A new in vitro model for the study of microbial microleakage around dental restorations: a preliminary qualitative evaluation

Bacteria in the cavity-restoration interface after varying periods of clinical service - SEM description of distribution and 16S rRNA gene sequence identification of isolates

OBJECTIVES

To use extracted human teeth with amalgam (n = 26) or GIC (n = 3) restorations in service up to 20 years to evaluate microbiota at the cavity/restoration interface by SEM or culture.

MATERIALS AND METHODS

Extracted teeth with intracoronal restorations (n = 20) of known history (2-20 years) were fixed, split, and prepared for SEM to ascertain the pattern and structure of bacterial aggregates on cavity and restoration surfaces. Another 9 teeth were anaerobically decontaminated, split and sampled (cavity/restorations), and cultured (anaerobically, aerobically); recovered isolates were identified by 16S rRNA gene sequencing.

RESULTS

SEM showed rods, cocci, and filaments in 11/20 teeth (55%) on cavity and corresponding restoration surfaces; 4/20 (20%) on neither surface; 1/20 (5%) on just cavity; and 4/20 (20%) on just restoration. Microbial growth extended from marginal openings into the deeper interfacial microspace to varying extents but was not always evident. Restoration size or age did not predict bacterial presence. Bacteria-free surfaces (cavity/amalgam) showed possible calcification. Cultivation yielded 160 isolates, mainly Gram-positive (86%) and facultative (81%); and morphotypes of rods (43%), cocci (36%), and cocco-bacilli (18%) belonging to Actinobacteria (45%) and Firmicutes (50%). The most frequent genera were Staphylococcus, Streptococcus, Actinomyces, and Lactobacillus. Biofilms on cavity and restoration appeared independent of each other.

CONCLUSIONS

Cavity and amalgam surfaces were independently colonised and some not. The penetration of microbiota into marginal gaps varied; resembled root caries and was dominated by Gram-positive species.

CLINICAL RELEVANCE

Marginal gaps around restorations are unavoidable but are not always colonised by bacteria after long-term clinical service. Calcification of biofilms in the restorative interface may prevent further colonisation. The viable microbiota in the restorative interface resembled root caries and may be subject to ecological fluxes of activity and arrest and therefore preventative management.

Development of a multispecies periodontal biofilm model within a stirred bioreactor

The objective of this work was to develop a subgingival biofilm model using a stirred bioreactor. Discs of bovine teeth were adapted to a stirred bioreactor filled with a culture medium containing bacterial species associated with periodontal health or disease. After anaerobic incubation, the biofilms growing on the substratum surfaces were collected and analyzed. The mean number of Colony-forming Units (CFUs) varied, but with no difference between 3 and 7 days of biofilm formation (p > 0.05). Scanning Electron Microscopy (SEM) analysis showed a uniform biofilm layer covering the cement layer of the root surface containing bacteria with diverse morphology. In checkerboard DNA-DNA hybridization, bacterial species were identified in both biofilms. In conclusion, a subgingival biofilm model was developed using a stirred bioreactor, allowing the in vitro reproduction of complex microbial communities. This is an advanced model that may be useful to mimic complex clinical periodontal biofilms.

Microleakage of a Self-Adhesive Flowable Composite, a Self-Adhesive Fissure Sealant and a Conventional Fissure Sealant in Permanent Teeth with/without Saliva Contamination

Objectives:

Application of fissure sealants is a practical method for prevention of occlusal pit and fissure caries. Microleakage is an important factor affecting the success of fissure sealant treatment. This study aimed to assess the microleakage of a self-adhesive flowable composite, a self-adhesive fissure sealant and a conventional fissure sealant in permanent teeth with/without saliva contamination.

Materials and Methods:

This in vitro, experimental study evaluated 108 extracted human third molars, which were randomly divided into six groups (n=18) of control, Denu-Seal conventional fissure sealant applied on etched enamel with/without saliva contamination, Vertise Flow self-adhesive flowable composite applied on rinsed and dried enamel with/without saliva contamination and Prevent Seal self-adhesive fissure sealant applied on rinsed and dried enamel with/without saliva contamination. Microleakage was assessed using the dye penetration technique and subsequent observation of samples under a stereomicroscope. Data were analyzed using the Kruskal-Wallis and Tukey’s test.

Results:

Microleakage of the conventional fissure sealant with/without saliva contamination was significantly lower than that of other groups (P<0.05).

Conclusion:

Microleakage of the conventional fissure sealant is less than that of self-adhesive fissure sealant and self-adhesive composite, irrespective of saliva contamination.

