How does ultrasonic cavitation remove dental bacterial biofilm?

Bacterial biofilm accumulation is problematic in many areas, leading to biofouling in the marine environment and the food industry, and infections in healthcare. Physical disruption of biofilms has become an important area of research. In dentistry, biofilm removal is essential to maintain health. The aim of this study is to observe biofilm disruption due to cavitation generated by a dental ultrasonic scaler (P5XS, Acteon) using a high speed camera and determine how this is achieved. Streptococcus sanguinis biofilm was grown on Thermanox™ coverslips (Nunc, USA) for 4 days. After fixing and staining with crystal violet, biofilm removal was imaged using a high speed camera (AX200, Photron). An ultrasonic scaler tip (tip 10P) was held 2 mm away from the biofilm and operated for 2 s. Bubble oscillations were observed from high speed image sequences and image analysis was used to track bubble motion and calculate changes in bubble radius and velocity on the surface. The results demonstrate that most of the biofilm disruption occurs through cavitation bubbles contacting the surface within 2 s, whether individually or in cavitation clouds. Cleaning occurs through shape oscillating microbubbles on the surface as well as through fluid flow.

A review of co-culture models to study the oral microenvironment and disease

Co-cultures allow for the study of cell-cell interactions between different eukaryotic species or with bacteria. Such an approach has enabled researchers to more closely mimic complex tissue structures. This review is focused on co-culture systems modelling the oral cavity, which have been used to evaluate this unique cellular environment and understand disease progression. Over time, these systems have developed significantly from simple 2D eukaryotic cultures and planktonic bacteria to more complex 3D tissue engineered structures and biofilms. Careful selection and design of the co-culture along with critical parameters, such as seeding density and choice of analysis method, have resulted in several advances. This review provides a comparison of existing co-culture systems for the oral environment, with emphasis on progression of 3D models and the opportunity to harness techniques from other fields to improve current methods. While filling a gap in navigating this literature, this review ultimately supports the development of this vital technique in the field of oral biology.

High speed imaging of biofilm removal from a dental implant model using ultrasonic cavitation

OBJECTIVES

Current instruments cannot clean in between dental implant threads and effectively remove biofilm from the rough implant surface without damaging it. Cavitation bubbles have the potential to disrupt biofilms. The aim of this study was to see how biofilms can be disrupted using non-contact cavitation from an ultrasonic scaler, imaged inside a restricted implant pocket model using high speed imaging.

METHODS

Streptococcus sanguinis biofilm was grown for 7 days on dental implants. The implants were placed inside a custom made restricted pocket model and immersed inside a water tank. An ultrasonic scaler tip was placed 0.5mm away from the implant surface and operated at medium power or high power for 2s. The biofilm removal process was imaged using a high speed camera operating at 500 fps. Image analysis was used to calculate the amount of biofilm removed from the high speed images. Scanning electron microscopy was done to visualize the implant surface after cleaning.

RESULTS

Cavitation was able to remove biofilm from dental implants. More biofilm was removed at high power. Scanning electron microscopy showed that the implant surface was clean at the points where the cavitation was most intense. High speed imaging showed biofilm removal underneath implant threads, in areas next to the ultrasonic scaler tip.

SIGNIFICANCE

A high speed imaging protocol has been developed to visualize and quantify biofilm removal from dental implants in vitro. Cavitation bubbles from dental ultrasonic scalers are able to successfully disrupt biofilm in between implant threads.

Which Parameters Affect Biofilm Removal with Acoustic Cavitation? A Review

Bacterial biofilms are a cause of contamination in a wide range of medical and biological areas. Ultrasound is a mechanical energy that can remove these biofilms using cavitation and acoustic streaming, which generate shear forces to disrupt biofilm from a surface. The aim of this narrative review is to investigate the literature on the mechanical removal of biofilm using acoustic cavitation to identify the different operating parameters affecting its removal using this method. The properties of the liquid and the properties of the ultrasound have a large impact on the type of cavitation generated. These include gas content, temperature, surface tension, frequency of ultrasound and acoustic pressure. For many of these parameters, more research is required to understand their mechanisms in the area of ultrasonic biofilm removal, and further research will help to optimise this method for effective removal of biofilms from different surfaces.

Human adipose tissue-derived mesenchymal stem/stromal cells adhere to and inhibit the growth of Staphylococcus aureus and Pseudomonas aeruginosa

We have cultured and phenotyped human adipose tissue-derived mesenchymal stem/stromal cells (AT MSCs) and inoculated these cultures with bacteria common to infected skin wounds, i.e. Staphylococcus aureus and Pseudomonas aeruginosa. Cell interactions were examined by scanning electron microscopy (SEM), whilst bacterial growth was measured by colony forming unit (c.f.u.) and biofilm assays. AT MSCs appeared to attach to the bacteria and to engulf S. aureus. Significantly fewer bacterial c.f.u. were present in AT MSC : bacterial co-cultures compared with bacteria cultured alone. Antibacterial activity, including an inhibition of P. aeruginosa biofilm formation, was observed when bacteria were treated with conditioned medium harvested from the AT MSC :  bacterial co-cultures, irrespective of the bacterial species to which the AT MSCs had been exposed to previously. Hence, we have demonstrated that AT MSCs inhibit the growth of two common bacterial species. This was associated with bacterial adhesion, potential engulfment or phagocytosis, and the secretion of antibacterial factors.

