Morphologic studies on dental plaque formation

The Effect of Amino Sugars on the Composition and Metabolism of a Microcosm Biofilm and the Cariogenic Potential against Teeth and Dental Materials

Amino sugars N-acetylglucosamine (GlcNAc) and glucosamine (GlcN) are abundant sources of carbon and nitrogen in the oral cavity. The aim of this study was to investigate the effects of GlcNAc metabolism on the genomics and biochemistry of a saliva-derived microbial community, and on the surface integrity of human teeth and restorative surfaces. Pooled cell-containing saliva (CCS) was used to establish a microcosm biofilm in vitro in a biofilm medium (BM) containing 5 different carbohydrates. The microbial composition of each biofilm was analyzed by 16S rRNA amplicon sequencing, and the concentrations of eight organic acids were determined for selected sugars by targeted metabolomics. Meanwhile, extracted human teeth and polished titanium and ceramic disks were submerged in BM supplemented with 1% of glucose or GlcNAc, inoculated with CCS and Streptococcus mutans UA159, and incubated for 30 days. To mimic the effects of other microbial byproducts, the specimens were immersed in 10 mM hydrogen peroxide and 10 mM ammonium hydroxide for 30 days. The surface of each specimen was evaluated by profilometry for roughness (Ra) and imaged by scanning electron microscopy. The pH of the biofilm supernatant was significantly higher for the medium containing GlcNAc (p < 0.0001), and was higher in samples containing teeth than the two restorative disks for media containing the same sugar. For both teeth and titanium specimens, the samples treated with glucose-biofilm presented higher roughness values (Ra) than those with GlcNAc-biofilm and every other group. SEM images of the teeth and titanium disks largely supported the profilometry results, with glucose-biofilm samples demonstrating the largest deviation from the reference. For ceramic disks, slightly higher Ra values were obtained for the ammonia group. These findings provide the first direct evidence to support the ability of amino sugars to significantly reduce the cariogenic potential of oral biofilms by altering their biochemistry and bacterial composition. Additionally, amino sugar metabolism appears to be less detrimental to teeth and restorative surfaces than glucose metabolism.

Early plaque formation on PTFE membranes with expanded or dense surface structures applied in the oral cavity of human volunteers

Objectives

This clinical randomized study aimed to evaluate the early plaque formation on nonresorbable polytetrafluoroethylene (PTFE) membranes having either a dense (d‐PTFE) or an expanded (e‐PTFE) microstructure and exposed to the oral cavity.

Material and Methods

Twelve individuals were enrolled in this study. In a split‐mouth design, five test membranes (e‐PTFE) with a dual‐layer configuration and five control membranes (d‐PTFE) were bonded on the buccal surfaces of posterior teeth of each subject. All study subjects refrained from toothbrushing during the study period. Specimens were detached from the teeth at 4 and 24 hr and subjected to viability counting, confocal microscopy, and scanning electron microscopy. Plaque samples were harvested from neighboring teeth at baseline, 4, and 24 hr, as control. Wilcoxon signed rank test was applied.

Results

No bond failure of the membranes was reported. Between the early and late time points, viable bacterial counts increased on all membranes, with no difference between the test and control. The number of Staphylococcus spp. decreased on the tooth surfaces and increased on both membranes overtime, with a significant difference compared to teeth. The total biomass and average biofilm thickness of live and dead cells were significantly greater at the d‐PTFE barriers after 4 hr.

Conclusion

This study demonstrated that the e‐PTFE membrane was associated with a lesser degree of biofilm accumulation during the initial exposure compared to the d‐PTFE membrane. The present experimental setup provides a valuable toolbox to study the in vivo behavior of different membranes used in guided bone regeneration (GBR).

Effect of fragaria vesca, hamamelis and tormentil on the initial bacterial colonization in situ

OBJECTIVE

The presentin situ study aims to examine the influence of the polyphenolic tea drugs fragaria vesca, hamamelis and tormentil on the initial oral bioadhesion.

DESIGN

Initial biofilm formation was performed on bovine enamel slabs which were carried intraorally by 12 subjects. After 1 min of intraoral pellicle formation, the subjects rinsed with fragaria vesca, tormentil (0.8 mg/8 mL) and hamamelis (0.2 mg/8 mL) for 10 min. Tap water served as negative control, 0.2 % CHX as positive control. The investigations took place on different days (wash-out: 2 days). Afterwards, fluorescence microscopy has been performed per test solution (n = 5) and per subject (n = 12) to visualize bacterial adhesion and glucan formation (8 h oral exposition) with DAPI, ConA and BacLight. Additionally, TEM was used to visualize the pellicle ultrastructure and expectorate samples. Statistical evaluation was carried out using the Kruskal-Wallis- (p < 0.5), Mann-Whitney U test (p < 0.5) and Bonferroni-Holm-correction (p < 0.1).

RESULTS

Rinsing with the polyphenolic tea extracts reduced significantly initial bacterial colonization (DAPI) compared to the negative control. There was no significant difference betweenfragaria vesca, hamamelis and tormentil. All solutions showed a reducing effect on the glucan formation. No significant difference was observed between fragaria vesca and CHX. Considerable alterations of the pellicle's ultrastructure manifested by an increase in thickness and electron density resulted from rinsing with the three polyphenolic aqueous extracts.

CONCLUSIONS

Fragaria vesca, hamamelis and tormentil significantly reduce initial bioadhesion and glucan formation in situ and are therefore recommended as adjuvant antibacterial oral therapeutics.

In vitro evaluation of barrier function against oral bacteria of dense and expanded polytetrafluoroethylene (PTFE) membranes for guided bone regeneration

AIM

This study evaluates biofilm formation and barrier function against Streptococcus oralis of nonresorbable polytetrafluoroethylene (PTFE) guided bone regeneration membranes having expanded (e-PTFE) and dense (d-PTFE) microstructure.

