Influence of surface roughness on streptococcal adhesion forces to composite resins

The effect of cadmium exposition on the structure and mechanical properties of rat incisors

Alterations in the structure and mechanical properties of teeth in adult Wistar rats exposed to cadmium were investigated. Analyses were conducted on two sets of incisors from female and male specimens, that were intoxicated with cadmium (n = 12) or belonged to the control (n = 12). The cadmium group was administered with CdCl2 dissolved in drinking water with a dose of 4mg/kgbw for 10 weeks. The oral intake of cadmium by adult rats led to the range of structural changes in enamel morphology and its mechanical features. A significant increase of cadmium levels in the teeth in comparison to the control, a slight shift in the colour and reduction of pigmented enamel length, higher surface irregularity, a decrease of hydroxyapatite crystals size in the c-axis and simultaneous increase in pigmented enamel hardness were observed. The extent of these changes was sex-dependent and was more pronounced in males.

Biofilm composition and composite degradation during intra-oral wear

OBJECTIVES

The oral environment limits the longevity of composite-restorations due to degradation caused by chewing, salivary and biofilm-produced enzymes and acids. This study investigates degradation of two resin-composites in relation with biofilm composition in vitro and in vivo.

METHODS

Surface-chemical-composition of two Bis-GMA/TEGDMA composites was compared using X-ray-Photoelectron-Spectroscopy from which the number ester-linkages was derived. Composite-degradation was assessed through water contact angles, yielding surface-exposure of filler-particles. Degradation in vitro was achieved by composite immersion in a lipase solution. In order to evaluate in vivo degradation, composite samples were worn in palatal devices by 15 volunteers for 30-days periods in absence and presence of manually-brushing with water. PCR-DGGE analysis was applied to determine biofilm composition on the samples, while in addition to water contact angles, degradation of worn composites was assessed through surface-roughness and micro-hardness measurements.

RESULTS

In vitro degradation by lipase exposure was highest for the high ester-linkage composite and virtually absent for the low ester-linkage composite. Filler-particle surface-exposure, surface-roughness and micro-hardness of both resin-composites increased during intra-oral wear, but filler-particle surface-exposure was affected most. However, based on increased filler-particle surface-exposure, the high ester-linkage composite degraded most in volunteers harvesting composite biofilms comprising Streptococcus mutans, a known esterase and lactic acid producer. This occurred especially in absence of brushing.

SIGNIFICANCE

Degradation during intra-oral wear of a low ester-linkage composite was smaller than of a high ester-linkage composite, amongst possible other differences between both composites. S. mutans herewith is not only a cariogenic, but also a composite-degradative member of the oral microbiome.

Micro- and Nanotopography Sensitive Bacterial Attachment Mechanisms: A Review

Bacterial attachment to material surfaces can lead to the development of biofilms that cause severe economic and health problems. The outcome of bacterial attachment is determined by a combination of bacterial sensing of material surfaces by the cell and the physicochemical factors in the near-surface environment. This paper offers a systematic review of the effects of surface topography on a range of antifouling mechanisms, with a focus on how topographical scale, from micro- to nanoscale, may influence bacterial sensing of and attachment to material surfaces. A good understanding of these mechanisms can facilitate the development of antifouling surfaces based on surface topography, with applications in various sectors of human life and activity including healthcare, food, and water treatment.

The Effects of β-Lactam Antibiotics on Surface Modifications of Multidrug-Resistant Escherichia coli: A Multiscale Approach

Possible multidrug-resistant (MDR) mechanisms of four resistant strains of Escherichia coli to a model β-lactam, ampicillin, were investigated using contact angle measurements of wettability, crystal violet assays of permeability, biofilm formation, fluorescence imaging, and nanoscale analyses of dimensions, adherence, and roughness. Upon exposure to ampicillin, one of the resistant strains, E. coli A5, changed its phenotype from elliptical to spherical, maintained its roughness and biofilm formation abilities, decreased its length and surface area, maintained its cell wall integrity, increased its hydrophobicity, and decreased its nanoscale adhesion to a model surface of silicon nitride. Such modifications are suggested to allow these cells to conserve energy during metabolic dormancy. In comparison, resistant strains E. coli D4, A9, and H5 elongated their cells, increased their roughness, increased their nanoscale adhesion forces, became more hydrophilic, and increased their biofilm formation upon exposure to ampicillin. These results suggest that these strains resisted ampicillin through biofilm formation that possibly introduces diffusion limitations to antibiotics. Investigations of how MDR bacterial cells modify their surfaces in response to antibiotics can guide research efforts aimed at designing more effective antibiotics and new treatment strategies for MDR bacterial infections.

A novel approach to create an antibacterial surface using titanium dioxide and a combination of dip-pen nanolithography and soft lithography

Soft lithography and Dip-Pen Nanolithography (DPN) are techniques that have been used to modify the surface of biomaterials. Modified surfaces play a role in reducing bacterial adhesion and biofilm formation. Also, titanium dioxide has been reported as an antibacterial substance due to its photocatalytic effect. This work aimed at creating patterns on model surfaces using DPN and soft lithography combined with titanium dioxide to create functional antibacterial micropatterned surfaces, which were tested against Streptococcus mutans. DPN was used to create a master pattern onto a model surface and microstamping was performed to duplicate and transfer such patterns to medical-grade stainless steel 316L using a suspension of TiO₂. Modified SS316L plates were subjected to UVA black light as photocatalytic activator. Patterns were characterized by atomic force microscopy and biologically evaluated using S. mutans. A significant reduction of up to 60% in bacterial adhesion to TiO₂ -coated and -micropatterned surfaces was observed. Moreover, both TiO₂ surfaces reduced the viability of adhered bacteria after UV exposure. TiO₂ micropatterned demonstrated a synergic effect between physical and chemical modification against S. mutans. This dual effect was enhanced by increasing TiO₂ concentration. This novel approach may be a promising alternative to reduce bacterial adhesion to surfaces.

