Evaluation of Fracture Resistance of Acrylic Teeth Immersed in Simulated Gastric ACID

Evaluation of Fracture Resistance of Acrylic Teeth Immersed in Simulated Gastric ACID | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Evaluation of Fracture Resistance of Acrylic Teeth Immersed in Simulated Gastric ACID Mustafa Baris Buldu, İpek İscan This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8917146/v1 This work is licensed under a CC BY 4.0 License Status: Under Revision Version 1 posted 10 You are reading this latest preprint version Abstract Aim: To evaluate the surface hardness and fracture resistance of acrylic teeth of different brands after immersion in artificial gastric acid. Method : Acrylic tooth specimens from five different brands were used. The teeth were immersed in artificial gastric acid and saliva (control group) for 96 hours. Fracture resistance was measured using Two-way ANOVA and the Tukey HSD test. Results : We found a statistically significant difference in the mean fracture resistance between the acrylic tooth groups (p=0.001; p<0.05). A significant difference was observed in the mean fracture resistance between the acid-exposed groups (p=0.001 and p0.05). When no acid was applied, the Vita group showed a significantly lower mean fracture resistance than the Eray and Acrylux groups (p0.05). After acid exposure, the Vita group exhibited significantly lower fracture resistance than the Eray, Yamahachi, and Acrylux groups, whereas the Ivoclar group had significantly lower fracture resistance than the Acrylux group (p<0.05). For all groups, teeth not exposed to acid demonstrated significantly higher fracture resistance than those exposed to acid (p<0.05). This result was consistent across the Eray, Yamahachi, Ivoclar, Acrylux, and Vita groups. Conclusion : This study evaluated the effects of different acrylic tooth brands and acid exposures on fracture resistance. Both the acrylic tooth type and acid exposure independently had a statistically significant impact on fracture resistance (p0.05), indicating that these factors independently influenced fracture resistance. Clinical Significance: Gastric acid exposure significantly reduces the fracture resistance of acrylic teeth; therefore, clinicians should consider this factor when selecting materials for patients with eating disorders or gastric reflux. Fracture resistance surface hardness acrylic teeth prosthetic teeth gastric acid Figures Figure 1 1.Introduction Acrylic prosthetic teeth are a type of dental prosthesis used to replace missing teeth and to treat various oral problems. These prostheses are created through polymerization of acrylic resins and are commonly preferred in cases of complete or partial edentulism. Acrylic prostheses are designed to restore chewing function by filling gaps in the oral cavity, while also providing an aesthetic appearance. In addition, they help improve a patient's speech function and support facial contours ( 1 ). Acrylic prostheses are regularly exposed to physical and chemical challenges in the oral environment, such as masticatory forces and changes in pH and temperature ( 2 ). To minimize the adverse effects of these challenges on teeth and prostheses, acrylic materials must possess ideal strength and durability within a complex oral environment ( 3 ). There is a continuous need to evaluate acrylic materials under harsh chemical conditions in the oral cavity. One such challenge is the contact of gastric acid with acrylic surfaces, which may affect surface hardness and fracture resistance. Extrinsic acid erosion results from a diet rich in acidic foods and/or beverages, whereas intrinsic acid erosion stems from gastroesophageal reflux ( 4 ). Gastric acid caused by gastroesophageal reflux has a pH ranging between 1 and 1.5, which is more acidic than the critical pH dropping below 5.5 for oral tissues ( 5 ). Thus, when gastric acid comes in contact with teeth, it can alter its chemical and physical properties. Bulimia nervosa (BN) is an intrinsic disorder that causes acid erosion. This behavioral eating disorder is characterized by self-induced vomiting after uncontrolled food intake to prevent weight gain ( 5 ). Gastric acid reaches the palatal and occlusal surfaces of the upper teeth and occlusal surfaces of the lower teeth, leading to varying effects in different dental regions ( 6 ). Two systematic reviews with meta-analyses reported odds ratios of 12.4 (95% confidence interval: 4.1–37.5) and 5.0 (95% confidence interval: 3.31–7.58), indicating significantly lower mechanical strength of teeth in individuals with eating disorders ( 7 , 8 ). Since gastric acid in the oral cavity can also cause chemical and physical changes in acrylic teeth upon contact, determining its effect on the fracture resistance of acrylic prosthetic teeth is crucial for appropriate clinical management of patients with gastroesophageal reflux and bulimia nervosa ( 9 ). This study examined the effects of simulated gastric acid on the hardness and flexural strength of five different brands of acrylic teeth, aiming to provide clinicians with information about potential changes in acrylic materials, guide the selection of ideal acrylic teeth, and enhance patient satisfaction. 