Imaging and analysis of individual cavitation microbubbles around dental ultrasonic scalers

Cavitation is a potentially effective and less damaging method of removing biofilm from biomaterial surfaces. The aim of this study is to characterise individual microbubbles around ultrasonic scaler tips using high speed imaging and image processing. This information will provide improved understanding on the disruption of dental biofilm and give insights into how the instruments can be optimised for ultrasonic cleaning. Individual cavitation microbubbles around ultrasonic scalers were analysed using high speed recordings up to a million frames per second with image processing of the bubble movement. The radius and rate of bubble growth together with the collapse was calculated by tracking multiple points on bubbles over time. The tracking method to determine bubble speed demonstrated good inter-rater reliability (intra class correlation coefficient: 0.993) and can therefore be a useful method to apply in future studies. The bubble speed increased over its oscillation cycle and a maximum of 27ms^-1 was recorded during the collapse phase. The maximum bubble radii ranged from 40 to 80μm. Bubble growth was observed when the ultrasonic scaler tip receded from an area and similarly bubble collapse was observed when the tip moved towards an area, corresponding to locations of low pressure around the scaler tip. Previous work shows that this cavitation is involved in biofilm removal. Future experimental work can be based on these findings by using the protocols developed to experimentally analyse cavitation around various clinical instruments and comparing with theoretical calculations. This will help to determine the main cleaning mechanisms of cavitation and how clinical instruments such as ultrasonic scalers can be optimised.

Backscattered electron imaging and electron backscattered diffraction in the study of bacterial attachment to titanium alloy structure

The application of secondary electron (SE) imaging, backscattered electron imaging (BSE) and electron backscattered diffraction (EBSD) was investigated in this work to study the bacterial adhesion and proliferation on a commercially pure titanium (cp Ti) and a Ti6Al4V alloy (Ti 64) with respect to substrate microstructure and chemical composition. Adherence of Gram-positive Staphylococcus epidermidis 11047 and Streptococcus sanguinis GW2, and Gram-negative Serratia sp. NCIMB 40259 and Escherichia coli 10418 was compared on cp Ti, Ti 64, pure aluminium (Al) and vanadium (V). The substrate microstructure and the bacterial distribution on these metals were characterised using SE, BSE and EBSD imaging. It was observed that titanium alloy-phase structure, grain boundaries and grain orientation did not influence bacterial adherence or proliferation at microscale. Adherence of all four strains was similar on cp Ti and Ti 64 surfaces whilst inhibited on pure Al. This work establishes a nondestructive and straight-forward statistical method to analyse the relationship between microbial distribution and metal alloy structure.

Penetration of sub-micron particles into dentinal tubules using ultrasonic cavitation

OBJECTIVES

Functionalised silica sub-micron particles are being investigated as a method of delivering antimicrobials and remineralisation agents into dentinal tubules. However, their methods of application are not optimised, resulting in shallow penetration and aggregation. The aim of this study is to investigate the impact of cavitation occurring around ultrasonic scalers for enhancing particle penetration into dentinal tubules.

METHODS

Dentine slices were prepared from premolar teeth. Silica sub-micron particles were prepared in water or acetone. Cavitation from an ultrasonic scaler (Satelec P5 Newtron, Acteon, France) was applied to dentine slices immersed inside the sub-micron particle solutions. Samples were imaged with scanning electron microscopy (SEM) to assess tubule occlusion and particle penetration.

RESULTS

Qualitative observations of SEM images showed some tubule occlusion. The particles could penetrate inside the tubules up to 60μm when there was no cavitation and up to ∼180μm when there was cavitation.

CONCLUSIONS

The cavitation bubbles produced from an ultrasonic scaler may be used to deliver sub-micron particles into dentine. This method has the potential to deliver such particles deeper into the dentinal tubules.

CLINICAL SIGNIFICANCE

Cavitation from a clinical ultrasonic scaler may enhance penetration of sub-micron particles into dentinal tubules. This can aid in the development of novel methods for delivering therapeutic clinical materials for hypersensitivity relief and treatment of dentinal caries.

High Speed Imaging of Cavitation around Dental Ultrasonic Scaler Tips

Cavitation occurs around dental ultrasonic scalers, which are used clinically for removing dental biofilm and calculus. However it is not known if this contributes to the cleaning process. Characterisation of the cavitation around ultrasonic scalers will assist in assessing its contribution and in developing new clinical devices for removing biofilm with cavitation. The aim is to use high speed camera imaging to quantify cavitation patterns around an ultrasonic scaler. A Satelec ultrasonic scaler operating at 29 kHz with three different shaped tips has been studied at medium and high operating power using high speed imaging at 15,000, 90,000 and 250,000 frames per second. The tip displacement has been recorded using scanning laser vibrometry. Cavitation occurs at the free end of the tip and increases with power while the area and width of the cavitation cloud varies for different shaped tips. The cavitation starts at the antinodes, with little or no cavitation at the node. High speed image sequences combined with scanning laser vibrometry show individual microbubbles imploding and bubble clouds lifting and moving away from the ultrasonic scaler tip, with larger tip displacement causing more cavitation.