Can whitening toothpastes maintain the optical stability of enamel over time?

Besides the effects on the health of individuals, cigarette smoking can also interfere with the appearance of their teeth.

Effect of Vital Tooth Bleaching on Surface Roughness and Streptococcal Biofilm Formation on Direct Tooth-Colored Restorative Materials

OBJECTIVE

To compare the effect of simulated bleaching with a 10% carbamide peroxide (CP) or a 40% hydrogen peroxide (HP) system on surface roughness of resin composite and resin-modified glass ionomer cement (RMGI) and streptococcal biofilm formation on these surfaces.

METHODS AND MATERIALS

Specimens of nanofilled resin composite and RMGI (n=108 each) were randomly divided into three groups (n=36 each): no treatment control, 10% CP, and 40% HP. The surface roughness values (Ra) were measured before and after treatments. The specimens in each group were randomly divided into three subgroups (n=12) and incubated with Streptococcus mutans, Streptococcus sanguinis, and trypticase soy broth control for 24 hours. Biofilm formation was quantified by crystal violet staining, and the structure was visualized by scanning electron microscopy. The differences between the mean changes in Ra between the 10% CP and 40% HP groups of each material were evaluated with an independent t-test. The quantity of biofilm formation on each material was analyzed with one-way analysis of variance with the post hoc Tukey test ( α=0.05).

RESULTS

Surface roughness significantly increased after bleaching in all groups. There was no significant difference between the 10% CP and 40% HP groups of each material. For S. mutans biofilm formation, bleaching with 10% CP and 40% HP increased biofilm on both materials compared to controls. However, S. sanguinis biofilm formation was significantly higher on bleached resin composite but not on RMGI specimens.

CONCLUSIONS

Simulated bleaching with 10% CP or 40% HP increased both surface roughness and biofilm formation on resin composite and RMGI, except for S. sanguinis biofilm on RMGI.

Bacterial Biofilms in Jones Tubes

PURPOSE

To investigate the presence and microbiology of bacterial biofilms on Jones tubes (JTs) by direct visualization with scanning electron microscopy and polymerase chain reaction (PCR) of representative JTs, and to correlate these findings with inflammation and/or infection related to the JT.

METHODS

In this study, prospective case series were performed. JTs were recovered from consecutive patients presenting to clinic for routine cleaning or recurrent irritation/infection. Four tubes were processed for scanning electron microscopy alone to visualize evidence of biofilms. Two tubes underwent PCR alone for bacterial quantification. One tube was divided in half and sent for scanning electron microscopy and PCR. Symptoms related to the JTs were recorded at the time of recovery.

RESULTS

Seven tubes were obtained. Five underwent SEM, and 3 out of 5 showed evidence of biofilms (60%). Two of the 3 biofilms demonstrated cocci and the third revealed rods. Three tubes underwent PCR. The predominant bacteria identified were Pseudomonadales (39%), Pseudomonas (16%), and Staphylococcus (14%). Three of the 7 patients (43%) reported irritation and discharge at presentation. Two symptomatic patients, whose tubes were imaged only, revealed biofilms. The third symptomatic patient's tube underwent PCR only, showing predominantly Staphylococcus (56%) and Haemophilus (36%) species. Two of the 4 asymptomatic patients also showed biofilms. All symptomatic patients improved rapidly after tube exchange and steroid antibiotic drops.

CONCLUSIONS

Bacterial biofilms were variably present on JTs, and did not always correlate with patients' symptoms. Nevertheless, routine JT cleaning is recommended to treat and possibly prevent inflammation caused by biofilms.

Biofilm-induced changes to the composite surface

OBJECTIVES

Composites may undergo biodegradation in the oral cavity. The objective was to investigate the effect of single- and multi-species biofilms on the surface roughness and topography of two composites.

METHODS

Disk-shaped specimens of a paste-like, Bis-GMA-free (Gradia Direct Anterior, GC), and a flowable, Bis-GMA-based composite (Tetric EvoFlow, Ivoclar-Vivadent) were prepared. After ethylene-oxide sterilization (38°C), specimens (n=3) were incubated with Streptococcus mutans or mixed bacterial culture (Streptococcus mutans, Streptococcus sanguinis, Actinomyces naeslundii and Fusobacterium nucleatum). As negative controls, unexposed specimens and specimens exposed to sterile medium (BHI) were used. Specimens exposed to acidified BHI medium (pH=5) and enzymatic solution of cholesterol esterase served as positive control. Following 6-week incubation, the attached biofilms were collected for real-time PCR assessment, after which the surface roughness and topography of the specimens were analyzed with atomic force microscopy. Surface hydrophilicity/hydrophobicity was determined by contact angle measurements. Biofilm structure was analyzed with scanning electron microscopy.

RESULTS

Even though multi-species biofilms were thicker, with more cells attached, they did not significantly affect the surface roughness of the composites. On the other hand, S. mutans alone significantly increased the roughness of Tetric by 40.3%, while its effect on Gradia was lower (12%). The total amount of attached bacteria, however, did not differ between the composites.

CONCLUSIONS

S. mutans can increase the surface roughness of composites, depending on their composition. This ability of S. mutans is, however, mitigated in co-culture with other species. In particular, bacterial esterases seem to be responsible for the increased composite surface roughness upon biofilms exposure.

CLINICAL SIGNIFICANCE

Cariogenic bacteria can degrade composites, thereby increasing the surface roughness. Increased roughness and subsequent improved bacterial accumulation may facilitate the development of secondary caries around composites, which is the most common reason for the restoration failure.