2. Materials and Methods This study investigated the effects of gastric acid on acrylic teeth of five different brands (Yamahachi, Eray, Acrylux ,Vita, and Ivoclar). The properties of the acrylic tooth brands are listed in Table 1 . Twenty-first molars from each brand were used in this study. Initially, the specimen surfaces were ground under water cooling using a Phonex Beta Twin Wheel polishing machine (Buehler Ltd., Lake Bluff, Illinois, USA) with 600, 800, and 1200 grit sandpaper. Following the grinding process, sandblasting was performed at a pressure of 2 bar from a 10 mm distance using 50-micron alumina particles. After sandblasting, the specimens were cleaned using an ultrasonic cleaner (Tchibo Maxingvest GmbH & Co. KGaA, Germany) in distilled water for 5 minutes. The prepared specimens were then divided into two main groups: one group was immersed in artificial gastric acid (pH 1.6), and the other in artificial saliva (control group, pH 6.8) for 96 h at 37°C to simulate oral conditions. Following the immersion period, all specimens underwent surface hardness measurements using a microhardness tester and fracture resistance tests using a universal testing machine (UTM). Statistical analysis was performed using Two-way ANOVA and Tukey's honest significant difference post-hoc test to evaluate differences between groups. Table 1 Properties of Acrylic Teeth from Different Brands BRAND SAMPLE SIZE TYPE MANUFACTURER INFORMATION Eray Deluxe 20 Polymethyl methacrylate (PMMA)- methyl methacrylate (MMA) Eray Dental Manufacturing Inc. (Istanbul, Turkey) Acrylux 20 Polymethyl methacrylate (PMMA) Ruthinium - Dental Manufacturing S.p.A., (İtaly) Yamahachi Naperce 20 Polymethyl methacrylate (PMMA) Yamahachi Dental Products Co., Ltd. (Tokyo, Japan) VitaPAN 20 microfiller reinforced polyacrylic (MRP) Vita Zahnfabrik (Bad Säckingen, Germany) Ivoclar Gnathostar 20 polymethyl methacrylate (PMMA) Ivoclar Vivadent AG (Schaan, Liechtenstein) A total of 100 cylindrical acrylic blocks were prepared using standardized molds with a Kulzer Paladent 20 (1 kg heat-cured acrylic + 500 mL liquid; Heraeus Kulzer GmbH, Germany). The teeth specimens were fixed to cylindrical blocks using the flask technique. Among the five different brands used in the study, specimens were prepared with 20 samples from each brand and equally divided into 10 control group samples and 10 test group samples. The acrylic specimens in the test group were immersed in previously prepared artificial gastric acid (pH 1.6), whereas those in the control group were placed in distilled water. After 96 h of exposure to gastric acid and distilled water, the specimens were positioned at a 90-degree angle using an INSTRON 3345 universal testing machine and shear bond strength tests were performed. 3. Statistical Analysis The data obtained in this study were analyzed using the IBM SPSS Statistics 22 software. The normality of distribution for all parameters was assessed using the Kolmogorov-Smirnov and Shapiro-Wilk tests, which confirmed that the parameters followed a normal distribution. To evaluate the combined effect of different acrylic tooth brands and acid application on fracture resistance, a Two-way ANOVA was performed, followed by post-hoc Tukey HSD tests for pairwise comparisons. Statistical significance was set at P < 0.05. 4. Results This study evaluated the fracture resistance of acrylic teeth of five different brands following gastric acid exposure. A total of 100 specimens were examined, with 50 specimens assigned to the control group and the remaining 50 specimens to the experimental group for gastric acid testing. The assessment compared fracture resistance values within each group before and after acid application, as well as between the different brand groups, to determine the effects of gastric acid exposure on the mechanical properties of acrylic teeth. Table 2: Evaluation of the Combined Effect of Different Acrylic Teeth and Acid Application on Fracture Resistance There was a statistically significant difference in the mean fracture resistance among the acrylic tooth groups (p = 0.001 and p < 0.05, respectively). There was also a statistically significant difference in the mean fracture resistance among the acid application groups (p = 0.001 and p 0.05). The acrylic tooth type and acid application did not affect fracture resistance. A more detailed analysis of the results is presented in Table 2. The mean fracture resistance values of the acrylic teeth with and without acid exposure are detailed in Table 3. Table 3 Fracture Resistance (MPa) Values of Acrylic Teeth With and Without Acid Exposure Brand No Acid (Control) Mean ± SD Acid Exposure Mean ± SD p-value Eray 23.78 ± 5.36 Aa 18.45 ± 1.93 Bac 0.013* Yamahachi 21.77 ± 3.56 Aab 17.81 ± 2.35 Bac 0.009* Ivoclar 20.14 ± 2.58 Aab 15.74 ± 2.30 Bab 0.001* Acrylux 24.16 ± 3.48 Aa 19.06 ± 2.72 Bc 0.002* Vita 18.67 ± 1.58 Ab 13.94 ± 1.83 Bb 0.001* p = 0.004* p = 0.001* Statistical Analysis: Two-way ANOVA test (*p < 0.05 considered significant) The letter-based notation system indicates that different capital letters (A, B) denote significant differences between acid exposure conditions, whereas different lowercase letters (a, b, c) reflect significant variations among acrylic tooth brands. Without acid application, statistically significant differences in the mean fracture resistance were observed among the acrylic tooth groups (p = 0.004; p < 0.05). Post-hoc Tukey test results revealed that the Vita group exhibited significantly lower mean fracture resistance than both the Eray (p = 0.019) and Acrylux (p = 0.010) groups (p 0.05). Following acid application, significant differences in the mean fracture resistance were observed among the acrylic tooth groups (p = 0.001; p < 0.05). Tukey’s test showed that the fracture resistance of the Vita group was significantly lower than that of the Eray (p = 0.001), Yamahachi (p = 0.003), and Acrylux (p = 0.001) groups. Additionally, the Ivoclar group demonstrated significantly lower resistance than the acrylux group (p = 0.016). No other statistically significant differences were detected among the remaining groups (p > 0.05). The bar graph in Fig. 1 illustrates the fracture resistance (in MPa) of each acrylic tooth group, comparing the pre- and post-acid exposure conditions. Key findings include: Eray® Group: Non-acid-exposed teeth showed a significantly higher mean fracture resistance than acid-exposed teeth (*p*=0.013). Yamahachi® Group: Control teeth exhibited statistically greater resistance than acid-treated specimens (*p*=0.009). Ivoclar® Group: Acid application significantly reduced fracture strength (*p*=0.001). Acrylux® Group: Superior performance in both conditions, although acid still caused a notable decline (*p*=0.002). Vita® Group: Marked vulnerability to acid, with the largest resistance drop (*p*=0.001). 