MATERIALS AND METHODS

Three e-PTFE membranes of varying openness, one d-PTFE membrane, and commercially pure titanium discs were evaluated. All e-PTFE membranes consisted of PTFE nodes interconnected by fibrils. The d-PTFE membrane was fibril-free, with large evenly spaced indentations. The surfaces were challenged with S. oralis and incubated statically for 2-48h. Bacterial colonization, viability, and penetration were evaluated.

RESULTS

S. oralis numbers increased over time on all surfaces, as observed using scanning electron microscopy, while cell viability decreased, as measured by colony forming unit (CFU) counting. At 24h and 48h, biofilms on d-PTFE were more mature and thicker (tower formations) than on e-PTFE, where fewer layers of cells were distributed mainly horizontally. Biofilms accumulated preferentially within d-PTFE membrane indentations. At 48h, greater biofilm biomass and number of viable S. oralis were found on d-PTFE compared to e-PTFE membranes. All membranes were impermeable to S. oralis cells.

CONCLUSIONS

All PTFE membranes were effective barriers against bacterial passage in vitro. However, d-PTFE favored S. oralis biofilm formation.

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.

Effect of surface characteristics on adherence of S. mutans biofilms to indirect resin composites

The purpose of this study was to evaluate the adherence of biofilms to the surfaces of two indirect resin composites, Estenia C&B and Gradia. Slabs were prepared from the materials, and then either ground with 800-grit silicon carbide paper or polished with diamond pastes up to 1 microm. Artificial biofilms of Streptococcus mutans were grown on the composite slabs in an artificial mouth system for 20 hours. Thereafter, the amounts of retained biofilm on the surfaces were measured after sonication. Surface characteristics of the resins--such as surface roughness, amount of residual monomers, and distribution of filler particles--were examined. Two-way ANOVA revealed that the amount of retained biofilm varied (p<0.05) according to the composition and surface roughness of the material. In particular, biofilm adherence was lowest on Estenia C&B slabs when polished with diamond pastes up to 1 microm. It was thus concluded that the surface roughness and composition of a resin composite influenced biofilm adherence.

Surface properties of resin composite materials relative to biofilm formation

The surface properties of three different resin composite materials which influence Streptococcus mutans biofilm formation were evaluated using an artificial mouth system (AMS). Specimens were prepared from Clearfil AP-X, Grandio, and Reactmer Paste, and each material was divided into two groups: (1) surface was ground with 800-grit silicon paper (SiC#800); or (2) surface was polished with up to 1- microm diamond paste (DP1 microm). Biofilms were grown on the surface of each specimen for 20 hours, and then subjected to vortex agitation followed by measurement of retained biofilms. Surfaces with retained biofilms were also inspected by SEM. Significant differences were detected in surface roughness (Ra) between the two polishing conditions for all materials. The quantity of retained biofilm was significantly less (p < 0.05) on Clearfil AP-X DP 1 microm than on Clearfil AP-X SiC#800. With Reactmer Paste, their surfaces registered the lowest amount of retained biofilm--but there were no significant differences between the two polishing conditions. In conclusion, polishing did not render all resin composites equally resistant to biofilm formation.

Detection of salivary α-amylase and lysozyme exposed on the pellicle formedin situ on different materials

Amylase and lysozyme are components of the salivary pellicle, exposing considerable enzymatic activity in the immobilized state. The purpose of the present study was to elucidate the influence of different solid substrata on the amount and distribution of amylase and lysozyme exposed on the surface of the salivary pellicle formed in situ. Slabs of titanium, feldspar ceramic, and bovine enamel were fixed on the buccal sites of individual splints worn by three subjects for 3 or 30 min, respectively, to allow pellicle formation. Subsequently, slabs were removed from the splints and rinsed with running water. Detection of amylase and lysozyme was performed by FEI-SEM after gold-immunolabeling of the enzymes. Both enzymes were found to be distributed randomly at the pellicle surface. Irrespective of formation time and substratum, significantly more labeled lysozyme molecules (5.23 +/- 4.5 microm(-2)) were detected compared with amylase (3.4 +/- 2.9 microm(-2)). Neither the substratum nor the pellicle formation time had significant impact on the amount of the respective enzyme that could be detected. This study for the first time provides evidence, that amylase and lysozyme are exposed at the surface of the salivary pellicle formed in situ on titanium and ceramics. Both enzymes are distributed randomly on the surface of the pellicle, irrespective of the underlying substratum.

The effect of periodontal treatment on the salivary bacterial load and early plaque formation

AIM

The purpose of the present study was to investigate in periodontitis patients the relationship between the number of bacteria in the saliva and the amount of de novo plaque formation before and after treatment.

METHODS

At baseline, before any treatment was provided, patients rinsed with 10 ml sterile saline. After professional tooth cleaning the patients were instructed to abolish all tooth cleaning procedures for the subsequent 24 h. After this period, the rinsing procedure was repeated and the amount of de novo plaque was assessed. Three months after the initial periodontal therapy was completed the experiment was repeated. The microbiological evaluation of the rinsing samples was carried out by means of phase contrast microscopy and anaerobic culturing.

RESULTS

After treatment the amount of de novo plaque was less compared to before treatment, 0.40 and 0.65 respectively. Both before and after treatment more de novo plaque was present at sites with inflammation than at healthy sites. In order to evaluate the contribution of the numbers of salivary bacteria to the amount of de novo plaque formation an analysis was carried out for healthy sites. This analysis included only healthy sites as determined before treatment and the same sites after treatment. The results showed a significant reduction in the de novo plaque formation after treatment (0.49 before and 0.22 after treatment). Phase contrast microscopic evaluation showed that the number of bacteria in the rinsing samples after treatment was less than before treatment. After treatment also a reduction was found in the prevalence of Prevotella intermedia, Tannerella forsythensis and Peptostreptococcus micros in the rinsing samples.

CONCLUSION

The present study confirms the observation in the literature that the periodontal condition is of major importance in the rate of de novo plaque formation. In addition, the results suggest that the number of bacteria in the saliva may play a role.

