Biomaterial engineering surface to control polymicrobial dental implant-related infections: focusing on disease modulating factors and coatings development.

INTRODUCTION: Peri-implantitis is the leading cause of dental implant loss and is initiated by a polymicrobial dysbiotic biofilm formation on the implant surface. The destruction of peri-implant tissue by the host immune response and the low effectiveness of surgical or non-surgical treatments highlight the need for new strategies to prevent, modulate and/or eliminate biofilm formation on the implant surface. Currently, several surface modifications have been proposed using biomolecules, ions, antimicrobial agents, and topography alterations. AREAS COVERED: Initially, this review provides an overview of the etiopathogenesis and host- and material-dependent modulating factors of peri-implant disease. In addition, a critical discussion about the antimicrobial surface modification mechanisms and techniques employed to modify the titanium implant material is provided. Finally, we also considered the future perspectives on the development of antimicrobial surfaces to narrow the bridge between idea and product and favor the clinical application possibility. EXPERT OPINION: Antimicrobial surface modifications have demonstrated effective results; however, there is no consensus about the best modification strategy and in-depth information on the safety and longevity of the antimicrobial effect. Modified surfaces display recurring challenges such as short-term effectiveness, the burst release of drugs, cytotoxicity, and lack of reusability. Stimulus-responsive surfaces seem to be a promising strategy for a controlled and precise antimicrobial effect, and future research should focus on this technology and study it from models that better mimic clinical conditions.

Optimizing citric acid protocol to control implant-related infections: An in vitro and in situ study.

OBJECTIVE: The present study aimed to establish an optimized protocol for biofilm removal from titanium (Ti) surfaces using citric acid (CA) solutions. BACKGROUND: Biofilm accumulation is the main factor to trigger peri-implant infections and to increase the risk of treatment failures. Although CA has been suggested as the anti-infective agent with highest potential for biofilm removal on Ti, there is no consensus that CA could improve the anti-infective treatment and its effect. METHODS: Physical and chemical alterations, electrochemical behavior, cytotoxicity, and antimicrobial effect of CA on Ti discs were evaluated using four concentrations (1, 10, 20, and 40%) and two application methods (immersion and rubbing). Negative control using 0.9% NaCl was used in all experiments. To evaluate whether different application times can have similar response, polymicrobial biofilm (microcosm model) was formed on Ti and treated with CA for 1, 2, 4, and 8 min. An in situ study was conducted to verify whether the established protocol is equally effective in biofilms formed on machined and sandblasted, large-grit, and acid-etched (SLA) Ti surfaces. RESULTS: CA 40% induced significantly higher surface alterations observed by confocal images and profilometry. In general, rubbing protocol decreased the surface roughness and increased the wettability (p < 0.05), exhibiting better surface cleaning by biofilm removal. CA 10% presented no indirect cytotoxicity and, when applied by rubbing for 8 min, presented proper in vitro antibacterial action and potential corrosion inhibition. When CA 10% was rubbed on Ti surfaces for 4 min, it displayed optimum cleaning ability as 8 min, working equally to remove in situ biofilm on machined and SLA surfaces. CONCLUSIONS: The application of CA 10% by rubbing for at least 4 min demonstrated to be a promising protocol to eliminate biofilms formed in smooth and rougher surfaces, which could improve implant-related infection therapies.

Antibacterial photocatalytic activity of different crystalline TiO2 phases in oral multispecies biofilm.

OBJECTIVE: Titanium dioxide (TiO2) incorporation in biomaterials is a promising technology due to its photocatalytic and antibacterial activities. However, the antibacterial potential of different TiO2 crystalline structures on a multispecies oral biofilm remains unknown. We hypothesized that the different crystalline TiO2 phases present different photocatalytic and antibacterial activities. METHODS: Three crystalline TiO2 films were deposited by magnetron sputtering on commercially pure titanium (cpTi), in order to obtain four groups: (1) machined cpTi (control); (2) A-TiO2 (anatase); (3) M-TiO2 (mixture of anatase and rutile); (4) R-TiO2 (rutile). The morphology, crystalline phase, chemical composition, hardness, elastic modulus and surface free energy of the surfaces were evaluated. The photocatalytic potential was assessed by methylene blue degradation assay. The antibacterial activity was evaluated on relevant oral bacteria, by using a multispecies biofilm (Streptococcus sanguinis, Actinomyces naeslundii and Fusobacterium nucleatum) formed on the treated titanium surfaces (16.5h) followed by UV-A light exposure (1h) to generate reactive oxygen species production. RESULTS: All TiO2 films presented around 300nm thickness and improved the hardness and elastic modulus of cpTi surfaces (p<0.05). A-TiO2 and M-TiO2 films presented superior photocatalytic activity than R-TiO2 (p<0.05). M-TiO2 revealed the greatest antibacterial activity followed by A-TiO2 (≈99.9% and 99% of bacterial reduction, respectively) (p<0.001 vs. control). R-TiO2 had no antibacterial activity (p>0.05 vs. control). SIGNIFICANCE: This study brings new insights on the development of extra oral protocols for the photocatalytic activity of TiO2 in oral biofilm-associated disease. Anatase and mixture-TiO2 showed antibacterial activity on this oral bacterial biofilm, being promising surface coatings for dental implant components.

Resins-based denture soft lining materials modified by chlorhexidine salt incorporation: an in vitro analysis of antifungal activity, drug release and hardness.

OBJECTIVES: To evaluate the in vitro growth inhibition of Candida albicans, the rate of chlorhexidine release and shore A hardness from resins-based denture soft lining materials modified by chlorhexidine diacetate (CDA) or chlorhexidine hydrochloride (CHC) incorporation. METHODS: Resin discs were prepared from soft denture liners based on poly (methyl methacrylate) (PMMA) or poly (ethyl methacrylate) (PEMA) containing 0.5, 1.0 and 2.0 wt.% of CDA or CHC. For antifungal activity resin discs were placed on agar plates inoculated with C. albicans, after 48 h at 37°C the diameters of inhibition zones were measured. For the chlorhexidine release, discs were immersed into distilled water at 37°C, and spectral measurements were made after 48 h. Shore A hardness was evaluated at the baseline, 2 and 7 days, using 6mm thick rectangular specimens also immersed into distilled water at 37°C. Data were statistically processed by SigmaStat software using ANOVA and all pairwise multiple comparison procedures was done using the Holm-Sidak method, with α=0.05 (p<0.001). RESULTS: CDA added to PMMA soft liner and PEMA soft liner had a dose-related inhibitory effect on C. albicans and on chlorhexidine release rate (p<0.001). The PMMA and PEMA hardness increased statistically by time but not for the different CDA concentrations. CHC had no inhibitory effect on C. albicans. SIGNIFICANCE: Chlorhexidine diacetate released from resins-based soft lining materials can be convenient to reduce the biofilm development on the material surface and treat denture stomatitis, without depending on patient compliance.