5. Discussion This study investigated the effects of different acrylic denture tooth brands and acid exposures on fracture resistance. The results demonstrated statistically significant differences in fracture resistance among various acrylic denture brands (p = 0.001; p < 0.05). Notably, the Vita brand exhibited consistently lower fracture resistance than the other brands both before and after acid application. In contrast, the Eray, Acrylux, Ivoclar, and Yamahachi brands showed higher fracture resistance, with no statistically significant differences observed among them. These findings suggest that differences in material composition and manufacturing processes may play a critical role in determining the mechanical strength of dentured teeth. A significant main effect of acid application was observed, as exposure to acid generally led to a decrease in fracture resistance across all brands (p = 0.001; p < 0.05). Although acid exposure did not significantly alter the ranking of fracture resistance among the brands, it did affect the overall strength of each brand to varying degrees. In particular, the Vita group experienced a more pronounced reduction in fracture resistance following acid exposure, whereas the Ivoclar and Acrylux groups demonstrated greater resistance to acid-induced degradation. Importantly, no significant interaction effect was found between denture tooth brand and acid application (p = 0.953; p > 0.05), indicating that these two factors independently influenced fracture resistance. Although acid exposure reduced fracture resistance in all brands, it did not modify the relative performance differences among them. These findings highlight the importance of selecting denture teeth with superior mechanical properties, especially in clinical scenarios in which exposure to acidic conditions is likely. 6. Conclusions This study demonstrates that acrylic denture tooth branding and acid application independently influence fracture resistance. Among the tested groups, the Vita brand exhibited significantly lower fracture resistance than the other brands, whereas no significant differences were observed among the Eray, Acrylux, Ivoclar, and Yamahachi groups. Acid exposure generally reduced the fracture resistance across all brands, although the extent of this reduction varied. Despite this variability, acid application did not significantly alter the relative differences among brands. In summary, although both denture tooth type and acid application independently affect fracture resistance, their interaction does not result in a significant combined effect. These findings emphasize the importance of selecting denture teeth with superior mechanical properties, particularly in clinical conditions in which exposure to acidic environments may occur. *All materials tested were purchased commercially. The authors confirm no affiliation with or financial support from the manufacturers of the tested acrylic brands. Declarations Funding Information This research received no external funding. Author Contributions Conceptualization, B.B. and İ.İ.; Methodology, B.B. and İ.İ.; Investigation, B.B.; Writing—original draft preparation, B.B.; Writing—review and editing, İ.İ.; Supervision, İ.İ. All authors have read and agreed to the published version of the manuscript. Conflict of Interest Statement The authors declare no conflict of interest. All materials used in this study were purchased commercially. The authors confirm no affiliation with or financial support from the manufacturers of the tested acrylic brands. Data Availability Statement The data supporting the findings of this study are available from the corresponding author upon reasonable request. Ethics approval and consent to participate Not applicable. This study was an in vitro laboratory investigation utilizing commercially available acrylic tooth specimens and artificial solutions. This research did not involve human participants, human biological samples, or animal subjects. Therefore, human ethics and consent to participate declarations are not applicable. Consent for publication Not applicable. References Gross M. Occlusion in implant dentistry. A review of the literature of prosthetic determinants and current concepts. Aust Dent J. 2008;53(Suppl 1):S60–8. Mystkowska J, Niemirowicz-Laskowska K, Łysik D, Tokajuk G, Dąbrowski JR, Bucki R. The role of oral cavity biofilm on metallic biomaterial surface destruction—corrosion and friction aspects. Int J Mol Sci. 2018;19(3):743. Alp CK, Gündogdu C, Ahısha CD. The effect of gastric acid on the surface properties of different universal composites: A SEM study. Scanning. 2022;2022:9217802. Donovan T, Nguyen-Ngoc C, Abd Alraheam I, Irusa K. Contemporary diagnosis and management of dental erosion. J Esthet Restor Dent. 2021;33(1):78–87. Loke C, Lee J, Sander S, Mei L, Farella M. Factors affecting intra-oral pH: A review. J Oral Rehabil. 2016;43(10):778–85. Bartlett D, O’Toole S. Tooth wear and aging. Aust Dent J. 2019;64(Suppl 1):S59–62. Hermont AP, Oliveira PAD, Martins CC, Paiva SM, Pordeus IA, Auad SM. Tooth erosion and eating disorders: A systematic review and meta-analysis. PLoS ONE. 2014;9(11):e111123. Kisely S, Baghaie H, Lalloo R, Johnson NW. Association between poor oral health and eating disorders: Systematic review and meta-analysis. Br J Psychiatry. 2015;207(4):299–305. Somacal DC, Bellan MC, Monteiro MSG, de Oliveira SD, Bittencourt HR, Spohr AM. Effect of gastric acid on the surface roughness and bacterial adhesion of bulk-fill composite resins. Braz Dent J. 2022;33(6):94–102. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Revision Version 1 posted Editorial decision: Revision requested 04 May, 2026 Reviews received at journal 16 Apr, 2026 Reviews received at journal 13 Apr, 2026 Reviewers agreed at journal 11 Apr, 2026 Reviewers agreed at journal 09 Apr, 2026 Reviewers invited by journal 09 Apr, 2026 Editor invited by journal 20 Mar, 2026 Editor assigned by journal 09 Mar, 2026 Submission checks completed at journal 07 Mar, 2026 First submitted to journal 07 Mar, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8917146","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":622728146,"identity":"72b4c8a8-3850-4df2-8055-cce550b5b323","order_by":0,"name":"Mustafa Baris Buldu","email":"","orcid":"","institution":"Istanbul Medipol University","correspondingAuthor":false,"prefix":"","firstName":"Mustafa","middleName":"Baris","lastName":"Buldu","suffix":""},{"id":622728147,"identity":"cfc2562e-f623-4ccc-a809-1869251b31a6","order_by":1,"name":"İpek İscan","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA30lEQVRIiWNgGAWjYBACNmYwZQPEiQ0MDAVA+gBxWtKgWgzAWhgbiLDsMBAnMBCnhY+d/eGHnzvOR/OzJ7c9+GDAIMd3I4H9cQVeh/EYS/aeuZ07s+dhu+EMAwZjyRsJjI1n8GthY+Btu5274UZimzSPAUPiBpAWfC5jY2Z/xvi37VzufqiWeiK0MJgx87YdyN0gAdGSYEBYC4+xtGxbcu6MM2C/SBjOPPOwcSY+LfL9xx9+fNtml9vfnv7swYcKG3m+48kHPuLTgmIjEEsAMVExidAyCkbBKBgFowATAAALy0yc1GBbegAAAABJRU5ErkJggg==","orcid":"","institution":"Istanbul Medipol University","correspondingAuthor":true,"prefix":"","firstName":"İpek","middleName":"","lastName":"İscan","suffix":""}],"badges":[],"createdAt":"2026-02-19 11:38:27","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8917146/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8917146/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":107254090,"identity":"4f1fed12-98e1-4efd-8150-8f3d65b72cef","added_by":"auto","created_at":"2026-04-19 12:00:15","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":79962,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eEvaluation of Fracture Resistance Across Different Groups and Materials\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-8917146/v1/bb3ee33e3c1f5ba5024e4895.png"},{"id":107482219,"identity":"cba7b943-2057-4a90-8626-f3476ad4ff2b","added_by":"auto","created_at":"2026-04-22 02:22:39","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":400998,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8917146/v1/8a258b49-0e58-48fa-b69a-eb29bc1a69f8.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eEvaluation of Fracture Resistance of Acrylic Teeth Immersed in Simulated Gastric ACID\u003c/p\u003e","fulltext":[{"header":"1.Introduction","content":"\u003cp\u003eAcrylic prosthetic teeth are a type of dental prosthesis used to replace missing teeth and to treat various oral problems. These prostheses are created through polymerization of acrylic resins and are commonly preferred in cases of complete or partial edentulism. Acrylic prostheses are designed to restore chewing function by filling gaps in the oral cavity, while also providing an aesthetic appearance. In addition, they help improve a patient's speech function and support facial contours (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAcrylic prostheses are regularly exposed to physical and chemical challenges in the oral environment, such as masticatory forces and changes in pH and temperature (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). To minimize the adverse effects of these challenges on teeth and prostheses, acrylic materials must possess ideal strength and durability within a complex oral environment (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThere is a continuous need to evaluate acrylic materials under harsh chemical conditions in the oral cavity. One such challenge is the contact of gastric acid with acrylic surfaces, which may affect surface hardness and fracture resistance.\u003c/p\u003e \u003cp\u003eExtrinsic acid erosion results from a diet rich in acidic foods and/or beverages, whereas intrinsic acid erosion stems from gastroesophageal reflux (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). Gastric acid caused by gastroesophageal reflux has a pH ranging between 1 and 1.5, which is more acidic than the critical pH dropping below 5.5 for oral tissues (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). Thus, when gastric acid comes in contact with teeth, it can alter its chemical and physical properties.\u003c/p\u003e \u003cp\u003eBulimia nervosa (BN) is an intrinsic disorder that causes acid erosion. This behavioral eating disorder is characterized by self-induced vomiting after uncontrolled food intake to prevent weight gain (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eGastric acid reaches the palatal and occlusal surfaces of the upper teeth and occlusal surfaces of the lower teeth, leading to varying effects in different dental regions (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). Two systematic reviews with meta-analyses reported odds ratios of 12.4 (95% confidence interval: 4.1\u0026ndash;37.5) and 5.0 (95% confidence interval: 3.31\u0026ndash;7.58), indicating significantly lower mechanical strength of teeth in individuals with eating disorders (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eSince gastric acid in the oral cavity can also cause chemical and physical changes in acrylic teeth upon contact, determining its effect on the fracture resistance of acrylic prosthetic teeth is crucial for appropriate clinical management of patients with gastroesophageal reflux and bulimia nervosa (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThis study examined the effects of simulated gastric acid on the hardness and flexural strength of five different brands of acrylic teeth, aiming to provide clinicians with information about potential changes in acrylic materials, guide the selection of ideal acrylic teeth, and enhance patient satisfaction.