Immobilisation and activity of human α-amylase in the acquired enamel pellicle

Amylase is an important salivary component and structural element of the acquired enamel pellicle. Aim of the study was to establish a method for precise and direct determination of pellicle bound amylase activity in order to analyse kinetics and activity of the immobilised enzyme. Six bovine enamel slabs (5mm diameter) were fixed on individual maxillary trays and worn by five subjects for different times (3, 30 and 120 min) on buccal and palatal sites on different days. Slabs were removed from the trays and rinsed with aqua dest. Afterwards, pellicle bound amylase activity was determined directly with a photometric method using 2-chloro-4-nitrophenyl-4-O-beta-D-galactopyranosylmaltotriosid (GalG2CNP) as substrate yielding the coloured product chloronitrophenolate (CNP). All investigated pellicles exhibited immobilised amylase activity. Mean activity was 1.39 +/- 187 mU/cm(2) (n=87, range 0.14-11.5 mU/cm(2)). Product formation of CNP by immobilised amylase was linear over time. Pellicle bound amylase showed a Michaelis type kinetic (Km = 3.3 x 10(-3) M). Immobilised activity on buccal surfaces ranged between 0.25 and 11.1 mU/cm(2) (palatal slabs: 0.14-3.06 mU/cm(2)). Thirty minutes pellicles formed on buccal sites exhibited significantly higher immobilised amylase activity (2.85 +/- 3.65 mU/cm(2)) than palatal ones (0.63 +/- 0.32 mU/cm(2)). Amylase activity showed great intraindividual variability when comparing same positions on different days.

CONCLUSION

Pellicle bound amylase activity can be determined directly with GalG2CNP and shows a Michaelis Menten kinetic. Enzyme activity of the amylase immobilised in the in situ pellicle reveals great intra- and interindividual differences.

Bacteria-binding plasma proteins in pellicles formed on hydroxyapatite in vitro and on teeth in vivo

Previous studies on dental pellicle formation and bacterial adherence have focussed on saliva and its components. The tooth surface is, however, also exposed to the plasma-derived crevicular fluid. In the present study, (i). plasma proteins in in vitro and in vivo pellicles were examined using sodium dodecyl sulphate-polyacrylamide gel electrophoresis (SDS-PAGE), immunoblotting and image analysis and (ii). the adherence of periodontopathogenic bacteria to experimental plasma and saliva pellicles was examined using radio-labelled bacteria and liquid scintillation counting. The plasma components fibrinogen, fibronectin, albumin and IgG were incorporated from plasma in the experimental pellicle and mediated the adherence of Porphyromonas gingivalis, Fusobacterium nucleatum and Actinomyces naeslundii. These proteins were also readily detected in in vivo pellicles and were found to a higher extent in pellicles formed at the gingival part of the tooth surface than at the incisal part.

Infectious risks for oral implants: a review of the literature

The use of oral implants in the rehabilitation of partially and fully edentulous patients is widely accepted even though failures do occur. The chance for implants to integrate can for example be jeopardised by the intra-oral presence of bacteria and concomitant inflammatory reactions. The longevity of osseointegrated implants can be compromised by occlusal overload and/or plaque-induced peri-implantitis, depending on the implant geometry and surface characteristics. Animal studies, cross-sectional and longitudinal observations in man, as well as association studies indicate that peri-implantitis is characterised by a microbiota comparable to that of periodontitis (high proportion of anaerobic Gram-negative rods, motile organisms and spirochetes), but this does not necessarily prove a causal relationship. However, in order to prevent such a bacterial shift, the following measures can be considered: periodontal health in the remaining dentition (to prevent bacterial translocation), the avoidance of deepened peri-implant pockets, and the use of a relatively smooth abutment and implant surface. Finally, periodontitis enhancing factors such as smoking and poor oral hygiene also increase the risk for peri-implantitis. Whether the susceptibility for periodontitis is related to that for peri-implantitis may vary according to the implant type and especially its surface topography.

Evaluation of the dentogingival area during early plaque formation

BACKGROUND

The aims of this investigation were to evaluate the pattern of supragingival plaque formation in the dentogingival area within 96 hours after abstinence from mechanical plaque control and to clinically analyze the gingival inflammatory response observed.

METHODS

Six male volunteers, 20 to 23 years of age, had their upper incisors and cuspids polished. Four independent periods of no mechanical plaque control--24, 48, 72, and 96 hours--were instituted. In each period, plaque was disclosed and standardized individual photographs were taken. Impressions were taken and replicas were analyzed by scanning electron microscopy. Gingival crevicular fluid (GCF) was collected at baseline and 96 hours. The height of the gingival papilla was measured at baseline, 24, and 96 hours.

RESULTS

Results showed the presence of a plaque-free zone (PFZ) along the gingival margin up to 72 hours. After 96 hours, there was a significant reduction in the presence of PFZ in the proximal thirds of the buccal surface when compared to the other experimental periods. At the end of the study, there was a significant increase in the GCF flow as well as edema of the interdental papilla, when compared to baseline values.

CONCLUSIONS

The PFZ observed during the initial phase was less apparent at the 96-hour period. At this time, there was an increase in the gingival inflammatory response, represented clinically by increased GCF flow and edema.

The effects of surface roughness and type of denture acrylic on biofilm formation by Streptococcus oralis in a constant depth film fermentor

AIMS

To investigate the effects of surface roughness and type of denture acrylic on the early development of a Streptococcus oralis biofilm in a constant depth film fermentor (CDFF).

METHODS AND RESULTS

Streptococcus oralis was incubated with acrylic of known surface roughness in the CDFF. Adherent Strep. oralis were enumerated by viable counting. Cold-cure acrylic was rougher (P < 0.01) than heat-cure acrylic after polishing with abrasive paper of any given grit-grade. Heat-cure acrylic was colonized by fewer (P < 0.001) bacteria than cold-cure acrylic at any given surface roughness. The number of bacteria adhering to heat-cure and cold-cure acrylic increased linearly with mean surface roughness after 2 h incubation, the increase being greater (P < 0.001) for the cold-cure compared with the heat-cure acrylic. However, after 4 h incubation, surface roughness appeared to have no effect on the number of adherent bacteria.

