Chlorhexidine-releasing methacrylate dental composite materials

Antibacterial activity of a triclosan-containing resin composite matrix against three common oral bacteria

This study investigated the antibacterial effect of a resin composite matrix with or without incorporated triclosan (0.3 wt%) on Streptococcus mutans, Actinomyces viscosus and Lactobacillus casei. In the quantitative assay, bacterial suspensions were filled into 20-μl cavities within temporary restorative resins. After 0, 4, 8, 12, 24 and 48 h of incubation, the suspensions were removed from the restoratives and the numbers of viable bacteria were determined. Bacterial suspensions incubated without restoratives served as the controls. Ten replicates were carried out for each experiment. The resin composite containing triclosan demonstrated variable degrees of antibacterial activity against the microorganisms, revealing a significant inhibitory effect on S. mutans within 12 h compared to the control. The viable counts of A. viscosus significantly decreased after 24 h. A significant reduction of L. casei was observed after 48 h. The unloaded resin composite did not reveal a marked antibacterial effect. The resin composite loaded with triclosan might be beneficial in preventing cavity contamination and minimizing the risk of pulpal irritation in the short-term.

Antibacterial activity of dental composites containing zinc oxide nanoparticles

The resin-based dental composites commonly used in restorations result in more plaque accumulation than other materials. Bacterial biofilm growth contributes to secondary caries and failure of resin-based dental composites. Methods to inhibit biofilm growth on dental composites have been sought for several decades. It is demonstrated here that zinc oxide nanoparticles (ZnO-NPs) blended at 10% (w/w) fraction into dental composites display antimicrobial activity and reduce growth of bacterial biofilms by roughly 80% for a single-species model dental biofilm. Antibacterial effectiveness of ZnO-NPs was assessed against Streptococcus sobrinus ATCC 27352 grown both planktonically and as biofilms on composites. Direct contact inhibition was observed by scanning electron microscopy and confocal laser scanning microscopy while biofilm formation was quantified by viable counts. An 80% reduction in bacterial counts was observed with 10% ZnO-NP-containing composites compared with their unmodified counterpart, indicating a statistically significant suppression of biofilm growth. Although, 20% of the bacterial population survived and could form a biofilm layer again, 10% ZnO-NP-containing composites maintained at least some inhibitory activity even after the third generation of biofilm growth. Microscopy demonstrated continuous biofilm formation for unmodified composites after 1-day growth, but only sparsely distributed biofilms formed on 10% ZnO-NP-containing composites. The minimum inhibitory concentration of ZnO-NPs suspended in S. sobrinus planktonic culture was 50 microg mL(-1). ZnO-NP-containing composites (10%) qualitatively showed less biofilm after 1-day-anaerobic growth of a three-species initial colonizer biofilm after being compared with unmodified composites, but did not significantly reduce growth after 3 days.

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.

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Key Words

• chlorhexidine
• binding
• debinding
• dentin bonding

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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

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Grants

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

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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

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In vitro drug release study of methacrylate polymer blend system: effect of polymer blend composition, drug loading and solubilizing surfactants on drug release

The application of polymers as the drug delivery systems for treating oral infections is a relatively new area of research. The present study was to test the release of the antibacterial drug chlorhexidine diacetate (CHDA), the antifungal drug Nystatin (NYS) and the antiviral drug acyclovir (ACY) from polymer blends of poly(ethyl methacrylate) and poly(n-hexyl methacrylate) of different compositions. The effects of polymer blend composition, drug loading and solubilizing surfactants on the release of the drugs have been studied. Measurements of the in vitro rate of drug release showed a sustained release of drug over extended periods of time. Drug release rates decreased with increasing PEMA content in polymer blends. CHDA release rates increased steadily with increasing drug load. The drug release rates increased with the addition of surfactants. This study demonstrates that the three therapeutic agents show a sustained rate of drug release from polymer blends of PEMA and PHMA over extended periods of time. By varying polymer blend compositions as well as the drug concentration (loading), it is possible to control the drug release rates to a desired value. The drug release rate is enhanced by addition of surfactants that solubilize drugs in the polymer blends.