\u003c/p\u003e"},{"header":"2. Materials and Methods","content":"\u003cp\u003eThis study investigated the effects of gastric acid on acrylic teeth of five different brands (Yamahachi, Eray, Acrylux ,Vita, and Ivoclar). The properties of the acrylic tooth brands are listed in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. Twenty-first molars from each brand were used in this study.\u003c/p\u003e \u003cp\u003eInitially, the specimen surfaces were ground under water cooling using a Phonex Beta Twin Wheel polishing machine (Buehler Ltd., Lake Bluff, Illinois, USA) with 600, 800, and 1200 grit sandpaper. Following the grinding process, sandblasting was performed at a pressure of 2 bar from a 10 mm distance using 50-micron alumina particles. After sandblasting, the specimens were cleaned using an ultrasonic cleaner (Tchibo Maxingvest GmbH \u0026amp; Co. KGaA, Germany) in distilled water for 5 minutes.\u003c/p\u003e \u003cp\u003e The prepared specimens were then divided into two main groups: one group was immersed in artificial gastric acid (pH 1.6), and the other in artificial saliva (control group, pH 6.8) for 96 h at 37\u0026deg;C to simulate oral conditions. Following the immersion period, all specimens underwent surface hardness measurements using a microhardness tester and fracture resistance tests using a universal testing machine (UTM). Statistical analysis was performed using Two-way ANOVA and Tukey's honest significant difference post-hoc test to evaluate differences between groups.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eProperties of Acrylic Teeth from Different Brands\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBRAND\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSAMPLE SIZE\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTYPE\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMANUFACTURER INFORMATION\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEray Deluxe\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePolymethyl methacrylate (PMMA)- methyl methacrylate (MMA)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eEray Dental Manufacturing Inc. (Istanbul, Turkey)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAcrylux\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePolymethyl methacrylate (PMMA)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eRuthinium - Dental Manufacturing S.p.A., (İtaly)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYamahachi Naperce\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePolymethyl methacrylate (PMMA)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eYamahachi Dental Products Co., Ltd. (Tokyo, Japan)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVitaPAN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003emicrofiller reinforced polyacrylic\u003c/p\u003e \u003cp\u003e(MRP)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eVita Zahnfabrik (Bad S\u0026auml;ckingen, Germany)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIvoclar Gnathostar\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003epolymethyl methacrylate (PMMA)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eIvoclar Vivadent AG (Schaan, Liechtenstein)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eA total of 100 cylindrical acrylic blocks were prepared using standardized molds with a Kulzer Paladent 20 (1 kg heat-cured acrylic\u0026thinsp;+\u0026thinsp;500 mL liquid; Heraeus Kulzer GmbH, Germany). The teeth specimens were fixed to cylindrical blocks using the flask technique.\u003c/p\u003e \u003cp\u003eAmong the five different brands used in the study, specimens were prepared with 20 samples from each brand and equally divided into 10 control group samples and 10 test group samples.\u003c/p\u003e \u003cp\u003eThe acrylic specimens in the test group were immersed in previously prepared artificial gastric acid (pH 1.6), whereas those in the control group were placed in distilled water. After 96 h of exposure to gastric acid and distilled water, the specimens were positioned at a 90-degree angle using an INSTRON 3345 universal testing machine and shear bond strength tests were performed.\u003c/p\u003e"},{"header":"3. Statistical Analysis","content":"\u003cp\u003eThe data obtained in this study were analyzed using the IBM SPSS Statistics 22 software. The normality of distribution for all parameters was assessed using the Kolmogorov-Smirnov and Shapiro-Wilk tests, which confirmed that the parameters followed a normal distribution.\u003c/p\u003e \u003cp\u003eTo evaluate the combined effect of different acrylic tooth brands and acid application on fracture resistance, a Two-way ANOVA was performed, followed by post-hoc Tukey HSD tests for pairwise comparisons. Statistical significance was set at P\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e"},{"header":"4. Results","content":"\u003cp\u003eThis study evaluated the fracture resistance of acrylic teeth of five different brands following gastric acid exposure. A total of 100 specimens were examined, with 50 specimens assigned to the control group and the remaining 50 specimens to the experimental group for gastric acid testing. The assessment compared fracture resistance values within each group before and after acid application, as well as between the different brand groups, to determine the effects of gastric acid exposure on the mechanical properties of acrylic teeth.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2: Evaluation of the Combined Effect of Different Acrylic Teeth and Acid Application on Fracture Resistance\u003c/strong\u003e\u003c/p\u003e\n\u003cdiv\u003e\n \u003cdiv align=\"left\" colname=\"c1\" colnum=\"1\"\u003e\u003cimg 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\"\u003e\u003c/div\u003e\n \u003cdiv align=\"char\" char=\".