CONCLUSION

The type of acrylic used, and its roughness, affect the early stages of biofilm formation by Strep. oralis.

SIGNIFICANCE AND IMPACT OF THE STUDY

Choosing an appropriate type of smooth acrylic could lead to reduced biofilm formation in vivo.

Denture plaque and adherence of Candida albicans to denture-base materials in vivo and in vitro

The aim of this paper is to review our understanding of the mechanisms and clinical significance of adhesion of C. albicans to denture-base materials in relation to denture plaque and denture-related stomatitis. Earlier reports in the literature of a 65% prevalence level of denture-related stomatitis seem to be exaggerated. More recent studies indicate that denture-related stomatitis is considerably less common, particularly in normal healthy subjects. The etiology of the condition is discussed in this review, and although much of the literature supports the view that the condition is strongly associated with C. albicans, this is not always so. In some subjects, the cause appears to be related to a non-specific plaque. This review also considers the role of denture plaque in the pathogenesis of denture-related stomatitis, the sequential development of denture plaque, and its colonization by Candida organisms. Designing controlled in vivo studies is difficult, and as a consequence, many investigators have had to resort to in vitro studies. The majority of these studies have attempted to investigate the hydrophobicity of C. albicans, relating the surface free-energy of denture-base materials, particularly acrylic resin, to that of the organism. Surprisingly little work has been directed at surface roughness and how it affects retention of organisms. Further, no attention has been paid to the properties and character of the surface, other than average surface roughness, as it affects adhesion. A comparison of results from in vitro studies on the effect on adhesion of pre-coating the surfaces of denture-base materials with saliva has produced equivocal conclusions. This is largely due to little standardization of experimental protocols between studies, particularly in the collection and handling of the saliva used. In conclusion, the review strongly supports the suggestion that adherence of C. albicans to denture-base materials in vitro is related to the hydrophobicity of the organism. The clinical significance of the observation and the mechanisms for the development and maturation of denture plaque are yet to be understood. There is a clear need for further investigation of other factors that may moderate the adhesion of organisms and subsequent colonization of denture-base materials.

The effect of chlorhexidine mouthrinses on early bacterial colonization of guided tissue regeneration membranes. An in vivo study

BACKGROUND

Different membrane materials accumulate varying amounts of bacteria when exposed in the oral cavity, due to their textural and structural surface characteristics. The aim of the study was to evaluate the effect of chlorhexidine mouthrinses on the in vivo early bacterial colonization of 3 different guided tissue regeneration membrane materials.

METHODS

Rectangular-shaped strips cut from 3 periodontal membranes (expanded polytetrafluoroethylene, polyglactin 910, and polylactic acid) were glued to removable devices adapted to the 2 upper quadrants in 8 dental students. In each student 1 quadrant was randomly selected as test side while the other served as control side. The experiment was divided in 2 phases: in the first phase plaque accumulation was followed for 4 hours while the second accumulation was followed for 24 hours. During the 4-hour experiment, students rinsed the test device twice (immediately following device application and after 2 hours) with 0. 12% chlorhexidine solution. The control device was rinsed with saline. In the second phase, students rinsed the test device with chlorhexidine and the control devices with saline 3 times (after device application and at 8 and 16 hours). Both the 4-hour and the 24-hour specimens were processed for scanning electron microscopy analysis. Fifty-four fields (at 200x magnification) were randomly selected and analyzed on each strip. Magnification was increased to determine the presence and morphotype of bacteria. The presence or absence of bacteria was assessed in a binomial fashion: the field was bacteria-positive when bacteria constituted the deposits covering the membrane surface. The microscopic field was negative (bacteria-negative) when no bacteria were observed. Bacteria-positive fields showing rods and filaments as prevalent morphotypes were recorded as rod-positive fields.

RESULTS

The results of data analysis suggest that bacterial contamination of membrane materials is significantly reduced by treatment with chlorhexidine. They also suggest that other variables affect plaque accumulation as well; i.e., the time allowed (4 versus 24 hours) and the different membrane materials. The interaction between these 2 variables is also highly significant, thereby indicating a different rate of plaque accumulation on different materials, irrespective of the treatment with chlorhexidine.

CONCLUSIONS

It was concluded that chlorhexidine mouthrinses may be effective in reducing and delaying the early bacterial accumulation on membrane materials although they are not able to fully prevent it. Membrane surface characteristics seem to be a more critical factor than the use of chlorhexidine, in influencing bacterial adhesion and colonization of barrier materials.

Early bacterial accumulation on guided tissue regeneration membrane materials. An in vivo study

The aim of the study was to compare the in vivo early bacterial plaque colonization of 3 different guided tissue regeneration (GTR) membrane materials using a morphological (scanning electron microscope) method. Rectangular-shaped strips were cut from 3 periodontal membranes (expanded polytetrafluoroethylene, polyglactin 910, and polylactic acid) and glued to the buccal aspect of removable acrylic devices, which were applied to the molar-premolar region of the upper quadrants in 8 dental students. Each device held 3 strips: one ePTFE, one polyglactin 910, and one polylactic acid. The surface roughness of each membrane material was measured by means of a laser profilometer. During a 24-hour period, the students had to refrain from any oral hygiene procedures and did not use chlorhexidine mouthrinses. In each subject, one device was removed after 4 hours and the other after 24 hours. After removal, the devices were placed in a 2.5% gluteraldehyde solution to fix the membranes, which were then processed for SEM analysis. Fifty-four microscopic fields (at 200x magnification) were randomly selected and analyzed in each strip. Magnification was increased to determine the presence of bacterial morphotypes. The presence or absence of bacteria was assessed in a binomial fashion. In such a system, the field was bacteria-positive when bacteria constituted the deposits covering the surface of the membrane. The microscopic field was considered bacteria-negative when no bacteria were present. Bacteria-positive fields showing rods and filaments as prevalent bacterial morphotypes were recorded as rod-positive fields. A different pattern of plaque accumulation was demonstrated on different membrane materials. The 4-hour results indicated a statistically significant difference (P = 0.008, ANOVA) in the proportion of bacteria-positive fields among the 3 membranes; a greater amount of bacteria was demonstrated on the ePTFE membrane compared to the other 2 membranes. At 24 hours, the difference in the proportion of bacteria-positive fields was statistically significant (P = 0.002, ANOVA); a lesser amount of bacterial plaque was present on the polylactic acid membrane compared to the ePTFE and polyglactin 910 membranes. No difference in the proportion of rod/bacteria-positive fields was demonstrated among the 3 membranes at either 4 or 24 hours. It was concluded that quantitative differences in early plaque accumulation on various membranes seem to be related to the textural and structural characteristics of the surface, which is not adequately represented by the surface Ra value measured with a profilometric instrument.