Gene expression and protein synthesis of esterase from Streptococcus mutans are affected by biodegradation by-product from methacrylate resin composites and adhesives

An esterase from S. mutans UA159, SMU_118c, was shown to hydrolyze methacrylate resin-based dental monomers.

OBJECTIVE

To investigate the association of SMU_118c to the whole cellular hydrolytic activity of S. mutans toward polymerized resin composites, and to examine how the bacterium adapts its hydrolytic activity in response to environmental stresses triggered by the presence of a resin composites and adhesives biodegradation by-product (BBP).

MATERIALS AND METHODS

Biofilms of S. mutans UA159 parent wild strain, SMU_118c knockout strain (ΔSMU_118c), and SMU_118c complemented strain (ΔSMU_118cC) were incubated with photo-polymerized resin composite. High performance liquid chromatography was used to quantify the amount of a universal 2,2-Bis[4-(2-hydroxy-3-methacryloxypropoxy)phenyl]propane (bisGMA)-derived BBP, bishydroxy-propoxy-phenyl-propane (bisHPPP) in the media. Fluorescence in situ hybridization (FISH) and quantitative proteomic analysis were used to measure SMU_118c gene expression and production of SMU_118c protein, respectively, from biofilms of S. mutans UA159 wild strain that were cultured with bisHPPP.

RESULTS

The levels of bisHPPP released from composite were similar for ΔSMU_118c and media control, and these were significantly lower compared to the parent wild-strain UA159 and complemented strain (ΔSMU_118cC) (p < 0.05). Gene expression of SMU_118c and productions of SMU_118c protein were higher for bisHPPP incubated biofilms (p < 0.05).

SIGNIFICANCE

This study suggests that SMU_118c is a dominant esterase in S. mutans and capable of catalyzing the hydrolysis of the resinous matrix of polymerized composites and adhesives. In turn, the bacterial response to BBP was to increase the expression of the esterase gene and enhance esterase production, potentially accelerating the biodegradation of the restoration, adhesive and restoration-tooth interface, ultimately contributing to premature restoration failure.

STATEMENT OF SIGNIFICANCE

We recently reported (Huang et al., 2018) on the isolation and initial characterization of a specific esterase (SMU_118c) from S. mutans that show degradative activity toward the hydrolysis of dental monomers. The current study further characterize this enzyme and shows that SMU_118c is a dominant degradative esterase activity in the cariogenic bacterium S. mutans and is capable of catalyzing the hydrolysis of the resinous matrix of polymerized composites and adhesives. In turn, the bacterial response to biodegradation by-products from composites and adhesives was to increase the expression of the esterase gene and enhance esterase production, accelerating the biodegradation of the restoration, adhesive and the restoration-tooth interface, potentially contributing to the pathogenesis of recurrent caries around resin composite restorations.

A reproducible oral microcosm biofilm model for testing dental materials

AIMS

Most studies of biofilm effects on dental materials use single-species biofilms, or consortia. Microcosm biofilms grown directly from saliva or plaque are much more diverse, but difficult to characterize. We used the Human Oral Microbial Identification Microarray (HOMIM) to validate a reproducible oral microcosm model.

METHODS AND RESULTS

Saliva and dental plaque were collected from adults and children. Hydroxyapatite and dental composite discs were inoculated with either saliva or plaque, and microcosm biofilms were grown in a CDC biofilm reactor. In later experiments, the reactor was pulsed with sucrose. DNA from inoculums and microcosms was analysed by HOMIM for 272 species. Microcosms included about 60% of species from the original inoculum. Biofilms grown on hydroxyapatite and composites were extremely similar. Sucrose pulsing decreased diversity and pH, but increased the abundance of Streptococcus and Veillonella. Biofilms from the same donor, grown at different times, clustered together.

CONCLUSIONS

This model produced reproducible microcosm biofilms that were representative of the oral microbiota. Sucrose induced changes associated with dental caries.

SIGNIFICANCE AND IMPACT OF THE STUDY

This is the first use of HOMIM to validate an oral microcosm model that can be used to study the effects of complex biofilms on dental materials.

Growing oral biofilms in a constant depth film fermentor (CDFF)

In order to grow organisms in such a manner as to mimic their physiological growth state in vivo, it is often desirable to grow them as biofilms in the laboratory. There are numerous systems available to accomplish this; however, some are more suited to the growth of oral biofilms (dental plaque) than others. The operating parameters of one such model, the constant depth film fermentor (CDFF), are given in this unit. This model is particularly suited to studying the varied biofilms which exist in the oral cavity because environmental factors such as the substratum, nutrient source, and gas flow can be altered.

