Chlorhexidine release and water sorption characteristics of chlorhexidine-incorporated hydrophobic/hydrophilic resins

Effects of different chlorhexidine pretreatments on adhesion of metal brackets in vitro

OBJECTIVE

To investigate the effect of chlorhexidine applications in various forms and concentrations on adhesion and failure modes of metal brackets in vitro.

MATERIAL AND METHODS

Ninety bovine enamel specimens were allocated to six groups (n=15). Metal brackets were bonded on all specimens after chlorhexidine pre-treatments forming the following groups: (1) untreated specimens (control); (2) 40% varnish (EC40, Biodent BV, Netherlands), remnants removed with brushing mimicking patient cleaning; (3) 40% varnish (EC40), remnants removed with brushing mimicking professional cleaning; (4) 1% varnish (Cervitec Plus, Ivoclar vivadent, Schaan, Liechtenstein), remnants not removed; (5) brushed with% 1 gel (Corsodyl, GlaxoSmithKline, Münchenbuchsee, Germany), remnants not removed; (6) immersed in 0.07% mouthrinse (Corsodyl, GlaxoSmithKline, Münchenbuchsee, Germany), remnant not rinsed. Debonding of brackets was performed using a universal testing machine. Data were analysed using one-way ANOVA and post-hoc Scheffé test.

RESULTS

Group 4 performed significantly inferior than all the other groups and the control. Group 4 presented the highest number of adhesive failures at the enamel-resin interface whereas in other groups no failures at adhesive-resin interface was observed.

CONCLUSION

Presence of chlorhexidine varnish prior to bracket bonding adversely affects adhesion. Concentration of chlorhexidine pre-treatment has no influence on shear bond strength.

Chlorhexidine salt-loaded polyurethane orthodontic chains: in vitro release and antibacterial activity studies

The widespread use of indwelling medical devices has enormously increased the interest in materials incorporating antibiotics and antimicrobial agents as a means to prevent dangerous device-related infections. Recently, chlorhexidine-loaded polyurethane has been proposed as a material suitable for the production of devices which are able to resist microbial contamination. The aim of the present study was to characterize the in vitro release of chlorhexidine from new polymeric orthodontic chains realized with polyurethane loaded with two different chlorhexidine salts: chlorhexidine diacetate or chlorhexidine digluconate. The orthodontic chains constituted of three layers: a middle polyurethane layer loaded with chlorhexidine salt inserted between two layers of unloaded polymer. In vitro release of chlorhexidine diacetate and digluconate from orthodontic chains loaded with 10% or 20% (w/w) chlorhexidine salt was sustained for 42 days and followed Fickian diffusion. The drug diffusion through the polyurethane was found to be dependent not only on chlorhexidine loading, but also on the type of chlorhexidine salt. The antibacterial activity of 0.2% (w/w) chlorhexidine diacetate-loaded orthodontic chain was successfully tested towards clinically isolated biofilm forming ica-positive Staphylococcus epidermidis via agar diffusion test. In conclusion, the chlorhexidine salt-loaded chains could provide an innovative approach in the prevention of oral infections related to the use of orthodontic devices.

Effect of green propolis addition to physical mechanical properties of glass ionomer cements

Objective

This study investigated the mechanical properties of glass ionomer cements (GICs) combined with propolis as a natural antimicrobial substance

Material and Methods

Typified green propolis, as an ethanolic extract (EEP) or in the lyophilized form (powder), was incorporated to specimens of Ketac Fil Plus, ChemFlex and Ketac Molar Easymix GICs. For each test, 8 specimens of each material were prepared. For water sorption and solubility tests, specimens were subjected to dehydration, hydration and re-dehydration cycles until a constant mass was obtained for each step. Measurements were recorded using a digital balance of 10^-4 g precision. For the diametral tensile strength test, specimens were tested in a universal test machine at 0.5 mm/min crosshead speed after 24 h storage in deionized water. Data were evaluated by one-way ANOVA and Tukey’s tests (p<0.05).