The effect of a 1-stage full-mouth disinfection on oral malodor and microbial colonization of the tongue in periodontitis. A pilot study

Oral malodor affects a large proportion of the population and may be the cause of a significant social and psychological handicap. This pilot study aimed to examine whether a 1-stage full-mouth disinfection in periodontitis patients (scaling and root planing of all pockets within 24 hours together with the application of chlorhexidine to all intra-oral niches followed by chlorhexidine mouth rinsing for 2 months) resulted in a significant improvement in malodor when compared to a fractionated periodontal therapy (consecutive root planings per quadrant, at a 1 to 2 week interval). The baseline and outcome data concerning oral malodor were linked to the presence of tongue coating and to its roughness (fissures). Twenty-four patients with severe periodontitis were randomly allocated to test and control groups. At baseline and after 1 and 2 months, the concentration of volatile sulfur compounds (VSC) in the mouth was measured and organoleptic ratings (expired air and total mouth air) were given. Plaque samples were collected from the dorsum of the tongue to calculate the number of colony forming units (CFU) per ml (anaerobic culturing) as well as the number of pigmented CFU/ml. Both the baseline organoleptic ratings and the VSC scores correlated well with the presence of tongue coating but not with the tongue roughness. Because a correlation between tongue coating and its microbial load could not be detected, it was hypothesized that the tongue coating per se, and not the bacteria, might be responsible for the malodor. The 1-stage full-mouth disinfection resulted in a faster and additional reduction in the organoleptic ratings of the oral malodor, even after 2 months. This might be explained by the improved periodontal outcome and/or the more significant reduction in the CFU/ml of pigmented species. In contrast to the organoleptic ratings, which were significantly reduced in both treatment groups (when compared to baseline), the VSC levels remained unchanged. This pilot study indicates that a 1-stage full-mouth disinfection has, in comparison to a standard periodontal therapy, additional beneficial effects in the treatment of oral malodor.

Scanning electron microscopy of microbial colonization of 'rapid' and 'slow' dental-plaque formers in vivo

The aim was to investigate the morphological features of supragingival plaque development in 'rapid' and 'slow' plaque formers using scanning electron microscopy (SEM). Forty-nine healthy volunteers were screened for their plaque-formation rate after 3 days of oral hygiene abstinence using the Plaque Index (PI). Five with the highest and six with the lowest mean PI were selected as 'rapid' and 'slow' plaque formers, respectively. Six enamel blocks measuring 2 x 2 x 1 mm were bonded onto the buccal surfaces of the upper left canine, premolars and first molar of each selected participant after a series of prophylaxes and oral hygiene instruction to ensure clinical gingival health. A 14-day period with no oral hygiene began thereafter. An enamel block was removed at 3 hr, 6 hr, 1 day, 3 days, 7 days and 14 days from each individual, fixed, and processed for SEM. Quantitatively, more bacteria were observed on the 3-hr to 1-day enamel blocks of the 'rapid' plaque formers. The day-1 specimens of the 'rapid' group showed a more complex supragingival plaque structure than those of the 'slow' group. From days 3 to 14, during the maturation period of supragingival plaque, there were no discernible differences between the two groups except that intermicrobial matrix was more prominent in the 'rapid' group. In general, the development of supragingival plaque followed known patterns. These observations indicate that morphological features of supragingival plaque in 'slow' and 'rapid' plaque formers differ, especially in the early developmental phases.

The effect of surface roughness on early in vivo plaque colonization on titanium

THE STUDY ASSESSES IN VIVO the surface roughness necessary to reduce plaque colonization on titanium after 24 hours. Three groups of 16 titanium disks were assigned to 3 different polishing groups (A, B, and C). The roughness was evaluated with a laser profilometer and the morphology with a scanning electron microscope (SEM). Eight volunteers were enrolled and two stents were applied in the mandibular posterior region of each. Each stent supported 3 disks, one per group. The volunteers suspended oral hygiene for 24 hours, after which the stents were removed; one was processed for evaluation of the adherent biomass and the other for SEM study. On each specimen a global area of 100 x 125 microns was examined with SEM. The area was composed of five 20 x 25 microns randomly selected fields. For each field the density of bacteria and the morphotypes were recorded. The data quoted for the global area are cumulative of those observed in the 20 x 25 microns fields. Group A had a significantly smoother surface than groups B and C. The adherent microbial biomass determination and SEM evaluation revealed that group A contained less bacteria than the roughest group. The bacterial population was composed of cocci in group A, and of cocci and short and long rods in groups B and C. We conclude that a titanium surface with Ra < or = 0.088 microns and Rz < or = 1.027 microns strongly inhibits accumulation and maturation of plaque at the 24-hour time period and that such smoothness can be achieved in transgingival and healing implant components.