Development of tissue engineered ligaments with titanium spring reinforcement

Titanium spring reinforced tissue-engineered ligament replacement: enhancing construct stiffness, load propagation and robustness under cyclic loading.

An In Vitro Comparison of the Incorporation, Growth, and Chondrogenic Potential of Human Bone Marrow versus Adipose Tissue Mesenchymal Stem Cells in Clinically Relevant Cell Scaffolds Used for Cartilage Repair

AIM

To compare the incorporation, growth, and chondrogenic potential of bone marrow (BM) and adipose tissue (AT) mesenchymal stem cells (MSCs) in scaffolds used for cartilage repair.

METHODS

Human BM and AT MSCs were isolated, culture expanded, and characterised using standard protocols, then seeded into 2 different scaffolds, Chondro-Gide or Alpha Chondro Shield. Cell adhesion, incorporation, and viable cell growth were assessed microscopically and following calcein AM/ethidium homodimer (Live/Dead) staining. Cell-seeded scaffolds were treated with chondrogenic inducers for 28 days. Extracellular matrix deposition and soluble glycosaminoglycan (GAG) release into the culture medium was measured at day 28 by histology/immunohistochemistry and dimethylmethylene blue assay, respectively.

RESULTS

A greater number of viable MSCs from either source adhered and incorporated into Chondro-Gide than into Alpha Chondro Shield. In both cell scaffolds, this incorporation represented less than 2% of the cells that were seeded. There was a marked proliferation of BM MSCs, but not AT MSCs, in Chondro-Gide. MSCs from both sources underwent chondrogenic differentiation following induction. However, cartilaginous extracellular matrix deposition was most marked in Chondro-Gide seeded with BM MSCs. Soluble GAG secretion increased in chondrogenic versus control conditions. There was no marked difference in GAG secretion by MSCs from either cell source.

CONCLUSION

Chondro-Gide and Alpha Chondro Shield were permissive to the incorporation and chondrogenic differentiation of human BM and AT MSCs. Chondro-Gide seeded with BM MSCs demonstrated the greatest increase in MSC number and deposition of a cartilaginous tissue.

Esthetic Evaluation of Single-Tooth Morse Taper Connection Implants Placed in Fresh Extraction Sockets or Healed Sites

The aim of this study was to compare the esthetic outcome of single implants placed in fresh extraction sockets with those placed in fully healed sites of the anterior maxilla. This retrospective study was based on data from patients treated with single-tooth Morse taper connection implants placed in fresh extraction sockets and in fully healed sites of the anterior maxilla. Only single implant treatments were considered with both neighboring teeth present. Additional prerequisites for immediate implant treatment were intact socket walls and a thick gingival biotype. The esthetic outcome was objectively rated using the pink esthetic/white esthetic score (PES/WES). The Mann-Whitney U test was used to compare the PES and the WES between the 2 groups. Twenty-two patients received an immediate implant, and 18 patients had conventional implant surgery. The mean follow-up was 31.09 months (SD 5.57; range 24–46) and 34.44 months (SD 7.10; range 24–48) for immediately and conventionally inserted implants, respectively. No implants were lost. All implants fulfilled the success criteria. The mean PES/WES was 14.50 (SD 2.52; range 9–19) and 15.61 (SD 3.20; range 8–20) for immediately and conventionally placed implants, respectively. Immediate implants had a mean PES of 7.45 (SD 1.62; range 4–10) and a mean WES of 7.04 (SD 1.29; range 5–10). Conventional implants had a mean PES of 7.83 (SD 1.58; range 4–10) and a mean WES of 7.77 (SD 1.66; range 4–10). The difference between the 2 groups was not significant. Immediate and conventional single implant treatment yielded comparable esthetic outcomes.

Three-dimensional geometry of honeycomb collagen promotes higher beating rate of myocardial cells in culture

Myocardial cells were isolated from newborn rats, cultured on a novel three-dimensional (3-D) honeycomb collagen scaffold (HC) and their morphology and beating rates compared with ones on conventional plastic dishes. On the first day, the cells attached to HC had already started beating. As time went on, the rate of beating increased as the pores of HC gradually filled with the cells, which integrated to form the cell-matrix complex. At day 8, beating reached the highest frequency of 162 beats per minute, which was twice that of the control cells on plastic dishes. It was concluded that 3-D geometry of the HC is conducive to functional growth of the myocardial tissues, and will potentially be useful for tissue engineering of myocardial regeneration.

Active screen plasma surface modification of polycaprolactone to improve cell attachment

To tailor polycaprolactone (PCL) surface properties for biomedical applications, film samples of PCL were surface modified by the active screen plasma nitriding (ASPN) technique. The chemical composition and structure were characterized by Fourier transform infrared spectroscopy and X-ray photoelectron spectroscopy. The wettability of the surface modified polymers was investigated by contact angle and surface energy methods. Biocompatibility of the prepared PCL samples was evaluated in vitro using MC3T3-E1 osteoblast-like cells. The degradability was assessed by determining the self-degradation rate (catalyzed by lipase). The results show that ASPN surface modification can effectively improve osteoblast cell adhesion and spreading on the surface of PCL. The main change in chemical composition is the exchange of some carboxyl groups on the surface for hydroxyl groups. The active-screen plasma nitriding technique has been found to be an effective and practical method to effectively improve osteoblast cell adhesion and spreading on the PCL surface. Such changes have been attributed to the increase in wettablity and generation of new hydroxyl groups by plasma treatment. After active-screen plasma treatment, the PCL film is still degradable, but the enzymatic degradation rate is slower compared with untreated PCL film.