Results

The addition of propolis to GIC clearly increased water sorption compared to pure material. Solubility was material-dependent and was not clearly evident. For the diametral tensile strength test, association with propolis altered negatively only Chemflex.

Conclusion

It may be concluded that incorporation of propolis to GICs alters some properties in a material-dependent condition.

Limitations in bonding to dentin and experimental strategies to prevent bond degradation

The limited durability of resin-dentin bonds severely compromises the lifetime of tooth-colored restorations. Bond degradation occurs via hydrolysis of suboptimally polymerized hydrophilic resin components and degradation of water-rich, resin-sparse collagen matrices by matrix metalloproteinases (MMPs) and cysteine cathepsins. This review examined data generated over the past three years on five experimental strategies developed by different research groups for extending the longevity of resin-dentin bonds. They include: (1) increasing the degree of conversion and esterase resistance of hydrophilic adhesives; (2) the use of broad-spectrum inhibitors of collagenolytic enzymes, including novel inhibitor functional groups grafted to methacrylate resins monomers to produce anti-MMP adhesives; (3) the use of cross-linking agents for silencing the activities of MMP and cathepsins that irreversibly alter the 3-D structures of their catalytic/allosteric domains; (4) ethanol wet-bonding with hydrophobic resins to completely replace water from the extrafibrillar and intrafibrillar collagen compartments and immobilize the collagenolytic enzymes; and (5) biomimetic remineralization of the water-filled collagen matrix using analogs of matrix proteins to progressively replace water with intrafibrillar and extrafibrillar apatites to exclude exogenous collagenolytic enzymes and fossilize endogenous collagenolytic enzymes. A combination of several of these strategies should result in overcoming the critical barriers to progress currently encountered in dentin bonding.

Ethanol wet-bonding challenges current anti-degradation strategy

The long-term effectiveness of chlorhexidine as a matrix metalloproteinase (MMP) inhibitor may be compromised when water is incompletely removed during dentin bonding. This study challenged this anti-bond degradation strategy by testing the null hypothesis that wet-bonding with water or ethanol has no effect on the effectiveness of chlorhexidine in preventing hybrid layer degradation over an 18-month period. Acid-etched dentin was bonded under pulpal pressure simulation with Scotchbond MP and Single Bond 2, with water wet-bonding or with a hydrophobic adhesive with ethanol wet-bonding, with or without pre-treatment with chlorhexidine diacetate (CHD). Resin-dentin beams were prepared for bond strength and TEM evaluation after 24 hrs and after aging in artificial saliva for 9 and 18 mos. Bonds made to ethanol-saturated dentin did not change over time with preservation of hybrid layer integrity. Bonds made to CHD pre-treated acid-etched dentin with commercial adhesives with water wet-bonding were preserved after 9 mos but not after 18 mos, with severe hybrid layer degradation. The results led to rejection of the null hypothesis and highlight the concept of biomimetic water replacement from the collagen intrafibrillar compartments as the ultimate goal in extending the longevity of resin-dentin bonds.

Chlorhexidine release and antibacterial properties of chlorhexidine-incorporated polymethyl methacrylate-based resin cement

This study evaluated chlorhexidine release from experimental, chlorhexidine-incorporated polymethyl methacrylate (PMMA)-based resin cements prepared from Super-Bond C&B (Sun Medical) and examined the antimicrobial activity against Streptococcus mutans and Enterococcus faecalis. Chlorhexidine diacetate was added into PMMA polymer to obtain chlorhexidine concentration of 0.0, 1.0, 2.0, 3.0, and 4.0 wt %. Chlorhexidine-incorporated, cured resin disks were immersed in distilled water at 37 degrees C for 5 weeks, and the chlorhexidine release was analyzed by high-performance liquid chromatography. The antibacterial effect of freshly mixed resin cements was examined using the agar diffusion test. For the direct contact test, the wells (n = 6) of microtiter plates were coated with cements. The coated wells were aged up to 3 weeks prior to the placement of bacterial suspensions directly on cured cements. The 3.0 and 4.0% chlorhexidine-incorporated cement exhibited chlorhexidine release for 5 weeks; however, more than 98% of chlorhexidine was retained in resin matrix. No release was detected from the 1.0 and 2.0% incorporated cement at 1 week and 2 weeks, respectively. The agar diffusion test failed to detect antibacterial effects against Enterococcus faecalis, whereas the direct contact test revealed the antibacterial effect of 3.0 and 4.0% incorporated cements against each microbe for 2 weeks. The 3.0 and 4.0% chlorhexidine-incorporated resin cement possessed prolonged chlorhexidine release and antibacterial properties for 2 weeks.

