Comparative Evaluation of Microbial Adhesion on Provisional Crowns Fabricated With Milled Polymethyl Methacrylate (PMMA) and Conventional Acrylic Resin: A Prospective Clinical Trial.

Introduction Provisional prosthetic restorations play a crucial role in dentistry by protecting dentinal tubules, offering thermal insulation, and ensuring a precise fit during dental treatments. Computer-aided design and computer-aided manufacturing (CAD/CAM) have improved polymethyl methacrylate (PMMA), enhancing its mechanical properties such as hardness and resistance compared to traditional methods. However, bacterial accumulation remains a challenge due to inherent surface roughness. This study aims to assess and compare adhesion on milled PMMA and conventional self-cure acrylic resin, providing insights into their microbial interaction dynamics. Materials and methods This study was a prospective trial approved by the Institutional Human Ethical Committee (SRB-IHEC) (registration number: IHEC/SDC/PROSTHO-2104/24/045) and registered in the Clinical Trial Registry, India (registration number: CTRI/2024/05/068196). The study involved 20 patients requiring single crowns in the right and left molar regions. Two groups were established: Group I (the milled PMMA group) and Group II (the conventional PMMA group). Criteria for participant selection and exclusion were set. A total of 120 swab samples from the buccal mucosa and tooth surfaces were collected before tooth preparation (the baseline) at one week and three weeks. Culture for was done, and colony-forming units were counted. Data analysis was carried out using IBM SPSS Statistics for Windows, Version 26 (Released 2019; IBM Corp., Armonk, New York, United States). An independent sample t-test was employed to compare the two materials for crowns. To analyze changes over time within each group, a repeated-measures analysis of variance (ANOVA) was conducted. When the ANOVA test indicated significance, Tukey's post-hoc test was utilized for pairwise mean comparison. The level of significance was set at P < 0.05. Results The mean colony-forming units (CFU) counts for the milled PMMA group were 4.46 ± 0.167 CFU at baseline, 4.163 ± 0.058 CFU at one week, and 3.87 ± 0.19 CFU at three weeks. The mean CFU counts for the conventional PMMA group were 4.41 ± 0.13 CFU at baseline, 4.29 ± 0.114 CFU at one week, and 4.16 ± 0.108 CFU at three weeks. At baseline (before cementation), there was no difference between milled PMMA and conventional PMMA (P = 0.578). After one week, a significant difference between milled PMMA and conventional PMMA was observed (P < 0.005). After three weeks, a significant difference between milled PMMA and conventional PMMA persisted (P < 0.005).  Conclusion There was a significant reduction in microbial adhesion in both the milled and conventional PMMA groups. However, milled PMMA demonstrated a greater decrease in microbial adhesion as compared to conventional PMMA.