Streptococcus mutans forms xylitol-resistant biofilm on excess adhesive flash in novel ex-vivo orthodontic bracket model

INTRODUCTION

During orthodontic bonding procedures, excess adhesive is invariably left on the tooth surface at the interface between the bracket and the enamel junction; it is called excess adhesive flash (EAF). We comparatively evaluated the biofilm formation of Streptococcus mutans on EAF produced by 2 adhesives and examined the therapeutic efficacy of xylitol on S mutans formed on EAF.

METHODS

First, we investigated the biofilm formation of S mutans on 3 orthodontic bracket types: stainless steel preadjusted edgewise, ceramic preadjusted edgewise, and stainless steel self-ligating. Subsequently, tooth-colored Transbond XT (3M Unitek, Monrovia, Calif) and green Grengloo (Ormco, Glendora, Calif) adhesives were used for bonding ceramic brackets to extracted teeth. S mutans biofilms on EAF produced by the adhesives were studied using the crystal violet assay and scanning electron microscopy. Surface roughness and surface energy of the EAF were examined. The therapeutic efficacies of different concentrations of xylitol were tested on S mutans biofilms.

RESULTS

Significantly higher biofilms were formed on the ceramic preadjusted edgewise brackets (P = 0.003). Transbond XT had significantly higher S mutans biofilms compared with Grengloo surfaces (P = 0.007). There was no significant difference in surface roughness between Transbond XT and Grengloo surfaces (P >0.05). Surface energy of Transbond XT had a considerably smaller contact angle than did Grengloo, suggesting that Transbond XT is a more hydrophilic material. Xylitol at low concentrations had no significant effect on the reduction of S mutans biofilms on orthodontic adhesives (P = 0.016).

CONCLUSIONS

Transbond XT orthodontic adhesive resulted in more S mutans biofilm compared with Grengloo adhesive on ceramic brackets. Surface energy seemed to play a more important role than surface roughness for the formation of S mutans biofilm on EAF. Xylitol does not appear to have a therapeutic effect on mature S mutans biofilm.

Influence of surface roughness on silicone rubber voice prostheses on in vitro biofilm formation and clinical lifetime in laryngectomised patients

OBJECTIVES

Evaluation of the influence of a smooth surface moulding technique of silicone rubber indwelling voice prostheses on in vitro biofilm formation and analysis of the clinical in situ lifetime.

DESIGN

Biofilm formation on smooth and Groningen ultra low resistance (URL) prostheses was studied in an artificial throat model. The clinical lifetime of smooth voice prostheses was compared to the previous lifetime of URL by counting the number of replacements in a consecutive 6-month period in the same patient.

PARTICIPANTS

Eleven laryngectomised patients in follow-up who required frequent replacement of their voice prostheses.

SETTINGS

Tertiary University Medical Center.

RESULTS

Use of a smoother mould and less viscous silicone rubber yielded a decrease in surface roughness from 46 to 8 nm and was accompanied by a 40% reduction in the prevalence of bacteria and yeast in in vitro formed biofilms. Clinically, the lifetime was significantly (P<.005) increased by a factor of 2.1.

CONCLUSIONS

This combined in vitro and clinical study suggests that the choice of material and in particular its surface finishing may be determining factors with respect to the clinical lifetime of silicone rubber implants and devices failing due to biofilm formation.

Enhanced antifungal activity by disinfected titanium dioxide nanotubes via reduced nano-adhesion bonds

We have provided evidence that the beneficial effect of super-oxidized water (SOW) disinfected Ti6Al4V-TiO₂ nanotubes (NTs) can reduce bacterial adhesion and biofilm formation. However, the need of antifungal nanostructured surfaces with osteoactive capabilities is an important goal that has been arising for dental implants (DI) applications. Thus, in the present study we isolated and tested the effects of Candida albicans (C. albicans) on disinfected, wetter and nanoroughness NTs compared to a non-modified control. Moreover, we elucidated part of the fungal adhesion mechanism by studying and relating the mycotic adhesion kinetics and the formation of fungal nanoadhesion bonds among the experimental materials, to gain new insight of the fungal-material-interface. Similarly, the initial behavior of human alveolar bone osteoblasts (HAOb) was microscopically evaluated. NTs significantly reduced the yeasts adhesion and viability with non-outcomes of biofilm than the non-modified surface. Cross-sectioning of the fungal cells revealed promoted nano-contact bonds with superior fungal spread on the control alloy interface; meanwhile NTs evidenced decreased tendency along time; suggesting, down-regulation by the nanostructured morphology and the SOW treatment. Importantly, the initial performance of HAOb demonstrated strikingly promoted anchorage with effects of filopodia formation and increased vital cell on NTs with SOW. The present study proposes SOW treatment as an active protocol for synthesis and disinfection of NTs with potent antifungal capability, acting in part by the reduction of nano-adhesion bonds at the surface-fungal interface; opening up a novel route for the investigation of mycotic-adhesion processes at the nanoscale for bone implants applications.

Adhesiveness of opportunistic Staphylococcus aureus to materials used in dental office: In vitro study

Staphylococcus aureus (S. aureus) is one of several opportunistic microbial pathogens associated with many healthcare problems. In the present study, S. aureus was assessed for its biofilm-forming ability on materials routinely used in dental offices, including stainless steel (SS), polyethylene (PE), and polyvinyl chloride (PVC). Materials that were tested were characterized for roughness (Ra) and surface free energy (SFE). The adhesion forces exerted by S. aureus to each substratum were investigated using atomic force microscopy (AFM), and biofilm formation was quantitatively assessed by crystal violet staining assay. AFM measurements demonstrated that the strongest adhesion forces (20 nN) were exerted on the PE surfaces (P < 0.05) and depended more on Ra. In addition, the results of biofilm formation capability indicated that S. aureus exhibited more affinity to SS materials when compared to the other materials (P < 0.05). This ability of biofilm formation seems to be more correlated to SFE (R = 0.65). Hence, control of the surface properties of materials used in dental practices is of crucial importance for preventing biofilm formation on dental materials to be used for patients' dental care.