A new in vitro model to study the relationship of gap size and secondary caries

OBJECTIVES

To investigate the relationship of gap size and secondary caries in a newly developed secondary caries microbial model that permits adjustment of the gap between the tooth and a restoration.

METHODS

Tooth-resin-matrix composite specimens were mounted on gap-model stages with a gap size of 50 or 500 microm in experiment 1, and 0, 25, 250, or 1,000 microm in experiment 2. They were attached to plastic Petri plates, gas-sterilized and then incubated in a microbial caries model (with Streptococcus mutans TH16 in 1% sucrose tryptic soy broth for 1 h, 4 times/day, and with a buffer solution for the rest of the day). After 8 days of incubation, tooth specimens were sectioned and stained overnight with a rhodamine B solution. Digital images taken under a confocal microscope were analyzed for lesion size at the outer surface lesion and wall lesion (WL).

RESULTS

Gap size was found to affect the development of dentin WL area in experiment 1 and enamel and dentin WL areas in experiment 2, with bigger lesions being observed in the wider gap group (p < 0.05).

CONCLUSION

The findings of this study suggest that the size of the gap between tooth and restoration affects the development of secondary caries along the cavity wall.

Chlorhexidine-releasing methacrylate dental composite materials

Light curable antibacterial, dental composite restoration materials, consisting of 80 wt% of a strontium fluoroaluminosilicate glass dispersed in methacrylate monomers have been produced. The monomers contained 40-100 wt% of a 10 wt% chlorhexidine diacetate (CHXA) in hydroxyethylmethacrylate (HEMA) solution and 60-0 wt% of a 50/50 mix of urethane dimethacrylate (UDMA) and triethyleneglycol dimethacrylate (TEGDMA). On raising HEMA content, light cure polymerisation rates decreased. Conversely, water sorption induced swelling and rates of diffusion controlled CHXA release from the set materials increased. Experimental composites with 50 and 90 wt% of the CHXA in HEMA solution in the monomer were shown, within a constant depth film fermentor (CDFF), to have slower rates of biofilm growth on their surfaces between 1 and 7 days than the commercial dental composite Z250 or fluoride-releasing dental cements, Fuji II LC and Fuji IX. When an excavated bovine dentine cylinder re-filled with Z250 was placed for 10 weeks in the CDFF, both bacteria and polymers from the artificial saliva penetrated between the material and dentine. With the 50 wt% experimental HEMA/CHXA formulation, this bacterial microleakage was substantially reduced. Polymer leakage, however, still occurred. Both polymer and bacterial microleakage were prevented with a 90 wt% HEMA/CHXA restoration in the bovine dentine due to swelling compensation for polymerisation shrinkage in combination with antibacterial release.

A laboratory model biofilm fermenter: design and initial trial on a single species biofilm

BACKGROUND

The minimum inhibitory concentration (MIC) does not provide information on the efficacy of antimicrobial agents against infections involving biofilms, which are many times more resistant than planktonic forms of bacteria. This report is on the design and initial trial of a device for growing standard biofilms and testing antimicrobial agents.

METHODS

We constructed a durable, autoclaveable laboratory model biofilm fermenter (LMBF) that holds hydroxyapatite discs 300 microm below a surface onto which an artificial saliva medium drips at a rate comparable to human salivary flow. Inoculated with Streptococcus sanguinis, the device formed biofilms that were swept with a Teflon wiper under aerobic conditions. Five-day-old biofilm-coated discs were aseptically removed and placed in 3 ml of sterile saline, 0.12% chlorhexidine gluconate, or 0.1% phosphate-buffered chlorine dioxide mouthwash for 1 minute. The discs and test agent were immediately diluted with saline to 10 ml, vortexed for 30 seconds, serially diluted, plated on blood agar, and incubated anaerobically 2 days. Bacterial counts were done, and the MIC of each mouthwash was determined.

RESULTS

In tests with sterile water and sterile medium, the device maintained a closed system. After inoculation with S. sanguinis, a steady state was reached at day 5. Chlorhexidine at stock concentration achieved about a 2 log10 reduction (P = 0.002), but never achieved complete killing. Chlorine dioxide had no significant effect. The MIC against planktonic S. sanguinis was 112.8 microg/ml for chlorhexidine and 9.0 microg/ml for chlorine dioxide.