Effect of localized experimental gingivitis on early supragingival plaque accumulation

Previous investigations have reported increased plaque formation in the presence of gingival inflammation as compared with gingival health. In these investigations, experimental gingivitis has been induced by total abolition of oral hygiene such that increased levels of salivary bacteria could contribute to the increased plaque formation. In the present study, experimental gingivitis was localized to 2 selected teeth whilst maintaining normal oral hygiene measures in the rest of the mouth. The aim of this study was to investigate whether the mass of plaque accumulating in a 3-day period is influenced by the inflammatory status of the adjacent gingival margins. Following scaling, prophylaxis and a period of optimal hygiene to establish gingival health, "plaque-guards" were worn during routine oral hygiene performance to prevent any cleaning on the buccal surfaces of teeth 14 and 15 from days 0 to 3. On day 3, accumulated plaque was removed from a 1.5 mm zone on the buccal surfaces of 14 and 15 adjacent to the gingival margins and weighed immediately. Subjects continued to wear their plaque-guards during oral hygiene until day 14 to induce experimental gingivitis around the experimental teeth. At day 14, all plaque was cleaned from the buccal surfaces of the experimental teeth and the mass of plaque accumulating over the next 3 days weighed on day 17. Comparison of plaque weights showed that the wet-weight of 3 day-old plaque was higher in the presence of experimental gingivitis than in the presence of gingival health (p = 0.02). This observation suggests that the inflammatory status of the marginal gingiva has an important effect on early, supragingival plaque accumulation.

Bacterial penetration in vitro through GTAM membrane with and without topical chlorhexidine application. A light and scanning electron microscopic study

Premature exposure of membrane in the oral cavity is considered the most common complication as well as a reason for failure or incomplete success of guided tissue regeneration, as the exposed membrane undergoes plaque accumulation. A method to control, or at least to reduce the bacterial invasion of the membrane allowing a delay in the membrane removal, could be of clinical interest. The purpose of the present study was to evaluate the possibility of treating, with topical chlorhexidine application, the bacterial colonization of exposed membranes. A special device was developed in order to evaluate, under an experimental environment, the bacterial colonization. This device was made from a removable acrylic denture base to which 5 gold cups were attached. The cups consisted of an internal compartment, isolated from the oral cavity by a GTAM membrane, and an external compartment exposed to the oral environment. 3 healthy subjects had this device fitted, bilaterally, in the molar-premolar region of the upper jaw. The cups of one side of each subject had 0.2% chlorhexidine gluconate gel applied 2x a day for 1 min, whereas those of the other side served as controls. 12 cups were removed after 2 weeks and the remainder removed after 1 month. The non-treated control specimens were characterized by greater amounts of plaque accumulation. In all the test sites, plaque deposits increased in thickness and quantity during the 4 weeks of the experiment. Complete invasion of the membrane and initial colonization of its internal surface were observed only in 4-week specimens. A relatively simple flora consisting mainly of cocci and short rods, was found in bacterial deposits forming under the influence of chlorhexidine, whereas in non-treated specimens, it was possible to observe a more mature and complex plaque, composed mostly of filamentous bacteria. In conclusion, topical application of chlorhexidine gel is an effective method of reducing plaque and calculus formation on the surface of GTAM membranes exposed to the oral cavity for up to 4 weeks. This study has, however, failed to demonstrate the capacity of chlorhexidine to prevent or to retard bacterial penetration through the thickness of the inner portion of the membranes.

The influence of surface roughness and surface-free energy on supra- and subgingival plaque formation in man. A review of the literature

In the oral cavity, an open growth system, bacterial adhesion to the non-shedding surfaces is for most bacteria the only way to survive. This adhesion occurs in 4 phases: the transport of the bacterium to the surface, the initial adhesion with a reversible and irreversible stage, the attachment by specific interactions, and finally the colonization in order to form a biofilm. Different hard surfaces are available in the oral cavity (teeth, filling materials, dental implants, or prostheses), all with different surface characteristics. In a healthy situation, a dynamic equilibrium exists on these surfaces between the forces of retention and those of removal. However, an increased bacterial accumulation often results in a shift toward disease. 2 mechanisms favour the retention of dental plaque: adhesion and stagnation. The aim of this review is to examine the influence of the surface roughness and the surface free energy in the adhesion process. Both in vitro and in vivo studies underline the importance of both variables in supragingival plaque formation. Rough surfaces will promote plaque formation and maturation, and high-energy surfaces are known to collect more plaque, to bind the plaque more strongly and to select specific bacteria. Although both variables interact with each other, the influence of surface roughness overrules that of the surface free energy. For the subgingival environment, with more facilities for microorganisms to survive, the importance of surface characteristics dramatically decreases. However, the influence of surface roughness and surface-free energy on supragingival plaque justifies the demand for smooth surfaces with a low surface-free energy in order to minimise plaque formation, thereby reducing the occurrence of caries and periodontitis.

Root grooves: a risk factor in periodontal attachment loss

Periodontal health reflects a balance between harmful and protective elements in the gingival margin area. The total plaque mass, specific periodontopathogens, and local environmental factors may challenge this balance. The aim of this retrospective study was to evaluate the effect of proximal root grooves as a risk factor in periodontal attachment loss. One-hundred and three (103) extracted, formalin-stored, single-rooted teeth showing loss of attachment and having one non-grooved and one grooved proximal root surface were selected for the study. Following staining in 0.1% toluidine blue to visualize attached periodontal ligament remnants, the teeth were examined in a light microscope under incident light. On each tooth, loss of attachment was measured along the long axis of the root from the cemento-enamel junction to the most coronal level of the stained periodontal ligament remnants on mesial as well as on distal surfaces. Incisors and premolars were grouped separately. For both groups, a statistically significant greater loss of attachment was present on grooved than on non-grooved surfaces (P < 0.0001). Generally, there was a direct relationship between groove location and maximum loss of attachment. The results indicate that proximal root grooves should be considered in periodontal diagnosis, prognosis, and treatment planning.