\" colname=\"c3\" colnum=\"3\"\u003eThere was a statistically significant difference in the mean fracture resistance among the acrylic tooth groups (p = 0.001 and p \u0026lt; 0.05, respectively).\u003c/div\u003e\n\u003c/div\u003e\n\u003cp\u003eThere was also a statistically significant difference in the mean fracture resistance among the acid application groups (p = 0.001 and p \u0026lt; 0.05, respectively).\u003c/p\u003e\n\u003cp\u003eThe combined effect of acrylic tooth type and acid application on fracture resistance was not significant (p = 0.953; p \u0026gt; 0.05).\u003c/p\u003e\n\u003cp\u003eThe acrylic tooth type and acid application did not affect fracture resistance.\u003c/p\u003e\n\u003cp\u003eA more detailed analysis of the results is presented in Table 2. The mean fracture resistance values of the acrylic teeth with and without acid exposure are detailed in Table 3.\u0026nbsp;\u003c/p\u003e\n\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv\u003eTable 3\u003c/div\u003e\n \u003cdiv\u003e\n \u003cp\u003eFracture Resistance (MPa) Values of Acrylic Teeth With and Without Acid Exposure\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eBrand\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003eNo Acid (Control) Mean ± SD\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003eAcid Exposure Mean ± SD\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003ep-value\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003e\u003cstrong\u003eEray\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e23.78 ± 5.36\u003csup\u003eAa\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e18.45 ± 1.93\u003csup\u003eBac\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\n \u003cp\u003e0.013*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003e\u003cstrong\u003eYamahachi\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e21.77 ± 3.56\u003csup\u003eAab\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e17.81 ± 2.35\u003csup\u003eBac\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\n \u003cp\u003e0.009*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003e\u003cstrong\u003eIvoclar\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e20.14 ± 2.58\u003csup\u003eAab\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e15.74 ± 2.30\u003csup\u003eBab\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\n \u003cp\u003e0.001*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003e\u003cstrong\u003eAcrylux\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e24.16 ± 3.48\u003csup\u003eAa\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e19.06 ± 2.72\u003csup\u003eBc\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\n \u003cp\u003e0.002*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003e\u003cstrong\u003eVita\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e18.67 ± 1.58\u003csup\u003eAb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e13.94 ± 1.83\u003csup\u003eBb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\n \u003cp\u003e0.001*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003ep = 0.004*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003ep = 0.001*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical Analysis: Two-way ANOVA test (*p \u0026lt; 0.05 considered significant)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe letter-based notation system indicates that different capital letters (A, B) denote significant differences between acid exposure conditions, whereas different lowercase letters (a, b, c) reflect significant variations among acrylic tooth brands. Without acid application, statistically significant differences in the mean fracture resistance were observed among the acrylic tooth groups (p = 0.004; p \u0026lt; 0.05). Post-hoc Tukey test results revealed that the Vita group exhibited significantly lower mean fracture resistance than both the Eray (p = 0.019) and Acrylux (p = 0.010) groups (p \u0026lt; 0.05), whereas no other significant differences were found among the remaining acrylic tooth groups (p \u0026gt; 0.05).\u003c/p\u003e\n\u003cp\u003eFollowing acid application, significant differences in the mean fracture resistance were observed among the acrylic tooth groups (p = 0.001; p \u0026lt; 0.05). Tukey’s test showed that the fracture resistance of the Vita group was significantly lower than that of the Eray (p = 0.001), Yamahachi (p = 0.003), and Acrylux (p = 0.001) groups. Additionally, the Ivoclar group demonstrated significantly lower resistance than the acrylux group (p = 0.016). No other statistically significant differences were detected among the remaining groups (p \u0026gt; 0.05).\u003c/p\u003e\n\u003cp\u003eThe bar graph in Fig.\u0026nbsp;1 illustrates the fracture resistance (in MPa) of each acrylic tooth group, comparing the pre- and post-acid exposure conditions. Key findings include:\u003c/p\u003e\n\u003cp\u003eEray® Group: Non-acid-exposed teeth showed a significantly higher mean fracture resistance than acid-exposed teeth (*p*=0.013).\u003c/p\u003e\n\u003cp\u003eYamahachi® Group: Control teeth exhibited statistically greater resistance than acid-treated specimens (*p*=0.009).\u003c/p\u003e\n\u003cp\u003eIvoclar® Group: Acid application significantly reduced fracture strength (*p*=0.001).\u003c/p\u003e\n\u003cp\u003eAcrylux® Group: Superior performance in both conditions, although acid still caused a notable decline (*p*=0.002).\u003c/p\u003e\n\u003cp\u003eVita® Group: Marked vulnerability to acid, with the largest resistance drop (*p*=0.001).