Efficacy of cling film for barrier protection in a dental clinical environment: short communication

Disposable plastic film is sometimes used as barrier protection for items of equipment in the dental surgery. This study was designed to investigate the efficacy of cling film for this purpose. The clinic experiment investigated whether there was a progressive accumulation of bacteria on the dental chair bracket table surface, protected by cling film, during 10 clinical sessions. The results showed that occasional contamination occurred (1—7 cfu/100cm2) but there was no evidence of accumulation of bacteria beneath the cling film. Laboratory experiments in which Escherichia coli, Staphylococcus epidermidis, and Streptococcus sanguinis in suspensions of approximately 3 × 105 cfu/ml were placed on the surface of cling film on agar plates for 30 minutes demonstrated that the organisms were unable to pass through but contaminants from the film were detected on 12/32 plates. We conclude that cling film is effective in this application but could itself potentially be a vehicle for cross-infection.

Microbial contamination of light curing units: a pilot study

Visible light units (LCU) used in routine dentistry to cure light activated materials may become contaminated with oral micro-organisms. This pilot study was designed to investigate whether the fan, handle and base unit mains on/off button areas of three different designs of quartz tungsten halogen LCUs (3M Unitek 2500, Elipar Highlight, Demetron Optilux 401) were effectively disinfected after use in a dental teaching hospital. Over a period of seven days 52 LCUs were swabbed before clinics in the morning and 28 were swabbed again after clinics in the afternoon. Bacterial contamination was detected on approximately 40% (20/52) of units before use and 64% (18/28) after use: few viable organisms were detected on the fan or handle areas, but many were isolated from the mains button, including Staphylococus aureus. These findings highlight the need for greater awareness of the potential risk of contamination of the base unit and compliance with recommendations to clean and disinfect all areas of the units.

Are computer keyboards a cross-infection risk in a dental clinic?

Computers in dental surgeries located within the patient treatment room could potentially pose a risk of cross-infection of patients and operators. The aims of this investigation were to determine the degree of contamination of computer keyboards located in clinics and study rooms in a teaching dental hospital, to determine the survival time of micro-organisms on keyboards and to compare the efficiency of two common disinfectants in disinfecting keyboards. All keyboards were found to be contaminated with a variety of micro-organisms including Staphylococcus aureus, coagulasenegative staphylococci, Gram-negative rods and cocci. A range of Gram-positive and -negative bacteria and Candida albicans were able to survive up to 10 days in dried suspensions on computer keys. Seventy per cent isopropanol wipes proved effective in reducing the numbers of viable test organisms on keys by at least 96% and reducing contamination of keyboards in routine use. The data suggest that computers in dental study areas and clinics act as reservoirs of potentially pathogenic organisms including S. aureus and should be regularly disinfected to reduce the risk of cross-infection.

Prospective evaluation of 2,549 Morse taper connection implants: 1- to 6-year data

BACKGROUND

The aim of this study is to evaluate the implant survival, the implant-crown success, and the prosthetic complications of 2,549 Morse taper interference-fit connection implants.

METHODS

A total of 2,549 Morse taper connection implants were inserted in 893 patients from January 2003 until December 2008. At each annual recall, clinical, radiographic, and prosthetic parameters were assessed. The implant-crown success criteria included the absence of pain, suppuration, and clinical mobility; an average distance between the implant shoulder and the first visible bone contact <2 mm from initial surgery; and the absence of prosthetic complications at the implant-abutment interface. Prosthetic restorations were fixed partial prostheses (462 units); fixed full-arch prostheses (60 units); single crowns (531 units); and overdentures (93 units).

RESULTS

The cumulative implant survival rate was 98.23% (97.25% maxilla, 99.05% mandible). The implant-crown success was 92.49%. A few prosthetic complications at implant-abutment interface were reported (0.37%). After 6 years, distance between the implant shoulder and the first visible bone contact was 1.10 mm (± 0.30 mm).

CONCLUSION

The use of Morse taper connection implants represents a successful procedure for the rehabilitation of partially and completely edentulous arches.

