Experimental salivary pellicles on the surface of orthodontic materials

Managing oral biofilms to avoid enamel demineralization during fixed orthodontic treatment

Enamel demineralization represents the most prevalent complication arising from fixed orthodontic treatment. Its main etiology is the development of cariogenic biofilms formed around orthodontic appliances. Ordinarily, oral biofilms exist in a dynamic equilibrium with the host's defense mechanisms. However, the equilibrium can be disrupted by environmental changes, such as the introduction of a fixed orthodontic appliance, resulting in a shift in the biofilm's microbial composition from non-pathogenic to pathogenic. This alteration leads to an increased prevalence of cariogenic bacteria, notably mutans streptococci, within the biofilm. This article examines the relationships between oral biofilms and orthodontic appliances, with a particular focus on strategies for effectively managing oral biofilms to mitigate enamel demineralization around orthodontic appliances.

Effectiveness of a New App in Improving Oral Hygiene in Orthodontic Patients: A Pilot Study

OBJECTIVES

The aim of this randomised clinical trial was to evaluate the effects of a mobile application (app) on the oral hygiene (OH) of adolescents undergoing fixed orthodontic treatment.

METHODS

Eight volunteers (14-19 years old) were randomly allocated to the experimental or control groups. Volunteers in the control group received standard OH (SOH) instructions, whilst volunteers in the experimental group received SHO + OH guidance and motivation through an app tailor-made for this study. Clinical assessments were made using the visible plaque index (VPI) and gingival bleeding index (GBI) at 5 different time points: before orthodontic device installation (T0); at baseline (T1); and 30 (T2), 60 (T3), and 90 (T4) days after randomisation. Significant differences were evaluated using Student t test and multilevel logistic regression analysis.

RESULTS

Although no significant difference could be observed, VPI at T1 and T2 were lower for volunteers in the experimental group (33.20 ± 19.29; 32.10 ± 7.72) than for the volunteers in the control group (42.11 ± 8.56; 43.59 ± 34.71). The same was observed for GBI, in which volunteers in the experimental group presented lower GBI at T1 and T2 (12.70 ± 8.10; 13.72 ± 7.39) than volunteers in the control group (27.53 ± 17.89; 20.38 ± 9.95). Good acceptance for using the app was shown by volunteers.

CONCLUSIONS

This study shows the potential utility of the mobile app for improving the OH of adolescents.

Proteomic profile of in situ acquired pellicle on tooth and restorative material surfaces

OBJECTIVES

To evaluate and compare the proteomic profile of acquired pellicle on smooth bovine tooth and tooth-coloured restorative materials, including resin composite (RC), glass ionomer cement (GIC), and casein phosphopeptide-amorphous calcium phosphate modified GIC (CPP-ACP GIC).

METHODS

Two-hour in situ pellicles on tooth/materials specimens mounted in oral appliances worn by ten healthy adults were investigated. Pellicle proteins and corresponding unstimulated whole saliva were quantitatively analysed through liquid chromatography-tandem mass spectrometry.

RESULTS

Significantly higher amounts of protein were adsorbed onto tooth surface than restorative materials tested (4.11 ± 0.69 vs. 2.54 ± 0.38/2.98 ± 0.80/3.01 ± 0.37 µg, RC/GIC/CPP-ACP GIC). From the ten participants, 1,444 (487-1,086/person), 1,454 (645-1,051/person), 1,731 (454-1,475/person), or 1,597 (423-1,261/person) pellicle proteins were detected at least once on bovine tooth, RC, GIC, or CPP-ACP GIC, respectively, and with 1,072 (304-793/person) salivary proteins identified. Comparative quantification revealed minor differences between tooth and restorative materials pellicle profiles. High inter-individual variations in pellicle protein composition were demonstrated. Compared to the salivary protein profile, 214/57 proteins showed significantly increased/decreased abundance in pellicle formed on at least one substrate (fold change > 3.325/fold change < 0.301). Gene Ontology enrichment analysis showed some pellicle proteins detected with increased affinity to tooth/material surface were identified as being related to "calcium-dependent protein binding" or "cell-cell adhesion mediator activity".

CONCLUSION

Similar protein quantity and composition was observed in 2 h in situ pellicles formed on different smooth restorative material surfaces. The proteomic profile of pellicles appeared distinct from that of the corresponding unstimulated whole saliva.

CLINICAL SIGNIFICANCE

Host backgrounds appeared more influential on the proteomic profile of the in situ acquired pellicle than the underlying substrate characteristics among systemically and orally healthy adults. Pellicle proteins preferentially adsorbed on tooth/materials were putatively associated with calcium ion homeostasis or host-microbiota interaction.

Biofilm formation following chitosan-based varnish or chlorhexidine-fluoride varnish application in patients undergoing fixed orthodontic treatment: a double blinded randomised controlled trial

BACKGROUND

Orthodontic treatment poses an increased risk of plaque accumulation and demineralisation of enamel leading to white spot lesion around the brackets. This parallel arm trial aims to assess the degree of bacterial plaque formation adjacent to orthodontic brackets, following the application of a chitosan-based varnish or chlorhexidene-fluoride varnish.