Influence of Surface Properties on Adhesion Forces and Attachment of Streptococcus mutans to Zirconia In Vitro

Zirconia is becoming a prevalent material in dentistry. However, any foreign bodies inserted may provide new niches for the bacteria in oral cavity. The object of this study was to explore the effect of surface properties including surface roughness and hydrophobicity on the adhesion and biofilm formation of Streptococcus mutans (S. mutans) to zirconia. Atomic force microscopy was employed to determine the zirconia surface morphology and the adhesion forces between the S. mutans and zirconia. The results showed that the surface roughness was nanoscale and significantly different among tested groups (P < 0.05): Coarse (23.94 ± 2.52 nm) > Medium (17.00 ± 3.81 nm) > Fine (11.89 ± 1.68 nm). The contact angles of the Coarse group were the highest, followed by the Medium and the Fine groups. Increasing the surface roughness and hydrophobicity resulted in an increase of adhesion forces and early attachment (2 h and 4 h) of S. mutans on the zirconia but no influence on the further development of biofilm (6 h~24 h). Our findings suggest that the surface roughness in nanoscale and hydrophobicity of zirconia had influence on the S. mutans initial adhesion force and early attachment instead of whole stages of biofilm formation.

Adhesion force of staphylococcus aureus on various biomaterial surfaces

Staphylococcus comprises of more than half of all pathogens in orthopedic implant infections and they can cause major bone infection which can result in destruction of joint and bone. In the current study, adhesion force of bacteria on the surface of various biomaterial surfaces is measured using atomic force microscope (AFM). Staphylococcus aureus was immobilized on an AFM tipless cantilever as a force probe to measure the adhesion force between bacteria and biomaterials (viz. ultra-high molecular weight poly ethylene (UHMWPE), stainless steel (SS), Ti-6Al-4V alloy, hydroxyapatite (HA)). At the contact time of 10s, UHMWPE shows weak adhesion force (~4nN) whereas SS showed strong adhesion force (~15nN) due to their surface energy and surface roughness. Bacterial retention and viability experiment (3M™ petrifilm test, agar plate) dictates that hydroxyapatite shows the lowest vaibility of bacteria, whereas lowest bacterial retention is observed on UHMWPE surface. Similar results were obtained from live/dead staining test, where HA shows 65% viability, whereas on UHMWPE, SS and Ti-6Al-4V, the bacterial viability is 78%, 94% and 97%, respectively. Lower adhesion forces, constrained pull-off distance (of bacterial) and high antibacterial resistance of bioactive-HA makes it a potential biomaterial for bone-replacement arthroplasty.

Adaptation of Campylobacter jejuni to biocides used in the food industry affects biofilm structure, adhesion strength, and cross-resistance to clinical antimicrobial compounds

The emergence of biocide-adapted Campylobacter jejuni strains that developed into biofilms and their potential to develop clinical resistance to antimicrobial compounds was studied. C. jejuni was grown in sub-lethal concentrations of five biocides used in the food industry. C. jejuni exhibited adaptation to these biocides with increased minimum inhibitory concentrations. The 3-D structures of the biofilms produced by the biocide-adapted cells were investigated by atomic force microscopy (AFM). The results revealed marked variability in biofilm architecture, including ice-crystal-like structures. Adaptation to the biocides enhanced biofilm formation, with significant increases in biovolume, surface coverage, roughness, and the surface adhesion force of the biofilms. Adaptation to commercial biocides induced resistance to kanamycin and streptomycin. This study suggests that the inappropriate use of biocides may lead to cells being exposed to them at sub-lethal concentrations, which can result in adaptation of the pathogens to the biocides and a subsequent risk to public health.

Bacterial Adhesion and Surface Roughness for Different Clinical Techniques for Acrylic Polymethyl Methacrylate

This study sought to assess the effect of different surface finishing and polishing protocols on the surface roughness and bacterial adhesion (S. sanguinis) to polymethyl methacrylates (PMMA). Fifty specimens were divided into 5 groups (n = 10) according to their fabrication method and surface finishing protocol: LP (3 : 1 ratio and laboratory polishing), NF (Nealon technique and finishing), NP (Nealon technique and manual polishing), MF (3 : 1 ratio and manual finishing), and MP (3 : 1 ratio and manual polishing). For each group, five specimens were submitted to bacterial adhesion tests and analyzed by scanning electron microscopy (SEM). Two additional specimens were subjected to surface topography analysis by SEM and the remaining three specimens were subjected to surface roughness measurements. Data were compared by one-way ANOVA. The mean bacterial counts were as follows: NF, 19.6 ± 3.05; MP, 5.36 ± 2.08; NP, 4.96 ± 1.93; MF, 7.36 ± 2.45; and LP, 1.56 ± 0.62 (CFU). The mean surface roughness values were as follows: NF, 3.23 ± 0.15; MP, 0.52 ± 0.05; NP, 0.60 ± 0.08; MF, 2.69 ± 0.12; and LP, 0.07 ± 0.02 (μm). A reduction in the surface roughness was observed to be directly related to a decrease in bacterial adhesion. It was verified that the laboratory processing of PMMA might decrease the surface roughness and consequently the adhesion of S. sanguinis to this material.

Prenatally administered HMB modifies the enamel surface roughness in spiny mice offspring: An atomic force microscopy study

OBJECTIVE

The aim of this research was to check the effect of the prenatally administered β-hydroxy β-methylbutyrate (HMB) on the development of enamel surface of the spiny mice offspring.

DESIGN

The spiny mice dams were randomly assigned into three groups: control group (not supplemented with HMB) and two experimental groups in which powdered HMB was given at the daily dosage of 0.2g/kg of body weight (group I) and 0.02g/kg of body weight (group II) during the last period of gestation. Newborn pups were euthanized by CO₂ inhalation. The morphology of incisor teeth was analysed using atomic force microscopy (AFM) in semi-contact mode in the height, magnitude and phase domains. Height images became a basis for determination of surface roughness parameters.