A preliminary report on a method for studying the permeability of expanded polytetrafluoroethylene membrane to bacteria in vitro: a scanning electron microscopic and histological study

The technique of guided tissue regeneration using expanded polytetrafluoroethylene (ePTFE) membranes has been shown to be effective in implant dentistry (bony defects, extremely thin alveolar ridges, and implants placed in fresh extraction sockets). One of the drawbacks associated with the use of membranes is their premature exposure with consequent bacterial contamination. The aim of this study was to examine the possibility that oral bacteria migrate through the occlusive portion of ePTFE membranes and to determine the time needed for microorganisms to pass from the outer surface to the inner surface of the membranes. A removable acrylic device was adapted to the molar-premolar region of one quadrant of the jaws in each of three volunteers. Five cylindrical teflon chambers were glued to the buccal aspect of each device. The chambers were divided into two rooms separated by the inner portion of a ePTFE membrane. The outer room was open to the oral cavity allowing plaque accumulation; the inner room was isolated from the oral cavity by the ePTFE membrane. One of the 5 chambers was completely closed and used as control. The test period lasted for 4 weeks. Every week, one chamber was removed from each device and processed for scanning electron microscopic and histologic examinations. Our study showed the possibility that oral bacteria may contaminate ePTFE membranes exposed to the oral cavity. One specimen showed partial bacterial penetration after 2 and 3 weeks, but after 4 weeks, all membrane specimens demonstrated bacterial contamination.(ABSTRACT TRUNCATED AT 250 WORDS)

Root surface texture after different scaling modalities

Root surface texture after scaling with hand instruments, ultrasonic scalers (Amdent 830 and Cavi-Med 2000), and a sonic scaler (Titan-S) was assessed in vitro. The experimental material consisted of 48 extracted human teeth divided into six groups. Root surface texture was assessed with scanning electron microscopy (SEM). Hand and sonic instrumentation produced large grooves and removed cementum evident at a magnification of x 70, while the root surface alterations after ultrasonic instrumentation were not detectable below a magnification of x 500. The working principle of each scaling instrument in relation to its effect on the root surface was discussed.

Microbial growth on the surfaces of various orthodontic bonding cements

An experimental technique was developed to examine the adhesion of a strain of Streptococcus mutans to the surface of discs of selected orthodontic bonding composites and a glass ionomer cement. Colonization by the bacterium was assessed by weight gain and scanning electron microscopy. Initial colonization occurred after about 3 days, and the specimens were usually completely covered by the fourth day. There were statistically significant differences between materials for weight gain, a strong correlation between weight gain and surface free energy of the materials measured as droplet contact angle (r = 0.9) and a moderate correlation between weight gain and surface roughness (r = 0.6).

Surface roughness and droplet contact angle measurement of various orthodontic bonding cements

Surface characteristics that are considered important for bacterial attachment to thirteen orthodontic bonding composite cements and one glass ionomer cement were examined in vitro before and after toothbrush abrasion. The surface roughness and contact angle measurements were found to be statistically significantly different between the materials, both before and after brushing, and there were also statistically significant changes within materials after brushing. There were low correlation coefficients between surface roughness and contact angle for both pre-and post-brushed materials.

An in vivo study of the influence of the surface roughness of implants on the microbiology of supra- and subgingival plaque

In nine patients with fixed prostheses supported by endosseous titanium implants, 2 titanium abutments (transmucosal part of the implant) were replaced by either an unused standard abutment or a roughened titanium abutment. After 3 months of habitual oral hygiene, plaque samples were taken for differential phase-contrast microscopy, DNA probe analysis, and culturing. Supragingivally, rough abutments harbored significantly fewer coccoid micro-organisms (64 vs. 81%), which is indicative of a more mature plaque. Subgingivally, the observations depended on the sampling procedure. For plaque collected with paper points, only minor qualitative and quantitative differences between both substrata could be registered. However, when the microbiota adhering to the abutment were considered, rough surfaces harbored 25 times more bacteria, with a slightly lower density of coccoid organisms. The presence and density of periodontal pathogens subgingivally were, however, more related to the patient's dental status than to the surface characteristics of the abutments. These results justify the search for optimal surface smoothness for all intra-oral and intra-sulcular hard surfaces for reduction of bacterial colonization and of periodontal pathogens.

Pain and discomfort levels in patients during root surface debridement with sonic metal or plastic inserts

The study was designed to evaluate whether root surface debridement with a sonic scaler plastic insert would cause less pain and discomfort to patients than an ordinary, probe-shaped metal sonic insert. One quadrant in each of 23 patients was debrided with each insert. Blood pressure, mean arterial pressure, and heart rate were monitored before, during, and immediately after each treatment. Pain was also evaluated on a visual analogue scale (VAS) after each treatment, as well as 2 weeks later following pain-provoking stimuli. Blood pressure, mean arterial pressure, and heart rate did not reveal any differences between quadrants treated with plastic or metal inserts. Heart rate had a weak, positive association with treatment time. The VAS gave a higher pain score for the plastic (30.8) than for the metal insert (24.4), but this difference was not statistically significant (P = 0.055). Following pain-provoking stimuli at the 2-week follow-up visit, quadrants debrided with the metal insert (31.3) scored significantly lower (less pain) (P < 0.01) on the VAS than quadrants treated with the plastic insert (30.7). It is concluded that the sonic metal insert caused less pain and discomfort to the patients due to its superior accessibility and water spray cooling. The significant difference between metal and plastic tip debrided quadrants at the follow-up visit was probably caused by the smearing effect of the metal insert with partial closure of the dentin tubule orifices.

