2-coated Uncoated TiO2-coated
Group Group
A B

n=10 n=10
Total Microbes [log10(CFU/mL)]

Total Microbes [log10(CFU/mL)]

8 8
*P<.05 * *P<.05

*
7 7

6 6

5 5

4 4
Uncoated TiO2-coated Uncoated TiO2-coated
Group Group
C D
Figure 3. Comparison of total number of microbes between uncoated group and TiO2-coated group. A, Buccal disks after 3 days. B, Buccal disks after 7
days. C, Total number of microbes on mucosal surface of palatal appliance after 3 days. D, Total number of microbes on mucosal surface of palatal
appliance after 7 days. *Indicates significant differences (Wilcoxon signed rank test).  Outlier. Horizontal line that forms top of box is 75th percentile.
Horizontal line that forms bottom of box is 25th percentile. Horizontal line that intersects box is median. Horizontal lines above and below box, called
whiskers, represent maximum and minimum values.

the maximum force (N) during pulling was measured as
the adhesive force. The measurement was performed 7
times in each group under 3 different conditions: when
the surfaces of the resin specimens were dry, wetted with
artificial saliva (40 mL of 60% glycerin solution in water),
and wetted with distilled water (40 mL).
The staining rates, the total number of microbes, and
the VAS values were compared between the TiO2-coated
and uncoated groups, using the Wilcoxon signed rank
test, and the adhesive forces of the TiO2-coated and
uncoated groups were compared using a Student t test
(a=.05). All analyses were performed using statistical
software (IBM SPSS Statistics v22.0; IBM Corp).
RESULTS
Figure 2 shows the results of the rate of staining. Sig-
nificant differences were observed between the TiO2-
coated group and the uncoated group (P<.001) (Table 1).
Figure 3 shows the results of the total microbial
measurement test. All data under all conditions were
within the measurement range of the bacterial counter.
Significant differences were observed between the TiO2-
coated and the uncoated groups after 3 days and 7 days
of placement in disk type and palatal type resin speci-
mens (P=.005) (Table 1).
Figure 4 shows scanning electron microscopy images
of 6 disk surfaces. The disk polished with waterproof
abrasive paper (up to #1000 grit) had grooves caused by
abrasion (Fig. 4A). On the primer-coated disk (Fig. 4B)
and the TiO2-coated disk (Fig. 4C), grooves caused by
abrasion were not observed. On the TiO2-coated disk
after placement in the mouth for 3 days, adhesion of
microbes on the surface was less notable, and biofilm
formation was inhibited (Fig. 4D). The disk polished
until buffing (uncoated disk) before placement in the
mouth (Fig. 4E) had shallow grooves compared with the
disk polished with waterproof abrasive paper (up to

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Figure 4. Surface observations of specimens by scanning electron microscopy (original magnification ×6000). A, Surface before primer coating.
Polished using water-proof abrasive paper (up to #1000). Arrows point to grooves caused by abrasion. B, Surface after primer coating. C, Surface after
TiO2 coating. D, Surface of TiO2-coated group after placement in mouth for 3 days. E, Surface of uncoated group polished until buffing. Arrows point to
grooves caused by abrasion. F, Surface of uncoated group after placement in mouth for 3 days. Arrows point to microbes.

#1000 grit). In uncoated disks after placement in the
mouth for 3 days, microbes and biofilm were observed
(Fig. 4F).
Figure 5 shows the results of the chewing gum
adherence tests. On the subjective and objective tests
results, significant differences were observed between
the TiO2-coated and the uncoated groups under all
conditions (P=.008 on the subjective test, P=.005 on the
objective test under all conditions) (Table 1).
DISCUSSION
According to results of this study, the null hypothesis was
rejected. Kado et al4 reported that TiO2 coating makes
the resin surface rougher and more hydrophilic, a ten-
dency similar to that found in the wettability of the
present study. Kado et al4 reported that the water contact
angle was 68.1 ±3.4 degrees in resin surfaces. However,
TiO2 coating makes the resin surface more hydrophilic,
with a water contact angle of 7.2 ±0.4 degrees. According
to the results of this study, the total number of microbes
decreased despite the increased surface roughness of
resin specimens in the TiO2-coated group. Arai et al5
reported that TiO2 coating applied to denture base
acrylic resin inhibited the adhesion of S sanguinis and C
albicans organisms. These findings were also supported
by the results obtained in this study. TiO2 coating
improved the hydrophilicity of the surface of denture
base acrylic resin and increased hydrophilicity inhibited
the adhesion of hydrophobic microbes such as S sangui-
nis. S sanguinis is an early colonizer in denture plaque
formation,15 thus, suppressing the subsequent adhesion
of other microbes and reducing the total number of mi-
crobes adhering to denture base resin.
Mixed infections of endogenous anaerobic bacteria
in the oral cavity are the main cause of aspiration
pneumonia,16 inadequate cleaning of the denture in-
creases the number of microorganisms in saliva,17
and denture plaque is a factor in microbial proliferation
in the pharynx.18 The microbial measurement test
showed that the total number of microbes adhering to
the denture base resin can be reduced by TiO2 coating,
which may contribute to the prevention of aspiration
pneumonia.
The 3 conditions used in the objective chewing gum
adherence test for resin simulated xerostomia, healthy
state, and water intake. The results of the subjective test
also suggested that TiO2 coating inhibited the adhesion
of gum to resin in the mouth. TiO2 coating of dentures
inhibits the adhesion not only of plaque but also adhesive
foods. This would benefit not only people requiring
nursing care but all denture wearers.
The participants in this study were younger than the
population of denture wearers. According to the study by
Toida et al,19 the prevalence of reduced stimulated sali-
vary flow rate is higher in the elderly than in younger
individuals. Therefore, the younger participants tested
will affect the number of microbes on the surface of resin

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100
* microbes, denture plaque, and adhesive food in the
n=10
*P<.05
mouth.
90
Visual Analog Scale (mm)

2. Further study is indicated to develop a TiO2 coating

80
on acrylic resin for use in clinical practice.
70
60
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Figure 5. A, Comparison of participants’ feelings of food adhesion
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Within the limitations of this clinical study, the following
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Corresponding author:
Dr Takayuki Ueda
Department of Removable Prosthodontics and Gerodontology
Tokyo Dental College
2-9-18 Misaki-cho, Chiyoda-ku, Tokyo 101-0061
JAPAN
Email: uedat@tdc.ac.jp
Copyright © 2017 by the Editorial Council for The Journal of Prosthetic Dentistry.

THE JOURNAL OF PROSTHETIC DENTISTRY Obata et al