RESULTS

Conducted study indicated that maternal HMB administration markedly influences enamel development. Enamel of offspring's teeth in both experimental groups was characterized by significantly smaller values of indices describing surface roughness and profile. HMB supplementation influenced the calculated parameters regardless of the diet type and offspring sex, however higher dose of HMB caused stronger changes in enamel surface's physical properties and could be observed in higher intensity in the male group.

CONCLUSIONS

HMB administration caused reduction in the irregularities of enamel surface, thereby possibly reducing the probability of bacteria adhesion and caries development. These observations may serve to improve nutrition and supplementation of animals and could be a lead for further research.

Probing the nanoadhesion of Streptococcus sanguinis to titanium implant surfaces by atomic force microscopy

As titanium (Ti) continues to be utilized in great extent for the fabrication of artificial implants, it is important to understand the crucial bacterium–Ti interaction occurring during the initial phases of biofilm formation. By employing a single-cell force spectroscopy technique, the nanoadhesive interactions between the early-colonizing Streptococcus sanguinis and a clinically analogous smooth Ti substrate were explored. Mean adhesion forces between S. sanguinis and Ti were found to be 0.32±0.00, 1.07±0.06, and 4.85±0.56 nN for 0, 1, and 60 seconds contact times, respectively; while adhesion work values were reported at 19.28±2.38, 104.60±7.02, and 1,317.26±197.69 aJ for 0, 1, and 60 seconds, respectively. At 60 seconds surface delays, minor-rupture events were modeled with the worm-like chain model yielding an average contour length of 668±12 nm. The mean force for S. sanguinis minor-detachment events was 1.84±0.64 nN, and Poisson analysis decoupled this value into a short-range force component of −1.60±0.34 nN and a long-range force component of −0.55±0.47 nN. Furthermore, a solution of 2 mg/mL chlorhexidine was found to increase adhesion between the bacterial probe and substrate. Overall, single-cell force spectroscopy of living S. sanguinis cells proved to be a reliable way to characterize early-bacterial adhesion onto machined Ti implant surfaces at the nanoscale.

The Relationship of Bacterial Biofilms and Capsular Contracture in Breast Implants

Capsular contracture is a common sequelae of implant-based breast augmentation. Despite its prevalence, the etiology of capsular contracture remains controversial. Numerous studies have identified microbial biofilms on various implantable materials, including breast implants. Furthermore, biofilms have been implicated in subclinical infections associated with other surgical implants. In this review, we discuss microbial biofilms as a potential etiology of capsular contracture. The review also outlines the key diagnostic modalities available to identify the possible infectious agents found in biofilm, as well as available preventative and treatment measures.

Effect of three nanobiomaterials on the surface roughness of bleached enamel

Background:

The ever-increasing demand for enhanced esthetic appearance has resulted in significant developments in bleaching products. However, the enamel surface roughness (SR) might be negatively affected by bleaching agents. This in vitro study was undertaken to compare the effects of three nanobiomaterials on the enamel SR subsequent to bleaching.

Materials and Methods:

The crowns of six extracted intact nonerupted human third molars were sectioned. Five dental blocks measuring 2 mm × 3 mm × 4 mm were prepared from each tooth and placed in colorless translucent acrylic resin. The enamel areas from all the specimens were divided into five groups (n = 6): Group 1 did not undergo any bleaching procedures; Group 2 was bleached with a 40% hydrogen peroxide (HP) gel; Groups 3, 4, and 5 were bleached with a 40% HP gel modified by bioactive glass (BAG), amorphous calcium phosphate, and hydroxyapatite, respectively. The enamel SR was evaluated before and after treatment by atomic force microscopy. The data were analyzed by Kruskal–Wallis and Mann–Whitney tests.

Results:

SR increased significantly in the HP group. SR decreased significantly in the HP gel modified by BAG group as compared to other groups.

Conclusions:

Within the limitations of this study, incorporation of each one of the three test biomaterials proved effective in decreasing enamel SR subsequent to in-office bleaching technique.

Erosion Potential of Tooth Whitening Regimens as Evaluated with Polarized Light Microscopy

AIMS

Tooth whitening is a widely utilized esthetic treatment in dentistry. With increased access to over-the-counter (OTC) systems concerns have been raised as to potential adverse effects associated with overuse of whitening materials. Therefore, this study aimed to evaluate enamel erosion due to different whitening regimens when used in excess of recommended guidelines.

MATERIALS AND METHODS

Extracted human teeth (n = 66) were randomly divided into 11 groups (n = 6/group). Specimens were exposed to OTC products: Crest Whitestrips and 5-minute natural white and a do-it-yourself (DIY) strawberry whitening recipe. Within each regimen, groups were further divided per exposure time: specimens receiving the recommended product dosage; 5 times the recommended dosage; and 10 times the recommended dosage. Negative and positive controls were treated with grade 3 water and 1.0% citric acid, respectively. Specimens were nail-varnished to limit application to a 1 × 4 mm window. Following treatment, specimens were sectioned and erosion (drop in μm) measured using polarized light microscopy. Two-sample t-test was used to detect difference in amount of enamel erosion between negative and positive groups, while one-way analysis of variance (ANOVA), followed by post hoc Dunnett's test was used to detect difference between set of treatment groups and negative control groups or among all experimental groups.

RESULTS

There was significant difference in mean amount of enamel erosion (p < 0.0001). Mean enamel erosion for positive control group was significantly greater than that for negative control group (23.50 vs 2.65 μm). There was significant effect for type of treatments on enamel erosion [F(9,50) = 25.19; p < 0.0001]. There was no significant difference between the negative control and each of treatment groups (p > 0.05 for all instances), except for Natural White_10 times treatment group (p < 0.0001) that was significantly greater than the negative control group (14.82 vs 2.65 μm).