Controlled release of chlorhexidine from amorphous microporous silica

A new system for the controlled release of the antiseptic chlorhexidine is presented. Amorphous microporous silica (AMS) excipient material was synthesized via an acid catalyzed sol-gel method and shaped as powder or coating. Chlorhexidine diacetate was introduced into the pores of the AMS silica via the incipient wetness impregnation method. This silica reservoir maintained a slow release of chlorhexidine over more than 7days. Chlorhexidine release was controlled by configurational diffusion in the AMS pores having free diameters of less than 1nm. The release of chlorhexidine was fine tuned by adapting particle size and pore diameter. Controlled release of chlorhexidine from an AMS coating on silicon wafer was demonstrated.

Development of remineralizing, antibacterial dental materials

Light curable methacrylate dental monomers containing reactive calcium phosphate filler (monocalcium phosphate monohydrate (MCPM) with particle diameter of 29 or 90microm) and beta-tricalcium phosphate (beta-TCP) at 1:1 weight ratio in a powder:liquid ratio (PLR) of 1:1 or 3:1 and chlorhexidine diacetate (0 or 5 wt.%), were investigated. Upon light exposure, approximately 90% monomer conversion was gained irrespective of the formulation. Increasing the PLR promoted water sorption by the set material, induced expansion and enhanced calcium, phosphate and chlorhexidine release. Concomitantly, a decline in compressive and biaxial flexural strengths occurred. With a reduction in MCPM particle diameter, however, calcium and phosphate release was reduced and less deterioration in strength observed. After 24h, the remaining MCPM had reacted with water and beta-TCP, forming, within the set materials, brushite of lower solubility. This provided a novel means to control water sorption, component release and strength properties. Measurable chlorhexidine release was observed for 6weeks. Both diffusion rate and total percentage of chlorhexidine release decreased with lowering PLR or by adding buffer to the storage solutions. Higher chlorhexidine release was associated with reduced bacterial growth on agar plates and in a biofilm fermenter. In cell growth media, brushite and hydroxyapatite crystals precipitated on the composite material surfaces. Cells spread on both these crystals and the exposed polymer composite surfaces, indicating their cell compatibility. These formulations could be suitable antibacterial, biocompatible and remineralizing dental adhesives/liners.

Chemical characterization of a degradable polymeric bone adhesive containing hydrolysable fillers and interpretation of anomalous mechanical properties

An experimental, light-curable, degradable polyester-based bone adhesive reinforced with phosphate glass particles ((P(2)O(5))(0.45)(CaO)(x)(Na(2)O)(0.55-)(x), x=0.3 or 0.4mol) or calcium phosphate (monocalcium phosphate/beta-tricalcium phosphate (MCPM/beta-TCP)) has been characterized. Early water sorption (8wt.% at 1week) by the unfilled set adhesive catalysed subsequent bulk degradation (4wt.% at 2weeks) and substantial decline in both elastic and storage moduli. Addition of phosphate glass fillers substantially enhanced this water sorption, catalysed greater bulk mass loss (40-50 and 52-55wt.%, respectively) but enabled generation of a microporous scaffold within 2weeks. The high levels of acidic polymer degradation products (38-50wt.% of original polymer) were advantageously buffered by the filler, which initially released primarily sodium trimetaphosphate (P(3)O93-). Calcium phosphate addition raised polymer water sorption to a lesser extent (16wt.%) and promoted intermediate early bulk mass loss (12wt.%) but simultaneous anomalous increase in modulus. This was attributed to MCPM reacting with absorbed water and beta-TCP to form more homogeneously dispersed brushite (CaHPO(4)) throughout the polymer. Between 2 and 10weeks, linear erosion of both polymer (0.5wt.%week(-1)) and composites (0.7-1.2wt.%week(-1)) occurred, with all fillers providing long-term buffer action through calcium and orthophosphate (PO43-) release. In conclusion, both fillers can raise degradation of bone adhesives whilst simultaneously providing the buffering action and ions required for new bone formation. Through control of water sorption catalysed filler reactions, porous structures for cell support or substantially stiffer materials may be generated.