Chlorhexidine binding to mineralized versus demineralized dentin powder

OBJECTIVES

The purposes of this work were to quantitate the affinity and binding capacity of chlorhexidine (CHX) digluconate to mineralized versus demineralized dentin powder and to determine how much debinding would result from rinsing with water, ethanol, hydroxyethylmethacrylate (HEMA) or 0.5M NaCl in water.

METHODS

Dentin powder was made from coronal dentin of extracted human third molars. Standard amounts of dentin powder were tumbled with increasing concentrations of CHX (0-30 mM) for 30 min at 37 degrees C. After centrifuging the tubes, the supernatant was removed and the decrease in CHX concentration quantitated by UV-spectroscopy. CHX-treated dentin powder was resuspended in one of the four debinding solutions for 3 min. The amount of debound CHX in the solvents was also quantitated by UV-spectroscopy.

RESULTS

As the CHX concentration in the medium increased, the CHX binding to mineralized dentin powder also increased up to 6.8 micromol/g of dry dentin powder. Demineralized dentin powder took up significantly (p<0.01) more CHX, reaching 30.1 micromol CHX/g of dry dentin powder. Debinding of CHX was in the order: HEMA

SIGNIFICANCE

As CHX is not debound by HEMA, it may remain bound to demineralized dentin during resin-dentin bonding. This may be responsible for the long-term efficacy of CHX as an MMP inhibitor in resin-dentin bonds.

Collapse

Key Words

• chlorhexidine
• binding
• debinding
• dentin bonding

Collapse

MESH Headings

• Anti-Infective Agents, Local/pharmacokinetics
• Anti-Infective Agents, Local/pharmacology
• Chlorhexidine/analogs & derivatives
• Chlorhexidine/pharmacokinetics
• Chlorhexidine/pharmacology
• Collagen/metabolism
• Dental Bonding
• Dentin/metabolism
• Durapatite
• Ethanol
• Humans
• Hydrogen Bonding
• Linear Models
• Matrix Metalloproteinase Inhibitors
• Methacrylates
• Protease Inhibitors/pharmacology
• Protein Binding
• Resin Cements/chemistry
• Sodium Chloride
• Solubility
• Spectroscopy, Fourier Transform Infrared
• Tooth Demineralization/metabolism
• Water

Collapse

Grants

• R01 DE015306 NIDCR NIH HHS
• R01 DE015306-06A1 NIDCR NIH HHS
• R01 DE015306-06 NIDCR NIH HHS

Collapse

Affiliation(s)