Microstructure and composition of biosynthetically synthesised hydroxyapatite

Biosynthetic hydroxyapatite (HA) manufactured utilising the bacterium Serratia sp. NCIMB40259 was characterised using X-ray diffraction (XRD), Fourier transform infra-red spectroscopy (FTIR), energy dispersive X-ray analysis (EDX) scanning electron microscopy (SEM), transmission electron microscopy (TEM) and electron diffraction (ED). SEM/EDX showed that the non-sintered material consisted mainly of calcium-deficient HA (CDHA) with a Ca/P ratio of 1.61 +/- 0.06 and crystal size (from TEM) of 50 +/- 10 nm. ED analysis of non-sintered powder showed resolvable ring patterns ascribed to (0002), (1122) and (0006) planes of crystalline HA. The crystallinity of the samples improved with heat treatment from approximately 9.4% (non-sintered) to 53% (1,200 degrees C). Samples heated at 600 degrees C and sintered at 1,200 degrees C were identified by XRD and FTIR as mainly CDHA with some sodium calcium phosphate in the sintered samples. Ca/P ratios (SEM/EDX) were 1.62 and 1.52, respectively. Single crystal spot patterns characteristic of HA were seen with commercial HA and Serratia HA heated at 600 degrees C. After sintering at 1,200 degrees C the material consisted of needle-like crystals with a length between 86 and 323 nm (from TEM) or 54-111 nm (from XRD) and lattice parameters of a = 9.441 A and c = 6.875 A. This study indicated that the material produced by Serratia bacteria was initially mainly nanophase calcium deficient hydroxyapatite, which sintered to a more highly crystalline form. With further refinements the method could be used as an inexpensive route for hydroxyapatite production for biomaterials applications.

Direct laser metal sintering as a new approach to fabrication of an isoelastic functionally graded material for manufacture of porous titanium dental implants

OBJECTIVES

This work focuses on a titanium alloy implants incorporating a gradient of porosity, from the inner core to the outer surface, obtained by laser sintering of metal powder. Surface appearance, microstructure, composition, mechanical properties and fractography were evaluated.

METHODS

All the specimens were prepared by a selective laser sintering procedure using a Ti-6Al-4V alloy powder with a particle size of 1-10 microm. The morphological and chemical analyses were performed by SEM and energy dispersive X-ray spectroscopy. The flexure strength was determined by a three-point bend test using a universal testing machine. The surface roughness was investigated using a confocal scanning laser microscope. The surface roughness variation was statistically evaluated by use of a Chi square test. A p value of <0.05 was considered statistically significant.

RESULTS

The original surface microstructure consisted of roughly spherical particles, diameter range 5-50 microm. After exposure to hydrofluoric acid some of these were removed and the microsphere diameter then ranged from 5.1 microm to 26.8 microm. Following an organic acid treatment, particles were replaced by grooves 14.6-152.5 microm in width and 21.4-102.4 microm depth. The metal core consisted of columnar beta grains with alpha and beta laths within the grains. The alloy was composed of 90.08% Ti, 5.67% Al and 4.25% V. The Young's modulus of the inner core material was 104+/-7.7 GPa; while that of the outer porous material was 77+/-3.5 GPa. The fracture face showed a dimpled appearance typical of ductile fracture.

SIGNIFICANCE

In conclusion, laser metal sintering proved to be an efficient means of construction of dental implants with a functionally graded material which is better adapted to the elastic properties of the bone. Such implants should minimize stress shielding effects and improve long-term performance.

Comparison of osteoblast spreading on microstructured dental implant surfaces and cell behaviour in an explant model of osseointegration

OBJECTIVES

To compare interactions between rat calvarial osteoblasts and titanium dental implants with different microstructured surfaces.

MATERIAL AND METHODS

Seven commercially available implants were used. Surfaces included plasma-sprayed, grit-blasted and/or acid-etched, smooth-machined and anodised titanium. Two methods were used to compare cell behaviour: (1) A cell-spreading assay in which percentages of cells at four different stages of attachment were identified by scanning electron microscopy and quantified within a 30 min attachment period. (2) Implants were placed in 'pocket culture' within nylon mesh sacs in contact with explanted calvarial bone fragments for 2 and 4 weeks.

RESULTS

Surfaces combining grit blasting and acid etching, of microporous topography, showed significantly enhanced rates of cell spreading in comparison with the others. Differential cell morphology was observed in both suspension assays and pocket cultures. In the latter, cells migrated onto all surfaces. Multicellular layers with extracellular matrix (ECM) were present between the layers and on the material surfaces after 2 weeks. After 4 weeks, cell layers were more consolidated, and microstructures were obscured by layers of cells and ECM. Mineralised tissue was seen in association with ECM on grit-blasted surfaces of rough and smooth microtopography.

CONCLUSIONS

The two methods provided complementary information: a rough surface of porous microstructure may enhance the rate of cell spreading. Differentiation and calcification occurred on surfaces of both rough and smooth microstructure.

A novel non line-of-sight method for coating hydroxyapatite onto the surfaces of support materials by biomineralization

A novel method is described for the non line-of-sight coating of hydroxyapatite onto polyurethane reticulated foam and titanium discs. This utilises a biofilm of Serratia sp. NCIMB 40259 which, when challenged with a solution containing calcium chloride and phosphatase substrate, manufactures biofilm-bound material identified as hydroxyapatite by X-ray powder diffraction analysis. Non-invasive magnetic resonance imaging was used to visualize the biofilm coating throughout the foam labyrinth and to measure the thickness of the film within reticulated foam cubes in situ. The film developed within the cube matrices was similar to that measured on the surface of a glass slide. Using LaPO(4) deposition as a model system the metallised biofilm was visualised in two-dimensional slices throughout three-dimensional images acquired by magnetic resonance imaging. A similar encrustation of hydroxyapatite on the surface of biofilm grown on titanium discs was confirmed by scanning electron microscopy. Potential applications for bio-hydroxyapatite as possible bone implant precursors are discussed.