Synthesis, characterization and in vitro activity of a surface-attached antimicrobial cationic peptide

Infection associated with implanted biomaterials is common and costly and such infections are extremely resistant to antibiotics and host defenses. Consequently, there is a need to develop surfaces which resist bacterial adhesion and colonization. The broad spectrum synthetic cationic peptide melimine has been covalently linked to a surface via two azide linkers, 4-azidobenzoic acid (ABA) or 4-fluoro-3-nitrophenyl azide (FNA), and the resulting surfaces characterized by X-ray photoelectron spectroscopy and contact angle measurements. The quantity of bound peptide was estimated by a modified Bradford assay. The antimicrobial efficacy of the two melimine-modified surfaces against Pseudomonas aeruginosa and Staphylococcus aureus was compared by scanning electron microscopy (SEM) and fluorescence microscopy. Attachment of melimine via ABA gave an approximately 4-fold greater quantity of melimine bound to the surface than attachment via FNA. Surfaces melimine-modified by either attachment strategy showed significantly reduced bacterial adhesion for both strains of bacteria. P. aeruginosa exposed to ABA-melimine and FNA-melimine surfaces showed marked changes in cell morphology when observed by SEM and a reduction of approximately 15-fold (p < 0.001) in the numbers of adherent bacteria compared to controls. For the ABA-melimine surface there was a 33% increase in cells showing damaged membranes (p = 0.0016) while for FNA-melimine there was no significant difference. For S. aureus there were reductions in bacterial adhesion of approximately 40-fold (p < 0.0001) and 5-fold (p = 0.008) for surfaces modified with melimine via ABA or FNA, respectively. There was an increase in cells showing damaged membranes on ABA-melimine surfaces of approximately 87% (p = 0.001) compared to controls, while for FNA-melimine there was no significant difference observed. The data presented in this study show that melimine has excellent potential for development as a broad spectrum antimicrobial coating for biomaterial surfaces. Further, it was observed that the efficacy of antimicrobial activity is related to the method of attachment.

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.

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

OBJECTIVES

The aim of this study was to evaluate chlorhexidine release from unfilled non-solvated methacrylate-based resins of increasing hydrophilicity and to examine relationships among Hoy's solubility parameters, water sorption, solubility and the rate of chlorhexidine release.

METHODS

Resin discs were prepared from light-cured, experimental resin blends (R1, R2, R3, R4 and R5) containing 0.0, 0.2, 1.0 and 2.0 wt.% chlorhexidine diacetate (CDA). Discs were immersed in distilled water at 37 degrees C, and mass changes were recorded at different periods. Spectral measurements were made to follow change in optical densities of storage solution to examine chlorhexidine release kinetics. After a 28-day period, water sorption, solubility, and the cumulative chlorhexidine release were obtained. Additionally, antibacterial study was performed by observing the presence of inhibition zone against Streptococcus mutans.

RESULTS

The most hydrophilic resin (R5) exhibited the highest chlorhexidine release rate. The most hydrophobic resin (R1) exhibited the lowest rate. However, no inhibition zone was produced by any specimens stored in water for 2 weeks. The addition of CDA increased solubility significantly but had no effect on water sorption. Significant positive correlations were seen between water sorption and the cumulative chlorhexidine release.

SIGNIFICANCE

Chlorhexidine release from resins may be related to water-induced swelling, which in turn is enhanced by the hydrophilicity of cured polymer matrix.

Concentration dependent aggregation properties of chlorhexidine salts

PURPOSE

Chlorhexidine (CHX), a chemical antiseptic, is known to bind to dentin and has been shown to be effective in treating bacterial infections caused by microbes. The solubility and aggregation properties of CHX salts were determined to guide the development of a sustained release formulation for long-term disinfection.

METHODS

The amount of CHX in solution was determined as a function of counterion concentration (chloride, acetate (Ac) or gluconate (G)) by UV spectrophotometry at 255nm. The weight average molecular weight was determined from the angular dependence of the scattered light. Proton NMR spectroscopy was used to investigate the dependence of the peak intensity and chemical shift on solution concentration and diffusion measurements were performed by Fourier-transform pulsed-field gradient spin-echo (PFG-SE) (1)H NMR.

RESULTS

The observed CHX concentration was highly dependent on the type and concentration of salt present in solution with the greatest CHX concentration achieved with gluconate, moderate to low with diacetate, and very low with dichloride solutions. Addition of sodium gluconate enhanced the amount of CHX-Ac(2) in solution; however, only low concentrations of chlorhexidine can be achieved in the presence of chloride ions. For solutions of CHX-G(2), the aggregate number appeared to range from a dimer at 40mM to perhaps a pentamer at 150mM. In contrast, no aggregation of CHX-Cl(2) or CHX-Ac(2) was detected, which was corroborated by diffusion NMR results. The change in chemical shift of protons is consistent with association of the phenyl group of one CHX with the hexamethylene chain of a second CHX. Based on the analysis of NMR peak intensities of CHX, gluconate, and acetate in saturated solutions, it appears that solubilization of the diacetate species occurs within digluconate aggregates, since the solubility product of chlorhexidine diacetate is such that the concentration of CHX will exceed the critical micelle concentration (CMC). However, no solubilization of CHX-Cl(2) occurs because the solubility product falls below the CMC.

