Nanoparticle-modified Acrylic Resin Denture Bases for Controlling Candida Species Growth, Adhesion, and Biofilm Formation: A Systematic Review

The colonization of Candida species on polymethyl methacrylate (PMMA) denture bases is a major contributor to denture stomatitis and continues to be a prevalent clinical problem. The purpose of this systematic review was to assess the efficacy of using organic and inorganic nanoparticles in acrylic resin denture bases to control the growth of Candida, its adhesion, and biofilm formation. This study aimed to determine whether adding nanoparticles would alter the material's mechanical and aesthetic properties.

In line with PRISMA, a systematic search was conducted across Web of Science (WOS), PubMed/MEDLINE, Scopus, Google Scholar, the Cochrane Library, and Embase for peer-reviewed in vitro studies published from January 2014 to February 2025. Combinations of words used in the search included “acrylic resin”, “denture base”, “nanoparticles”, “nanomaterials”, “Candida”, “antifungal,” and “biofilm”. The eligibility and selection of studies were then done tightly based on the PICO criteria.

28 studies were identified after screening 1,430 records and met the strict inclusion criteria. Metallic particles (Ag and Cu), metal oxides TiO₂, ZnO, ZrO₂, SiO_2, and CuO, and even bimetallic (Ag-ZnO) and carbon-based (nanodiamonds) were found to be antifungal and antibiofilm with a dose-dependent effect. The ability of silver nanoparticles (AgNPs) in general, and TiO₂ in particular, to suppress the growth of Candida biofilm was fairly consistent at concentrations in the range of 0.5 to 1.0 wt%. With higher concentrations, metal nanoparticles sometimes caused decreased flexural strength, reduced surface hardness, and esthetic discoloration. Nevertheless, the use of low concentrations (0.5-1.0 wt%) of nanodiamonds and silanized ZrO₂ was found to effectively inhibit fungal growth while not affecting the denture base structure.

The main mechanisms of action appear to be the continuous release of ions, the generation of reactive oxygen species (ROS), and the disruption of the fungal cell membrane, which, in practice, physically limits biofilm adhesion. However, biocompatibility can be an issue; nanoparticles can aggregate, and there is an increased risk of cytotoxicity at high concentrations.

Adding a low concentration of silanized or hybrid nanoparticles (1 wt% AgNPs, TiO2, or ZrO2) would be a promising method to prevent denture stomatitis by limiting Candida growth on acrylic resin denture bases. For these nanocomposites to be routinely applied in dental care, standardized clinical trials are necessary, and long-term biocompatibility testing should be conducted.