Synthesis of nanophase hydroxyapatite by a Serratia sp. from waste-water containing inorganic phosphate

Synthesis of nanophase hydroxyapatite (HA) on a bacterial surface was achieved at the expense of CaCl2 and inorganic phosphate (Pi). After initial nucleation, calcium was precipitated on and around the cells as calcium phosphate at the expense of inorganic phosphate in the challenge solution, with no precipitation in cell-free controls. HA was also biomanufactured using inorganic phosphate ions scavenged from a phosphate-containing waste-water. With additional Ca2+, the concentration of phosphate was decreased from 0.27 (approximately 25 ppm) to approximately 0.02 m (approximately 2 ppm) in the waste-water. Crystals of calcium phosphate manufactured by the cells were located by scanning electron microscopy (SEM) and identified as HA by X-ray powder diffraction, with an average crystal size calculated as approximately 25 nm. Possible application of bioHA as a biomaterial and implications for one-step 'waste-into product' are discussed.

Isolation and characterization of subgingival staphylococci from periodontitis patients and controls

OBJECTIVES

To isolate and characterize subgingival staphylococci from patients with periodontal disease and from periodontally healthy controls, to evaluate the periodontal environment as a potential source for systemic staphylococcal infections.

METHODS

Periopaper strips were used to isolate subgingival staphylococci from 28 patients with chronic periodontitis and 28 periodontally healthy age and sex-matched controls. Staphylococci were identified by microbiological methods and antibiotic resistance profiles determined.

RESULTS

Staphylococci were isolated from 54% diseased subgingival and 43% healthy subgingival sites in over 50% periodontitis patients and from 29% healthy subgingival sites in 54% controls. No significant differences in the frequency of isolation or numbers of staphylococci isolated from diseased and healthy sites were noted. Staphylococcus epidermidis was the predominant oral species. Seventy per cent (115 of 165) of all isolates were penicillin-resistant.

CONCLUSIONS

Subgingival staphylococci are present in both periodontitis patients and controls. In periodontitis there is an increased risk of bacteraemia because of the increased dentogingival surface area. The dental and periodontal health of patients at risk from haematogenous infections should therefore be maintained at a high level. Antibiotic resistance profiles of the oral staphylococcal isolates suggest that amoxicillin may no longer be a suitable antibiotic for prophylaxis against systemic infections such as prosthetic valve endocarditis.

Bacterial biosynthesis of a calcium phosphate bone-substitute material

A species of Serratia bacteria produces nano-crystalline hydroxyapatite (HA) crystals by use of a cell-bound phosphatase enzyme, located both periplasmically and within extracellular polymeric materials. The enzyme functions in resting cells by cleaving glycerol-2-phosphate (G-2-P) to liberate free phosphate ions which combine with calcium in solution to produce a cell-bound calcium phosphate material. Bacteria grown as a biofilm on polyurethane reticulated foam cubes were challenged with calcium and G-2-P in a bioreactor to produce a 3-D porous bone-substitute material. The scaffold has 1 mm macropores and 1 microm micropores. XRD showed the crystallites to be 25-28 nm in size, resembling HA before sintering and beta-tricalcium phosphate (beta-TCP, whitlockite) after. When biofilm was grown on titanium discs and challenged with calcium and G-2-P, a calcium phosphate layer formed on the discs. Biomineralisation is therefore a potential route to production of precursor nanophase HA, which has the potential to improve strength. The scaffold material produced by this method could be used as a bone-filler or as an alternative method for coating implants with a layer of HA.

Histochemical, immunohistological and scanning electron microscope analysis of tissue retained on spontaneously extruded ventilation tubes

The aim of this study was to analyse the tissue surrounding prematurely extruded ventilation tubes (grommets). Thirty-one ventilation tubes, including 21 Shah and six Shepherd tubes, that had been extruded naturally into the ear canal were examined. After formalin fixation, material adhering to the tubes was retrieved and processed to paraffin wax. Five tubes were processed for scanning electron microscope (SEM) analysis. Sections were stained using histochemical methods for collagen, keratin and keratohyaline. In addition, the presence of collagen (type I and III), keratin, vimentin, fibronectin, tenascin, factor VIII-related antigen, CD31 and CD45 was tested for by immunohistochemistry. Results showed that all specimens consisted of an acellular fibrous material, oriented in concentric rings parallel to the tube surface that was often associated with small collections of CD45+ inflammatory cells. Two specimens contained collagen that was detectable by histochemical and immunohistological methods. Twelve specimens contained identifiable desquamated epithelial cells containing keratin and keratohyaline. Only one specimen stained positively for connective tissue markers (vimentin, fibrous fibronectin, tenascin) or showed the presence of vascular epithelium. SEM revealed adherent clusters or sheets of plate-like structures, consistent with the presence of epithelial squames, on three of the five ventilation tubes examined. It is concluded that tissue retained on extruded grommets consists of orthokeratinitizing epithelium infiltrated by inflammatory cells, a finding that is consistent with the theory that tube extrusion occurs as a result of squamous epithelial proliferation, medial migration, differentiation and desquamation.