CONCLUSIONS

The low concentration of CHX that can be achieved in physiological concentrations of chloride in the oral cavity may be problematic for dental and slow release formulations. Achieving a high concentration of CHX appears to require that the monomer be present at a concentration greater than that required to produce self-association.

Characterization of chlorhexidine-releasing, fast-setting, brushite bone cements

The effect of antibacterial chlorhexidine diacetate powder (CHX) on the setting kinetics of a brushite-forming beta-tricalcium phosphate/monocalcium phosphate monohydrate (beta-TCP/MCPM) cement was monitored using attenuated total reflection Fourier transform infrared spectroscopy. The final composition of the set cement with up to 12 wt.% CHX content before and after submersion in water for 24h, the kinetics of chlorhexidine release and the total sample mass change in water over four weeks was monitored using Raman mapping, UV spectroscopy and gravimetry, respectively. Below 9 wt.%, CHX content had no significant effect on brushite formation rate at 37 degrees C, but at 12 wt.% the half-life of the reaction decreased by one-third. Raman mapping confirmed that brushite was the main inorganic component of the set cements irrespective of CHX content, both before and after submersion in water. The CHX could be detected largely as discrete solid particles but could also be observed partially dispersed throughout the pores of the set cement. The percentage of CHX release was found to follow Fick's law of diffusion, being independent of its initial concentration, proportional to the square root of time and, with 1mm thick specimens, 60% was released at 24h. Total set cement mass loss rate was not significantly affected by CHX content. On average, cements exhibited a loss of 7 wt.% assigned largely to surface phosphate particle loss within the initial 8h followed by 0.36 wt.% per day.

EVA copolymer matrix for intra-oral delivery of antimicrobial and antiviral agents

Biocompatible ethylene vinyl acetate copolymer (EVA) was utilized to study the release of an antiviral drug (acyclovir (ACY)) and an antimicrobial drug (doxycycline hyclate (DOH)). Release of both drugs from EVA was measured individually and in combination. The effect of drug combination of DOH and ACY is presented. Additionally, the release rate of DOH after coating of the matrix with a different copolymer, in drug-loading with increasing loads of DOH, and with increases in temperature are also presented. The drugs incorporated in EVA films were prepared from the dry sheet obtained by solvent evaporation of polymer casting solutions with drugs. Drug release from the films was examined for about 12 days in distilled water at 37 degrees C. Changes in optical density were followed spectrophotometrically. The combination of ACY and DOH resulted in an increased release of ACY by about three times (P < 0.001) while DOH showed a decrease in rate of about two times compared to the individual release rates (P = 0.008). Increases in drug levels of DOH resulted in increases in drug release rates (P = 0.001). The release rate of DOH increased with temperature (P = .001; 27, 32, 37 and 42 degrees C were studied) and the energy of activation (DeltaE ( not equal) = 56.69 kJ/mol) was calculated using the Arrhenius equation for the diffusion of DOH molecules. Thus, the release rates of drugs were influenced by many factors: drug combination, coating the device, drug-loading, and temperature variation. Therefore it is proposed that controlling these variables should make it possible to obtain therapeutic levels of drugs released from drug loaded polymer, which may be beneficial in treating oral infections.

Controlled release of chlorhexidine from UDMA-TEGDMA resin

Chlorhexidine salts are available in various formulations for dental applications. This study tested the hypothesis that the release of chlorhexidine from a urethane dimethacrylate and triethylene glycol dimethacrylate resin system can be effectively controlled by the chlorhexidine diacetate content and pH. The filler concentrations were 9.1, 23.1, or 33.3 wt%, and the filled resins were exposed to pH 4 and pH 6 acetate buffers. The results showed that Fickian diffusion was the dominant release mechanism. The rates of release were significantly higher in pH 4 buffer, which was attributed to the increase of chlorhexidine diacetate solubility at lower pH. The higher level of filler loading reduced the degree of polymerization, leading to a greater loss of organic components and higher chlorhexidine release rates.