\u003c/p\u003e"},{"header":"5. Discussion","content":"\u003cp\u003eThis study investigated the effects of different acrylic denture tooth brands and acid exposures on fracture resistance. The results demonstrated statistically significant differences in fracture resistance among various acrylic denture brands (p\u0026thinsp;=\u0026thinsp;0.001; p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Notably, the Vita brand exhibited consistently lower fracture resistance than the other brands both before and after acid application. In contrast, the Eray, Acrylux, Ivoclar, and Yamahachi brands showed higher fracture resistance, with no statistically significant differences observed among them. These findings suggest that differences in material composition and manufacturing processes may play a critical role in determining the mechanical strength of dentured teeth.\u003c/p\u003e \u003cp\u003eA significant main effect of acid application was observed, as exposure to acid generally led to a decrease in fracture resistance across all brands (p\u0026thinsp;=\u0026thinsp;0.001; p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Although acid exposure did not significantly alter the ranking of fracture resistance among the brands, it did affect the overall strength of each brand to varying degrees. In particular, the Vita group experienced a more pronounced reduction in fracture resistance following acid exposure, whereas the Ivoclar and Acrylux groups demonstrated greater resistance to acid-induced degradation.\u003c/p\u003e \u003cp\u003eImportantly, no significant interaction effect was found between denture tooth brand and acid application (p\u0026thinsp;=\u0026thinsp;0.953; p\u0026thinsp;\u0026gt;\u0026thinsp;0.05), indicating that these two factors independently influenced fracture resistance. Although acid exposure reduced fracture resistance in all brands, it did not modify the relative performance differences among them. These findings highlight the importance of selecting denture teeth with superior mechanical properties, especially in clinical scenarios in which exposure to acidic conditions is likely.\u003c/p\u003e"},{"header":"6. Conclusions","content":"\u003cp\u003eThis study demonstrates that acrylic denture tooth branding and acid application independently influence fracture resistance. Among the tested groups, the Vita brand exhibited significantly lower fracture resistance than the other brands, whereas no significant differences were observed among the Eray, Acrylux, Ivoclar, and Yamahachi groups.\u003c/p\u003e \u003cp\u003eAcid exposure generally reduced the fracture resistance across all brands, although the extent of this reduction varied. Despite this variability, acid application did not significantly alter the relative differences among brands.\u003c/p\u003e \u003cp\u003eIn summary, although both denture tooth type and acid application independently affect fracture resistance, their interaction does not result in a significant combined effect. These findings emphasize the importance of selecting denture teeth with superior mechanical properties, particularly in clinical conditions in which exposure to acidic environments may occur.\u003c/p\u003e \u003cp\u003e \u003cem\u003e*All materials tested were purchased commercially. The authors confirm no affiliation with or financial support from the manufacturers of the tested acrylic brands.\u003c/em\u003e \u003c/p\u003e"},{"header":"Declarations","content":"\u003ch3\u003e\u003cstrong\u003eFunding Information\u003c/strong\u003e\u003c/h3\u003e\n\u003cp\u003eThis research received no external funding.\u003c/p\u003e\n\u003ch3\u003e\u003cstrong\u003eAuthor Contributions\u003c/strong\u003e\u003c/h3\u003e\n\u003cp\u003eConceptualization, B.B. and İ.İ.; Methodology, B.B. and İ.İ.; Investigation, B.B.; Writing\u0026mdash;original draft preparation, B.B.; Writing\u0026mdash;review and editing, İ.İ.; Supervision, İ.İ. All authors have read and agreed to the published version of the manuscript.\u003c/p\u003e\n\u003ch3\u003e\u003cstrong\u003eConflict of Interest Statement\u003c/strong\u003e\u003c/h3\u003e\n\u003cp\u003eThe authors declare no conflict of interest. All materials used in this study were purchased commercially. The authors confirm no affiliation with or financial support from the manufacturers of the tested acrylic brands.\u003c/p\u003e\n\u003ch3\u003e\u003cstrong\u003eData Availability Statement\u003c/strong\u003e\u003c/h3\u003e\n\u003cp\u003eThe data supporting the findings of this study are available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003eEthics approval and consent to participate\u003c/p\u003e\n\u003cp\u003eNot applicable. This study was an in vitro laboratory investigation utilizing commercially available acrylic tooth specimens and artificial solutions. This research did not involve human participants, human biological samples, or animal subjects. Therefore, human ethics and consent to participate declarations are not applicable.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Consent for publication\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Not applicable.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eGross M. Occlusion in implant dentistry. A review of the literature of prosthetic determinants and current concepts. Aust Dent J. 2008;53(Suppl 1):S60\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMystkowska J, Niemirowicz-Laskowska K, Łysik D, Tokajuk G, Dąbrowski JR, Bucki R. The role of oral cavity biofilm on metallic biomaterial surface destruction\u0026mdash;corrosion and friction aspects. Int J Mol Sci. 2018;19(3):743.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAlp CK, G\u0026uuml;ndogdu C, Ahısha CD. The effect of gastric acid on the surface properties of different universal composites: A SEM study. Scanning. 2022;2022:9217802.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDonovan T, Nguyen-Ngoc C, Abd Alraheam I, Irusa K. Contemporary diagnosis and management of dental erosion. J Esthet Restor Dent. 2021;33(1):78\u0026ndash;87.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLoke C, Lee J, Sander S, Mei L, Farella M. Factors affecting intra-oral pH: A review. J Oral Rehabil. 2016;43(10):778\u0026ndash;85.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBartlett D, O\u0026rsquo;Toole S. Tooth wear and aging. Aust Dent J. 2019;64(Suppl 1):S59\u0026ndash;62.