Thyroid hormone, vitamin D and retinoid receptor expression and signalling in primary cultures of rat osteoblastic and immortalised osteosarcoma cells

3,5,3'-Tri-iodothyronine (T3), 1 alpha,25(OH)2-vitamin D3 (D3) and retinoids activate related nuclear receptors which interact by heterodimerisation to regulate gene expression. Actions of each hormone are discrete and may be specified by changes in the relative concentrations of their receptors (T3R, vitamin D receptor (VDR), retinoic acid receptor (RAR), retinoid X receptor (RXR)). T3, D3 and retinoids are essential for skeletal development and maintenance and we have previously shown complex interactions amongst their signalling pathways in osteosarcoma cells. In these studies we demonstrate that similar T3R, VDR, RAR and RXR proteins are co-expressed in both osteoblast lineage cell primary cultures and osteosarcoma cells by Western blotting. We investigated whether hormone interactions in bone result from changes in receptor stoichiometry. Cells were treated with combinations of T3, D3, 9-cis retinoic acid (9-cis RA) and all-trans retinoic acid (RA) that are known from previous studies to produce complex cell specific responses. No alteration in expression of any receptor protein was seen in response to any hormone combination in three phenotypically distinct osteosarcoma cell lines. Thus, in contrast to studies of overexpressed receptors in vitro, changes in the physiological concentrations of endogenous T3R, VDR, RAR and RXR do not specify discrete hormone actions in osteoblastic cells. Other unidentified factors are likely to modulate hormone action in these bone cells.

Effect of pH on protein adsorption to hydroxyapatite and tricalcium phosphate ceramics

Calcium phosphate ceramics used for clinical applications vary considerably in their phase composition. A range of hydroxyapatite and tricalcium phosphate powders, some of which are used in plasma-sprayed coatings for metal prostheses, were found to leach substances which change the pH of water and cell culture medium. The adsorption of serum proteins from cell culture medium to the same hydroxyapatite and tricalcium phosphate ceramics was compared by sodium dodecyl sulphate-polyacrylamide gel electrophoresis and individual bands identified by enhanced chemiluminescence immunodetection and gas chromatography sequencing. The iron transport protein transferrin showed distinct differences in adsorption to a variety of hydroxyapatite and tricalcium phosphate powders, with higher concentrations of transferrin adsorbed to powders which caused no change or a drop in the pH of cell culture medium or water. Transferrin was also adsorbed to Biotal HA 120 in greater concentrations at a lower pH than it was at a higher pH. These preliminary studies show that pH changes brought about by the leaching of soluble ions may have an effect on protein adsorption.

Alanine germination receptors of Bacillus subtilis

The alanine-stimulated spore germination responses of Bacillus subtilis 168 have been dissected by combining physiological and genetical approaches. From the analyses the authors infer that there are three classes of alanine response. Two of the responses are mediated via the GerA proteins, with and without germinal adjuncts, the third is mediated via the GerB proteins and obligately requires adjuncts.

Molecular genetical and phenotypical analysis of the gerM spore germination gene of Bacillus subtilis 168

The gerM gene, encoding a single product of 22.5 kDa, has been identified by subcloning and sequencing of DNA recovered from adjacent to a Tn917 insertion. The gene product has a potential lipoprotein signal sequence, but otherwise has no homology to known sequences. Spores of the gerM mutant were more heat sensitive than wild-type, but their dipicolinic acid content was normal. The level of cortical peptidoglycan in mutant spores is also normal but release at germination of hexosamine-containing fragments, the breakdown products of cortex degradation, is less complete than wild-type. The sporulation, resistance and germination phenotypes of the gerM mutant would be consistent with the gene product having a role, either directly or indirectly, in peptidoglycan synthesis during sporulation.

Use of enhanced chemiluminescence to quantify protein adsorption to calcium phosphate materials and microcarrier beads

The adsorption of serum proteins to calcium phosphate bone substitute materials, positively-charged dextrose and negatively-charged polystyrene microcarrier beads was compared by SDS-PAGE (sodium dodecyl sulphate-polyacrylamide gel electrophoresis). Protein adsorption to hydroxyapatite (HA)-based materials was influenced by chemical composition. Surface charge sign, distribution and/or functional group affected protein adsorption to microcarrier beads. Enhanced chemiluminescence was used to quantify adsorption of fibronectin and vitronectin following Western blotting, and to monitor the kinetics of adsorption of these two proteins to HA and Biosilon. Relative to total protein, fluctuating levels of fibronectin were detected on both materials. In contrast, vitronectin adsorption increased over the course of the incubation period with maximal relative adsorption detected after 30 min on Biosilon and 60 min on HA.

Novel culture procedure permitting the synthesis of proteins by rat calvarial cells cultured on hydroxyapatite particles to be quantified

A simple culture procedure and assay conditions are described which have permitted us to quantify the synthesis of proteins which are associated with an osteoblastic phenotype, by rat calvarial periosteal cells grown on particulate materials. The main feature of the method is the use of an adhesive which does not permit cells to attach to itself but allows attachment and growth of cells on material particles embedded in it on glass coverslips. Cells were cultured for 27 d on hydroxyapatite particle-coated coverslips. Alkaline phosphatase, osteopontin and collagen type I were monitored in cell lysates from d 10 to d 20. After Western blotting, osteopontin and collagen type I were quantified using specific antisera and enhanced chemiluminescence. Maximum levels coincided with peak alkaline phosphatase activity, after 10 and 17 d. The procedures described will be generally applicable to the comparison of cell behaviour on particulate substrata.