Jongryul Kim Department of Conservative Dentistry, School of Dentistry, Kyung Hee National University, Seoul, Republic of Korea
Toshikazu Uchiyama Department of Regenerative Dentistry, Nihon University School of Dentistry at Matsuso, Chiba, Japan
Marcela Carrilho GEO/UNIBAN, Health Institute, Bandeirante University of São Paulo, Brazil and Department of Dental Materials and Oral Biochemistry, University of São Paulo, School of Dentistry, São Paulo/SP, Brazil
Kelli A. Agee Medical College of Georgia, School of Dentistry, Medical College of Georgia, Augusta, Georgia, USA
Annalisa Mazzoni Department of SAU & FAL, University of Bologna, Bologna, Italy
Lorenzo Breschi Department of Biomedicine, University of Trieste + IGM-CNR, Unit of Bologna, c/o IOR, Bologna, Italy
Ricardo M. Carvalho Department of Operative Dentistry, College of Dentistry, University of Florida, Gainesville, Florida, USA
Leo Tjäderhane Institute of Dentistry, University of Oulu and Oulu University Hospital, Oulu, Finland
Stephen Looney Department of Biostatistics, Medical College of Georgia, Augusta, Georgia, USA
Courtney Wimmer Department of Biostatistics, Medical College of Georgia, Augusta, Georgia, USA
Arzu Tezvergil-Mutluay Department of Prosthodontics, School of Dentistry, University of Turku, Turku, Finland
Franklin R. Tay Department of Endodontics, School of Dentistry, Medical College of Georgia, Augusta, Georgia, USA
David H. Pashley Medical College of Georgia, School of Dentistry, Medical College of Georgia, Augusta, Georgia, USA

Collapse

Substantivity of chlorhexidine to human dentin

OBJECTIVES

To better comprehend the role of CHX in the preservation of resin-dentin bonds, this study investigated the substantivity of CHX to human dentin.

MATERIAL AND METHODS

Dentin disks (n=45) were obtained from the mid-coronal portion of human third molars. One-third of dentin disks were kept mineralized (MD), while the other two-thirds had one of the surfaces partially demineralized with 37% phosphoric acid for 15 s (PDD) or they were totally demineralized with 10% phosphoric acid (TDD). Disks of hydroxyapatite (HA) were also prepared. Specimens were treated with: (1) 10 microL of distilled water (controls), (2) 10 microL of 0.2% chlorhexidine diacetate (0.2% CHX) or (3) 10 microL of 2% chlorhexidine diacetate (2% CHX). Then, they were incubated in 1 mL of PBS (pH 7.4, 37 degrees C). Substantivity was evaluated as a function of the CHX-applied dose after: 0.5 h, 1 h, 3 h, 6 h, 24 h, 168 h (1 week), 672 h (4 weeks) and 1344 h (8 weeks) of incubation. CHX concentration in eluates was spectrophotometrically analyzed at 260 nm.

RESULTS

Significant amounts of CHX remained retained in dentin substrates (MD, PPD or TDD), independent on the CHX-applied dose or time of incubation (p<0.05). High amounts of retained CHX onto HA were observed only for specimens treated with the highest concentration of CHX (2%) (p<0.05).

CONCLUSION

The outstanding substantivity of CHX to dentin and its reported effect on the inhibition of dentinal proteases may explain why CHX can prolong the durability of resin-dentin bonds.

Selected physicochemical properties of the experimental endodontic sealer

This study explores water sorption, hygroscopic expansion, mechanical strength and ion release from the experimental amorphous calcium phosphate (ACP) composites formulated for application as endodontic sealers. Light-cure (LC) and dual-cure (DC; combined light and chemical cure) resins comprised urethane dimethacrylate (UDMA), 2-hydroxyethyl methacrylate (HEMA), methacryloyloxyethyl phthalate (MEP) and a high molecular mass oligomeric co-monomer, poly(ethyleneglycol)-extended UDMA (PEG-U) (designated UPHM resin). To fabricate composites, a mass fraction of 60% UPHM resin was blended with a mass fraction of 40% as-made (am-) or ground (g-) ACP. Glass-filled composites were used as controls. Both DC and LC ACP UPHM composites exhibited relatively high levels of water sorption accompanied by a significant hygroscopic expansion. The latter may potentially be useful to offset high polymerization stresses that develop in these materials. Ion release profiles of the experimental materials confirmed their potential for regeneration of mineral-deficient tooth structures. Their moderate to low mechanical strength after 3 months of aqueous immersion did not diminish the enthusiasm for the proposed use as endodontic sealers. For that application, DC g-ACP composites appear to be the most adequate, but micro-leakage and quantitative leachability studies are needed to fully establish their suitability.