CONCLUSION

Caution is advised when using certain over-the-counter products beyond recommended guidelines as there is potential for enamel erosion.

CLINICAL SIGNIFICANCE

Enamel erosion due to the overuse of whitening products varies for different modalities and products. Therefore, caution is advised when using certain over-the-counter products beyond recommended guidelines, as there is potential for enamel erosion.

Effect of enamel morphology on nanoscale adhesion forces of streptococcal bacteria : An AFM study

We explore the influence of enamel surface morphology on nanoscale bacterial adhesion forces. Three dimensional morphology characteristics of enamel slices, which were treated with phosphoric acid (for 0 s, 5 s, 10 s, 20 s, and 30 s), were acquired. Adhesion forces of three initial colonizers (Streptococcus oralis, Streptococcus sanguinis, and Streptococcus mitis) and two cariogenic bacterial strains (Streptococcus mutans and Streptococcus sobrinus) with etched enamel surfaces were determined. Comparison of the forces was made by using bacterial probe method under atomic force microscope (AFM) in adhesion buffer. The results showed that enamel morphology was significantly altered by etching treatment. The roughness, peak-to-valley height, and valley-to-valley width of the depth profile, surface area, and volume increased linearly with acid exposure time, and reached the maximum at 30s, respectively. The adhesion forces of different strains increased accordingly with etching time. Adhesion forces of S. oralis, S. mitis, S. mutans, and S. sobrinus reached the maximum values of 0.81 nN, 0.84 nN, 0.73 nN, and 0.64 nN with enamel treated for 20s, respectively, whereas that of S. sanguinis at 10s (1.28nN), and dropped on coarser enamel surfaces. In conclusion, enamel micro-scale morphology may significantly alter the direct adhesion forces of bacteria. And there may be a threshold roughness for bacterial adhesion on enamel surface.

Tridimensional surface roughness analysis after resin infiltration of (deproteinized) natural subsurface carious lesions

OBJECTIVES

The objectives of this study were to evaluate ex vivo the effects of resin infiltration on the areal surface roughness of natural non-cavitated proximal subsurface lesions with or without previous deproteinization and to determine differences between E2 and D1 lesions or between premolars and molars.

MATERIALS AND METHODS

Forty premolars and 40 molars with proximal carious lesions and macroscopically intact surfaces (International Caries Detection and Assessment System (ICDAS) II; code 2) were radiologically assessed and randomly allocated to four groups (with 20 E2 and 20 D1 lesions, respectively). In each group, 10 lesions were deproteinized (NaOCl; 1%) before etching (HCl; 15%) and resin infiltration (Icon). Areal surface roughness (Sa) at the most demineralized lesion part (DIAGNOdent) was evaluated topometrically before and after deproteinization, after etching, and after infiltration using focus variation 3D scanning microscopy.

RESULTS

Pretreatment with NaOCl (n = 40) had no significant effects on Sa (p = 0.208), but resulted in significantly differing Sa values between premolars and molars after etching (p = 0.011). Regarding the effects between etching and baseline, significantly differing Sa values (p = 0.0498) were found for premolars and molars (n = 40/40); Sa after resin infiltration (compared to etching) differed significantly between premolars and molars (p = 0.009). No treatment regimen lead to differences among the radiological grades (E2 vs. D1; p > 0.106).

CONCLUSIONS

Resin infiltration showed only minor effects on Sa values of etched subsurface lesions (p < 0.170) and did neither equal nor improve baseline surface roughness (p > 0.401) of the different tooth types.

CLINICAL RELEVANCE

Deproteinization should be recommended before etching and infiltration, even if surface roughness of infiltrated advanced (pre-)molar lesions will not be improved.

Utilization of star-shaped polymer architecture in the creation of high-density polymer brush coatings for the prevention of platelet and bacteria adhesion

We demonstrate utilization of star-shaped polymers as high-density polymer brush coatings and their effectiveness to inhibit the adhesion of platelets and bacteria. Star polymers consisting of poly(2-hydroxyethyl methacrylate) (PHEMA) and/or poly(methyl methacrylate) (PMMA), were synthesized using living radical polymerization with a ruthenium catalyst. The polymer coatings were prepared by simple drop casting of the polymer solution onto poly(ethylene terephthalate) (PET) surfaces and then dried. Among the star polymers prepared in this study, the PHEMA star polymer (star-PHEMA) and the PHEMA/PMMA (mol. ratio of 71/29) heteroarm star polymer (star-H71M29) coatings showed the highest percentage of inhibition against platelet adhesion (78-88% relative to noncoated PET surface) and Escherichia coli (94-97%). These coatings also showed anti-adhesion activity against platelets after incubation in Dulbecco's phosphate buffered saline or surfactant solution for 7 days. In addition, the PMMA component of the star polymers increased the scratch resistance of the coating. These results indicate that the star-polymer architecture provides high polymer chain density on PET surfaces to prevent adhesion of platelets and bacteria, as well as coating stability and physical durability to prevent exposure of bare PET surfaces. The star polymers provide a simple and effective approach to preparing anti-adhesion polymer coatings on biomedical materials against the adhesion of platelets and bacteria.