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHermont AP, Oliveira PAD, Martins CC, Paiva SM, Pordeus IA, Auad SM. Tooth erosion and eating disorders: A systematic review and meta-analysis. PLoS ONE. 2014;9(11):e111123.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKisely S, Baghaie H, Lalloo R, Johnson NW. Association between poor oral health and eating disorders: Systematic review and meta-analysis. Br J Psychiatry. 2015;207(4):299\u0026ndash;305.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSomacal DC, Bellan MC, Monteiro MSG, de Oliveira SD, Bittencourt HR, Spohr AM. Effect of gastric acid on the surface roughness and bacterial adhesion of bulk-fill composite resins. Braz Dent J. 2022;33(6):94\u0026ndash;102.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-oral-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ohea","sideBox":"Learn more about [BMC Oral Health](http://bmcoralhealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/ohea/default.aspx","title":"BMC Oral Health","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Fracture resistance, surface hardness, acrylic teeth, prosthetic teeth, gastric acid","lastPublishedDoi":"10.21203/rs.3.rs-8917146/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8917146/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eAim:\u003c/strong\u003eTo evaluate the surface hardness and fracture resistance of acrylic teeth of different brands after immersion in artificial gastric acid.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethod\u003c/strong\u003e: Acrylic tooth specimens from five different brands were used. The teeth were immersed in artificial gastric acid and saliva (control group) for 96 hours. Fracture resistance was measured using Two-way ANOVA and the Tukey HSD test.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e: We found a statistically significant difference in the mean fracture resistance between the acrylic tooth groups (p=0.001; p\u0026lt;0.05). A significant difference was observed in the mean fracture resistance between the acid-exposed groups (p=0.001 and p\u0026lt;0.05, respectively). However, the combined effect of acrylic tooth type and acid exposure on fracture resistance was not statistically significant (p=0.953; p\u0026gt;0.05).\u003c/p\u003e\n\u003cp\u003eWhen no acid was applied, the Vita group showed a significantly lower mean fracture resistance than the Eray and Acrylux groups (p\u0026lt;0.05), while no significant difference was found among the other groups (p\u0026gt;0.05). After acid exposure, the Vita group exhibited significantly lower fracture resistance than the Eray, Yamahachi, and Acrylux groups, whereas the Ivoclar group had significantly lower fracture resistance than the Acrylux group (p\u0026lt;0.05).\u003c/p\u003e\n\u003cp\u003eFor all groups, teeth not exposed to acid demonstrated significantly higher fracture resistance than those exposed to acid (p\u0026lt;0.05). This result was consistent across the Eray, Yamahachi, Ivoclar, Acrylux, and Vita groups.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e: This study evaluated the effects of different acrylic tooth brands and acid exposures on fracture resistance. Both the acrylic tooth type and acid exposure independently had a statistically significant impact on fracture resistance (p\u0026lt;0.05). However, the combined effect of acrylic tooth brand and acid exposure was not significant (p\u0026gt;0.05), indicating that these factors independently influenced fracture resistance.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical Significance:\u003c/strong\u003e Gastric acid exposure significantly reduces the fracture resistance of acrylic teeth; therefore, clinicians should consider this factor when selecting materials for patients with eating disorders or gastric reflux.\u003c/p\u003e","manuscriptTitle":"Evaluation of Fracture Resistance of Acrylic Teeth Immersed in Simulated Gastric ACID","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-04-19 12:00:11","doi":"10.21203/rs.3.rs-8917146/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-05-04T09:27:20+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-16T14:55:15+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-13T12:21:57+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"237050920113679620661284090132336894665","date":"2026-04-11T07:42:44+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"305106285897692829037909728926028256547","date":"2026-04-09T11:16:47+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-04-09T06:00:47+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-03-20T08:28:45+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-03-09T18:00:44+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-03-07T10:37:48+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Oral Health","date":"2026-03-07T10:35:28+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-oral-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ohea","sideBox":"Learn more about [BMC Oral Health](http://bmcoralhealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/ohea/default.aspx","title":"BMC Oral Health","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"d2278d25-ac12-4615-934f-6a0af76c5b81","owner":[],"postedDate":"April 19th, 2026","published":true,"recentEditorialEvents":[{"type":"decision","content":"Revision requested","date":"2026-05-04T09:27:20+00:00","index":"","fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"in-revision","subjectAreas":[],"tags":[],"updatedAt":"2026-05-04T09:40:01+00:00","versionOfRecord":[],"versionCreatedAt":"2026-04-19 12:00:11","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8917146","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8917146","identity":"rs-8917146","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}