CONCLUSIONS

The LMBF generates and maintains a single-species oral model biofilm to a steady state and enables in vitro tests of disinfectant mouthwashes in simulated clinical use. It should be usable for more advanced tests of multiple species biofilms.

Soluble phosphate glasses: in vitro studies using human cells of hard and soft tissue origin

This report describes the short-term response of two typical cellular components of a hard/soft tissue interface such as the periodontal ligament/mandible and patellar tendon/tibia. Tissue engineering of such interfaces requires a contiguous scaffold system with at least two cell types associated with it. Human oral osteoblasts, oral fibroblasts and hand flexor tendon fibroblasts were seeded on phosphate-based glasses of different dissolution rates. Quantitative and morphological assessment of cell adhesion and proliferation for all cell types was assessed, after first elucidating an experimental composition range using MG63 cells. In addition, immunolabelling of bone-specific non-collagenous proteins bone sialoprotein, osteonectin and osteopontin was performed to determine osteoblast phenotype. Fibroblast phenotype was established by immunolabelling for prolyl-4-hydroxylase, an enzyme vital for collagen biosynthesis. Results indicated that both cell types maintained their respective phenotypes over time in culture on glass discs of generic composition (CaO)x-(Na2O)(0.5-x)-(P2O5)0.5, remained attached and proliferated dependent on glass composition and cell type. Glasses containing at least 46 mol% CaO, produced no adverse cell reaction suggesting that these compositions that support both osteoblasts and fibroblasts would be ideal as a scaffold material for engineering the hard/soft tissue interface.

Demineralization of dentin by Streptococcus mutans biofilms grown in the constant depth film fermentor

To develop a bacterial demineralization model, we grew Streptococcus mutans biofilms in a constant depth film fermentor (CDFF) and studied the effects of sucrose pulsing frequency (SPF) in time on dentin demineralization. S. mutans biofilms were grown in dentin specimens with grooves and on dentin surface specimens for 20 days. During the experiments, 2% sucrose was pulsed either 4 or 8 times per day for periods of 30 min. Diluted brain-heart infusion medium containing 25 mM PIPES buffer and 1.5 mM CaCl2 was pulsed as the alternative growth medium. Specimens with intact biofilms were taken out on days 5, 12 and 20. The model was assessed by viable counts of the biofilm, mineral loss and lesion depth in the dentin specimens (by transversal microradiography) and pH measurements in the groove (by pH microelectrode). The results showed that biofilms formed on the dentin surface specimens were constant in viable counts for the low SPF, while this parameter tended to increase with time under the high SPF. Lesions with intact surfaces were formed and the lesion size increased significantly over time and increased significantly with increasing SPF. Typical Stephan curves were found after sucrose pulsing. The pH inside the groove returned to neutral under low SPF, but remained below 6.5 under high SPF. With the CDFF S. mutans biofilm model, lesions can be created in dentin within reasonable experimental time periods, as a result of the presence of a biofilm and in response to carbohydrate challenges.

Study of Bacterial Viability within Human Supragingival Dental Calculus

BACKGROUND

There is evidence that supragingival calculus contains unmineralized channels and lacunae. The purpose of this study was to investigate the viability of bacteria within these areas.

METHODS

Supragingival calculus harvested from patients with moderate to severe chronic periodontitis was immediately frozen to -70 degrees C. Six samples were cryosectioned, stained with a bacterial viability kit, and examined with fluorescence microscopy. Controls comprised heat treatment of cryosections prior to staining. Four additional samples were stained and examined whole in a confocal laser scanning microscope (CLSM). Nine additional samples were prepared for bacterial culture, after initial irradiation with ultraviolet light to kill viable organisms on the covering plaque layer. Test samples were crushed to expose internal bacteria, while two controls were used without crushing.

RESULTS

Viable bacteria, as identified using the bacterial viability stain, were found within cavities/lacunae in supragingival calculus cryosections. Similar results were obtained from whole calculus samples using CLSM. Of the nine experimental samples where bacterial culture was attempted, five provided positive bacterial culture under both aerobic and anaerobic conditions; one showed positive growth under aerobic conditions only; while one showed no bacterial growth. The controls showed no bacterial growth.

CONCLUSIONS

From this study, it appears that viable aerobic and anaerobic bacteria may be present within supragingival calculus, specifically within the internal channels and lacunae. Clinically, this may be important, since incomplete removal of supragingival calculus may expose these reservoirs of possible pathogenic bacteria and be a factor in the recurrence of periodontal diseases after treatment.