The gerB region of the Bacillus subtilis 168 chromosome encodes a homologue of the gerA spore germination operon

Spores of gerB spore germination mutants of Bacillus subtilis 168 are defective in response to the germinative mixture of L-asparagine, glucose, fructose and potassium ions (AGFK), but are normal in the L-alanine (ALA) triggered germination response. A lambda clone of 15 kbp carrying the gerB region has been identified. Sequencing of the gerB region of the clone revealed a cluster of three ORFs encoding putative proteins of 53.3, 41.3 and 42.4 kDa (GerBA, GerBB and GerBC, respectively). The first two of these proteins have substantial hydrophobic regions and the third is a possible lipoprotein. At least two, and probably all three products are required for normal germination in AGFK. The three proteins form a set of homologues of the products of the gerA operon, mutations in which cause a defect in the ALA germination pathway, but cause no defect in AGFK. The GerB proteins show 42%, 31% and 35% identity at the amino-acid level to the corresponding GerA proteins, and the homologues occur in the same order in both operons.

Analysis of transcriptional control of the gerD spore germination gene of Bacillus subtilis 168

The gerD locus of Bacillus subtilis comprises a single gene whose function is essential for the germination of B. subtilis spores in media containing asparagine, glucose, and fructose. The expression of gerD has been characterized by using a chromosomal lacZ fusion to the gerD promoter. The promoter is switched on at the same time as the synthesis of glucose dehydrogenase, 2.5 h after sporulation has been initiated in the developing forespore. The gerD gene is not expressed in spoIIB or spoIIIA, -IIIB, -EIII, -FIII, or -IIIG mutants, but it is expressed in spoIIIC and -IIID and spoIVA mutant backgrounds. The in vivo transcriptional start point of the gene has been mapped by primer extension analysis, and sequences upstream from the start point show considerable homology with the promoter consensus sequences recognized by RNA polymerase containing the forespore-specific sigma factor sigma G (E sigma G). gerD is transcribed in vitro by E sigma G with a similar if not identical start point to that found in vivo, and expression of the gene can be rapidly induced in vegetative cells following the induction of sigma G synthesis. These results indicate that gerD is another member of the sigma G regulon, which includes a number of genes expressed only in the forespore compartment of sporulating cells of B. subtilis.

Cloning and sequencing of the gerD gene of Bacillus subtilis

A Tn917 insertion in the same region of the chromosome as gerD gave rise to a mutant (ger-97) with a germination phenotype similar to that of two gerD mutants which germinate abnormally in a range of germinants. The insertion and two gerD mutations were cotransformed with ribosomal protein genes rpoB, rpsE and rpsI. DNA cloned from one side of the insertion carried the 16S end of the ribosomal RNA operon rrnI. These data were consistent with the order rpoB-rpsE-rpsI-gerD/ger-97::Tn917-rrnI. Insertion into the wild-type chromosome of a plasmid carrying DNA adjacent to the insertion permitted the recovery of a 1.8 kb fragment of DNA which complemented ger-97::Tn917 and the gerD mutations. The DNA nucleotide sequence of the region of this fragment at which Tn917 had inserted revealed a 555 bp open reading frame, preceded by a ribosome-binding site and potential sigma E and sigma A promoter regions and encoding a predicted polypeptide of 21,117 Da. This polypeptide was largely hydrophilic but contained a hydrophobic region at the N-terminus resembling a signal peptide.

Genetical and molecular studies on gerM, a new developmental locus of Bacillus subtilis

A transposon Tn917 insertion between gerE and ilvB has identified a new developmental locus, gerM, in Bacillus subtilis. gerM96::Tn917 affects both sporulation and germination. DNA on either side of the transposon has been cloned and includes the previously cloned sdhC and gerE loci. gerE terminates 2.1 kb from the end of the transposon. The gerM96::Tn917 mutant is oligosporogenous, yielding approximately 1% of the number of wild-type heat resistant spores in liquid medium and 10% on solid medium. Six hours after the onset of sporulation alkaline phosphatase and glucose dehydrogenase levels were 90% and 7%, respectively, of those of the wild-type. At this time 50% of the mutant cells were still dividing. The occurrence of multiple polar septa and 'pygmy' cells suggested a block at stage II of sporulation. Following addition of germinants, mutant spores prepared on nutrient agar lost heat resistance normally but released slightly less dipicolinic acid than wild-type spores. They also showed only partial loss of optical density, associated with a phase-grey appearance and striations in the cortex suggesting partial degradation. Expression of the gerM gene was monitored by production of beta-galactosidase encoded by a promotorless lacZ gene fused to the gerM96::Tn917 insertion. It occurred 1.5-4 h after commencement of sporulation. Transcription was directed from a promoter on the gerE side of gerM and was unaffected by a mutation in the gerE gene.