Surface roughness mediated adhesion forces between borosilicate glass and gram-positive bacteria

It is well-known that a number of surface characteristics affect the extent of adhesion between two adjacent materials. One of such parameters is the surface roughness as surface asperities at the nanoscale level govern the overall adhesive forces. For example, the extent of bacterial adhesion is determined by the surface topography; also, once a bacteria colonizes a surface, proliferation of that species will take place and a biofilm may form, increasing the resistance of bacterial cells to removal. In this study, borosilicate glass was employed with varying surface roughness and coated with bovine serum albumin (BSA) in order to replicate the protein layer that covers orthopedic devices on implantation. As roughness is a scale-dependent process, relevant scan areas were analyzed using atomic force microscope (AFM) to determine Ra; furthermore, appropriate bacterial species were attached to the tip to measure the adhesion forces between cells and substrates. The bacterial species chosen (Staphylococci and Streptococci) are common pathogens associated with a number of implant related infections that are detrimental to the biomedical devices and patients. Correlation between adhesion forces and surface roughness (Ra) was generally better when the surface roughness was measured through scanned areas with size (2 × 2 μm) comparable to bacteria cells. Furthermore, the BSA coating altered the surface roughness without correlation with the initial values of such parameter; therefore, better correlations were found between adhesion forces and BSA-coated surfaces when actual surface roughness was used instead of the initial (nominal) values. It was also found that BSA induced a more hydrophilic and electron donor characteristic to the surfaces; in agreement with increasing adhesion forces of hydrophilic bacteria (as determined through microbial adhesion to solvents test) on BSA-coated substrates.

Hydrophilicity of dentin bonding systems influences in vitro Streptococcus mutans biofilm formation

OBJECTIVE

To evaluate in vitro Streptococcus mutans (S. mutans) biofilm formation on the surface of five light-curing experimental dental bonding systems (DBS) with increasing hydrophilicity. The null hypothesis tested was that resin chemical composition and hydrophilicity does not affect S. mutans biofilm formation.

METHODS

Five light-curing versions of experimental resin blends with increasing hydrophilicity were investigated (R1, R2, R3, R4 and R5). R1 and R2 contained ethoxylated BisGMA/TEGDMA or BisGMA/TEGDMA, respectively, and were very hydrophobic, were representative of pit-and-fissure bonding agents. R3 was representative of a typical two-step etch-and-rinse adhesive, while R4 and R5 were very hydrophilic resins analogous to self-etching adhesives. Twenty-eight disks were prepared for each resin blend. After a 24h-incubation at 37°C, a multilayer monospecific biofilm of S. mutans was obtained on the surface of each disk. The adherent biomass was determined using the MTT assay and evaluated morphologically with confocal laser scanning microscopy (CLSM) and scanning electron microscopy (SEM).

RESULTS

R2 and R3 surfaces showed the highest biofilm formation while R1 and R4 showed a similar intermediate biofilm formation. R5 was more hydrophilic and acidic and was significantly less colonized than all the other resins. A significant quadratic relationship between biofilm formation and hydrophilicity of the resin blends was found. CLSM and SEM evaluation confirmed MTT assay results.

CONCLUSIONS

The null hypothesis was rejected since S. mutans biofilm formation was influenced by hydrophilicity, surface acidity and chemical composition of the experimental resins. Further studies using a bioreactor are needed to confirm the results and clarify the role of the single factors.

Comparative short-term in vitro analysis of mutans streptococci adhesion on esthetic, nickel-titanium, and stainless-steel arch wires

OBJECTIVE

To test the hypothesis that there are no differences in mutans streptococci (MS) adhesion between esthetic and metallic orthodontic arch wires based on their surface characteristics.

MATERIALS AND METHODS

Surface roughness (Ra) and apparent surface free energy (SFE) were measured for six wires-four esthetic, one nickel-titanium (NiTi), and one stainless-steel (SS)-using profilometry and dynamic contact angle analysis, respectively. The amount of MS (Streptococcus mutans and Streptococcus sobrinus) adhering to the wires was quantified using the colony-counting method. The surfaces, coating layers, and MS adhesion were also observed by scanning electron microscopy. Statistical significance was set at P < .05.

RESULTS

The Ra values of the esthetic wires were significantly different from one another depending on the coating method (P < .05). The NiTi wire showed the highest SFE, followed by the SS wire and then the four esthetic wires. The NiTi wires produced a significantly higher MS adhesion than did the SS wires (P < .05). The esthetic wires showed significantly lower MS adhesions than did the NiTi wire (P < .05). Pearson correlation analyses found moderate significant positive correlations between the SFE and the S mutans and S sobrinus adhesions (r  =  .636/.427, P < .001/P  =  .001, respectively).

CONCLUSIONS

The hypothesis is rejected. This study indicates that some esthetic coatings on NiTi alloy might reduce MS adhesion in vitro in the short term.

Crystalline anatase-rich titanium can reduce adherence of oral streptococci

Dental implant abutments that emerge through the mucosa are rapidly covered with a salivary protein pellicle to which bacteria bind, initiating biofilm formation. In this study, adherence of early colonizing streptococci, Streptococcus gordonii, Streptococcus oralis, Streptococcus mitis and Streptococcus sanguinis to two saliva-coated anodically oxidized surfaces was compared with that on commercially pure titanium (CpTi). Near edge X-ray absorption (NEXAFS) showed crystalline anatase was more pronounced on the anodically oxidized surfaces than on the CpTi. As revealed by fluorescence microscopy, a four-species mixture, as well as individual bacterial species, exhibited lower adherence after 2 h to the saliva-coated, anatase-rich surfaces than to CpTi. Since wettability did not differ between the saliva-coated surfaces, differences in the concentration and/or configuration of salivary proteins on the anatase-rich surfaces may explain the reduced bacterial binding effect. Anatase-rich surfaces could thus contribute to reduced overall biofilm formation on dental implant abutments through diminished adherence of early colonizers.

Soft tissue integration versus early biofilm formation on different dental implant materials

OBJECTIVE

Dental implants anchor in bone through a tight fit and osseo-integratable properties of the implant surfaces, while a protective soft tissue seal around the implants neck is needed to prevent bacterial destruction of the bone-implant interface. This tissue seal needs to form in the unsterile, oral environment. We aim to identify surface properties of dental implant materials (titanium, titanium-zirconium alloy and zirconium-oxides) that determine the outcome of this "race-for-the-surface" between human-gingival-fibroblasts and different supra-gingival bacterial strains.