The influence of surface free energy and surface roughness on early plaque formation. An in vivo study in man

Previous in vivo studies suggested that a high substratum surface free energy (s.f.e.) and an increased surface roughness facilitate the supragingival plaque accumulation. It is the aim of this clinical trial to explore the "relative" effect of a combination of these surface characteristics on plaque growth. 2 strips, one made of fluorethylenepropylene (FEP) and the other made of cellulose acetate (CA) (polymers with surface free energies of 20 and 58 erg/cm2, respectively) were stuck to the labial surface of the central incisors of 16 volunteers. Half the surface of each strip was smooth (Ra +/- 0.1 microns) and the other half was rough (Ra +/- 2.2 microns). The undisturbed plaque formation on these strips was followed over a period of 6 days. The plaque extension at day 3 and 6 was scored planimetrically from color slides. Finally, of 6 subjects samples were taken from the strips as well as from a neighbouring smooth tooth surface (s.f.e. 88 erg/cm2; Ra +/- 0.14 microns). These samples were analysed with a light microscope to score the proportion of coccoid cells, and small, medium, and large rods or fusiform bacteria. At day 3, a significant difference in plaque accumulation was only obtained when a rough surface was compared with a smooth surface. However, at day 6, significantly less plaque was recorded on FEP smooth (19.4%) when compared with CA smooth (39.5%). Between FEP rough (96.8%) and CA rough (98.2%), no significant difference appeared.(ABSTRACT TRUNCATED AT 250 WORDS)

A rationale for comparison of plaque-retaining properties of crown systems

The sequence of the initiation, formation, development, and maturation of dental plaque was reviewed. The gingival response to plaque formation was identified to control plaque growth for prolonged gingival health. A strong implication has been established between rough, overcontoured metal ceramic restorations and periodontal disease. Unsightly soft tissue around crowns result from increased plaque accumulation. In comparing esthetic crowns, three critical variables are considered. The factors that mediate plaque accumulation and influence gingival health at the tissue-restoration interface are (1) surface roughness, (2) marginal fit, and (3) contour. Minimizing plaque accumulation is crucial for gingival health.

Is early plaque growth rate constant with time?

Early plaque growth and plaque topography were studied in 15 young adults with a healthy periodontium during a 4-day period of no oral hygiene. After perfect tooth-cleaning, the recolonisation of the buccal surfaces of 48 teeth (front teeth and premolars) was recorded at the start and after 6, 12, 24, 30, 36, 48, 54, 60, 72, 84 and 96 h. At each visit, reproducible colour slides of the buccal tooth surfaces were taken after plaque disclosure. Plaque extension was calculated planimetrically as a % of the total surface area of the tooth. At the end of the experimental period, an average of 27.7% of the surface area was covered by plaque. The early plaque growth followed an exponential curve with a slight tendency for saturation at 96 h. During the night, the plaque growth rate decreased by up to 50%. Clear differences in plaque growth rate were observed between types of teeth, and the plaque growth pattern seemed to be closely correlated to irregularities of the tooth surface. The discontinuity in plaque growth and the influence from the tooth surface roughness have important implications for oral hygiene planning.

Scanning electron microscopy of early microbial colonization of human enamel and root surfaces in vivo

This study describes the pattern of microbial colonization in six dental students, who carried test pieces of enamel and root surface in intraoral acrylic appliances for 4, 8, 12, 24, and 48 h, respectively. Oral hygiene was discontinued during the experimental periods. The results showed that oral microorganisms colonized enamel and root surfaces individually. The pattern of colonization mimicked the surface structure of the tooth; on enamel surfaces the first bacteria appeared in pits and surface irregularities followed by proliferation along the perikymata, while on root surfaces bacterial colonization was characterized by a haphazard distribution. Within the initial 24-h period root surfaces were more heavily colonized than were enamel surfaces. This pattern was characteristic irrespective of differences in the intra- and interindividual rates of bacterial coverage. It is concluded that early microbial colonization in vivo is determined by the surface structure of the tooth. Consequently, natural tooth surfaces should not be replaced by artificial surfaces in structural studies of microbial deposits in the oral cavity.

Surface-free energy and bacterial adhesion. An in vivo study in beagle dogs

Conflicting reports have been presented on the rôle of substratum surface free energy (s.f.e.) on bacterial adherence. It is the aim of the present study to evaluate the effect of the s.f.e. of substrata on bacterial adherence in vivo. The following substrata with s.f.e. varying from 23.3-124.9 erg X cm-2 were cut into facings of 5 by 6 mm, polished and cleaned: polytetrafluorethylene (PTFE), Parafilm, polyvinylchloride (PVC), polymethylmethacrylate (PMMA), bovine dentin, bovine enamel and glass. In 5 beagle dogs, 7-9 years old, part of the buccal periodontium of the upper cuspids was excised and crowns were made and cemented with a non-fluoridated cement. The facings were placed in the crowns and placed in the oral cavity for 2 h. After removal, the facings were rinsed in saline. S.f.e. was assessed from contact angles with water, water/n-propanol mixtures and a-bromonaphthalene, according to the concept of dispersion and polar components, firstly on clean air dried facings and later on facings exposed to the oral cavity for 2 h. Immediately after rinsing, the water contact angle was measured as a function of time, to monitor the evaporation of free water from the protein layer adsorbed on the substrate which had been exposed to the oral cavity. It appeared that after a rapid increase in contact angle, a stable maximum value was obtained after 40-120 min depending on the substratum. S.f.e.'s of the protein-coated substrata were subsequently determined after a 120 min drying period. Following the contact angle determinations, the exposed facings were stained with ethidium bromide, enabling fluorescence microscopical counting of the adhered microorganisms.(ABSTRACT TRUNCATED AT 250 WORDS)

Surface coatings on dental cementum incident to periodontal disease. (II). Scanning electron microscopic confirmation of a mineralized cuticle

Root surfaces, exposed by periodontal disease, were studied after treatment with sodium hypochlorite. Observations of the anorganic specimens demonstrated that substantial changes occur in root surfaces incident to periodontal disease. A mineralized surface coating was seen in all areas of the involved root surface, although local regions occurred where the coating was apparently unmineralized. These findings generally confirmed the results of a previous study where the same specimens were studied without hypochlorite treatment. It is concluded that the coating is probably identical to the dental cuticle, and stems from adsorption of components of the gingival inflammatory exudate to the root surface. The coating may also be the carrier matrix for exogenous cytotoxic substances, previously thought to be located in the cementum. The findings may have implications for the way of treating periodontitis-involved root surfaces.

Dental bacterial plaque

The literature on the subject of dental bacterial plaque is extensive. In spite of considerable research, the mode of its formation together with the variability in bacterial content requires further clarification. Mechanical methods of plaque control are effective but limited in a population sense. Of the numerous chemotherapeutic agents in plaque control, chlorhexidin appears the most effective.