METHODS

Biofilms of three streptococcal species or a Staphylococcus aureus strain were grown in mono-cultures on the different implant materials in a parallel-plate-flow-chamber and their biovolume evaluated using confocal-scanning-laser-microscopy. Similarly, adhesion, spreading and growth of human-gingival-fibroblasts were evaluated. Co-culture experiments with bacteria and human-gingival-fibroblasts were carried out to evaluate tissue interaction with bacterially contaminated implant surfaces. Implant surfaces were characterized by their hydrophobicity, roughness and elemental composition.

RESULTS

Biofilm formation occurred on all implant materials, and neither roughness nor hydrophobicity had a decisive influence on biofilm formation. Zirconium-oxide attracted most biofilm. All implant materials were covered by human-gingival-fibroblasts for 80-90% of their surface areas. Human-gingival-fibroblasts lost the race-for-the-surface against all bacterial strains on nearly all implant materials, except on the smoothest titanium variants.

SIGNIFICANCE

Smooth titanium implant surfaces provide the best opportunities for a soft tissue seal to form on bacterially contaminated implant surfaces. This conclusion could only be reached in co-culture studies and coincides with the results from the few clinical studies carried out to this end.

Nanoscale characterization of effect of L-arginine on Streptococcus mutans biofilm adhesion by atomic force microscopy

A major aetiological factor of dental caries is the pathology of the dental plaque biofilms. The amino acid L-arginine (Arg) is found naturally in saliva as a free molecule or as a part of salivary peptides and proteins. Plaque bacteria metabolize Arg to produce alkali and neutralize glycolytic acids, promoting a less cariogenous oral microbiome. Here, we explored an alternative and complementary mechanism of action of Arg using atomic force microscopy. The nanomechanical properties of Streptococcus mutans biofilm extracellular matrix were characterized under physiological buffer conditions. We report the effect of Arg on the adhesive behaviour and structural properties of extracellular polysaccharides in S. mutans biofilms. High-resolution imaging of biofilm surfaces can reveal additional structural information on bacterial cells embedded within the surrounding extracellular matrix. A dense extracellular matrix was observed in biofilms without Arg compared to those grown in the presence of Arg. S. mutans biofilms grown in the presence of Arg could influence the production and/or composition of extracellular membrane glucans and thereby affect their adhesion properties. Our results suggest that the presence of Arg in the oral cavity could influence the adhesion properties of S. mutans to the tooth surface.

Novel strategies for the prevention and treatment of biofilm related infections

Biofilm formation by human bacterial pathogens on implanted medical devices causes major morbidity and mortality among patients, and leads to billions of dollars in healthcare cost. Biofilm is a complex bacterial community that is highly resistant to antibiotics and human immunity. As a result, novel therapeutic solutions other than the conventional antibiotic therapies are in urgent need. In this review, we will discuss the recent research in discovery of alternative approaches to prevent or treat biofilms. Current anti-biofilm technologies could be divided into two groups. The first group focuses on targeting the biofilm forming process of bacteria based on our understanding of the molecular mechanism of biofilm formation. Small molecules and enzymes have been developed to inhibit or disrupt biofilm formation. Another group of anti-biofilm technologies focuses on modifying the biomaterials used in medical devices to make them resistant to biofilm formation. While these novel anti-biofilm approaches are still in nascent phases of development, efforts devoted to these technologies could eventually lead to anti-biofilm therapies that are superior to the current antibiotic treatment.

Denture polymers with antimicrobial properties: a review of the development and current status of anionic poly(methyl methacrylate) polymers

The denture base polymer poly(methyl methacrylate) (PMMA) is highly susceptible for microbial colonization resulting in denture-associated infections. Over the years research has focused on ways to modify the PMMA properties via surface and chemical modification. These studies led to the development of new denture polymers that include anionic PMMA polymers. The new anionic polymers presented the possibility of compromising the physical and mechanical properties required for denture fabrication. These obstacles were overcome by generating anionic PMMA polymers with physical and mechanical properties suitable for denture fabrication. A large body of literature is available on the anionic PMMA polymers, their antimicrobial properties and their potential for the commercial and clinical application as dental biomaterials. This article describes a review and evaluation of the anionic PMMA polymers for their suitability to serve as denture base polymers, their antimicrobial properties, their efficacy to prevent denture-induced infection and their safety in the oral environment.

Determination of surface roughness and topography of dental resin-based nanocomposites using AFM analysis

The aim of this study was to determine surface roughness and topography of polished dental resin-based nanocomposites. Four representative dental resin-based nanocomposites were tested in the study: two nanohybrids (Filtek Z550 and Tetric EvoCeram) and two nanofilled (Filtek Ultimate Body and Filtek Ultimate Translucent); and two reference materials: one microfilled (Gradia Direct) and one microhybrid (Filtek Z250). Polymerized cylindrical specimens (4 mm x 2 mm) were polished with multi-step polishing system- Super Snap. Immediately after the polishing, topography of each specimen was examined by Veeco di CP-II Atomic Force Microscope. Specimen's surface has been scanned in 6 points in contact mode with CONT20A-CP tips. 1 Hz scan rate and 256 × 256 resolution were used to obtain topography on a 90 µm × 90 µm scanning area. Measured topography data were processed by Image Processing and Data Analysis v2.1.15 software. Following parameters were compared among specimens: average roughness and maximum peak-to-valley distance. All of the tested materials had similar average surface roughness after finishing and polishing procedure. The lowest values occurred in the material Filtek Ultimate Body, and the highest in the Filtek Z550. When interpreting maximum peak-to-valley distance the larger differences in values (up to 100%) occurred in Filtek Z550, Filtek Z250 and Filtek Ultimate Body, which is a result of the deep polishing channels and tracks. Type, size, distribution of fillers and filler loading in tested materials, didn't influence average roughness values, but had an impact on maximum peak-to-valley distance values.