METHODS

A total of 200 teeth from 20 patients undergoing fixed orthodontic therapy were assessed and biofilm formation around the brackets were recorded using the Bonded Bracket Index (Plaque index) at baseline and weekly for 6 weeks. The bacterial count and plaque pH at corresponding weekly intervals were also recorded. Following bracket bonding, the patients were cluster randomised to receive chitosan-based varnish-CHS (UNO Gel Bioschell, Germiphene corp., Brantford, Canada) or chlorhexidine-fluoride varnish-CFV (Cervitec F, Ivoclar Vivadent, Schaan, Liechtenstein) every week on the representative teeth respectively. BBI proportions were compared between groups at all time intervals using Chi square test. Mean plaque bacterial count and plaque pH were compared using Mann Whitney U test and Tukey's HSD test respectively.

RESULTS

Baseline characteristics were similar between the groups: Mean age was CHS = 23 and CFV = 21; male to female ratio was CHS = 5/5, CFV = 7/3. At the end of 6 weeks, chitosan-based varnish performed equal to chlorhexidine-fluoride varnish (P > 0.05) with 98% and 95% of teeth with acceptable scores respectively. The plaque bacterial count significantly reduced at 6 weeks for both varnish compared to the baseline; The value for CHS was 0.43 ± 0.4 × 104 and CFV was 0.77 ± 0.64 × 104 CFU (P < 0.05), with no difference between both the varnishes. Both varnishes had no effect on the plaque pH that remained neutral.

CONCLUSION

This trial showed that both chitosan-based varnish and chlorhexidine-fluoride varnish reduced bacterial count, while the plaque pH remained neutral over a period of six weeks in patients undergoing fixed orthodontic therapy. The anti-plaque effects of the natural biopolymeric chitosan-based varnish was similar to that of chlorhexidine-fluoride varnish, a known chemotherapeutic agent. Registration: This trial protocol was registered with https://www.ctri.nic.in (CTRI/2019/05/018896). (Date of registration 02/05/2019).

PROTOCOL

The protocol was not published before trial commencement.

Proteome difference among the salivary proteins adsorbed onto metallic orthodontic brackets and hydroxyapatite discs

The aim of this study was to investigate the atomic composition and the proteome of the salivary proteins adsorbed on the surface of orthodontic metallic bracket. For this, the atomic composition of orthodontic metallic brackets was analyzed with X-ray Photoelectron Spectroscopy (XPS). The acquired bracket pellicle was characterized after brackets were immersed in human whole saliva supernatant for 2 hours at 37°C. Hydroxyapatite (HA) discs were used as a control. Acquired pellicle was harvested from the HA discs (n = 12) and from the metallic brackets (n = 12). Proteomics based on mass spectrometry technology was used for salivary protein identification and characterization. Results showed that most of the proteins adsorbed on the surface of orthodontic metallic brackets and on the HA discs were identified specifically to each group, indicating a small overlapping between the salivary proteins on each study group. A total of 311 proteins present on the HA discs were unique to this group while 253 proteins were unique to metallic brackets, and only 45 proteins were common to the two groups. Even though most proteins were unique to each study group, proteins related to antimicrobial activity, lubrication, and remineralization were present in both groups. These findings demonstrate that the salivary proteins adsorbed on the bracket surface are dependent on the material molecular composition.

Saliva and Serum Protein Adsorption on Chemically Modified Silica Surfaces

Biomaterials, once inserted in the oral cavity, become immediately covered by a layer of adsorbed proteins that consists mostly of salivary proteins but also of plasma proteins if the biomaterial is placed close to the gingival margin or if it becomes implanted into tissue and bone. It is often this protein layer, rather than the pristine biomaterial surface, that is subsequently encountered by colonizing bacteria or attaching tissue cells. Thus, to study this important initial protein adsorption from human saliva and serum and how it might be influenced through chemical modification of the biomaterial surface, we have measured the amount of protein adsorbed and analyzed the composition of the adsorbed protein layer using gel electrophoresis and western blotting. Here, we have developed an in vitro model system based on silica surfaces, chemically modified with 7 silane-based self-assembled monolayers that span a broad range of physicochemical properties, from hydrophilic to hydrophobic surfaces (water contact angles from 15° to 115°), low to high surface free energy (12 to 57 mN/m), and negative to positive surface charge (zeta potentials from –120 to +40 mV at physiologic pH). We found that the chemical surface functionalities exerted a substantial effect on the total amounts of proteins adsorbed; however, no linear correlation of the adsorbed amounts with the physicochemical surface parameters was observed. Only the adsorption behavior of a few singular protein components, from which physicochemical data are available, seems to follow physicochemical expectations. Examples are albumin in serum and lysozyme in saliva; in both, adsorption was favored on countercharged surfaces. We conclude from these findings that in complex biofluids such as saliva and serum, adsorption behavior is dominated by the overall protein-binding capacity of the surface rather than by specific physicochemical interactions of single protein entities with the surface.

The salivary pellicle on dental biomaterials

The salivary pellicle, an adlayer formed by adsorption of salivary components on teeth and dental biomaterials, has direct consequences on basic outcomes of dentistry. Here, we provide an overview of salivary pellicle formation processes with a critical focus on dental biomaterials. We describe and critique the array of salivary pellicle measurement techniques. We also discuss factors that may affect salivary pellicle formation and the heterogeneity of the published literature describing salivary pellicle formation on dental biomaterials. Finally, we survey the many effects salivary pellicles have on dental biomaterials and highlight its implications on design criteria for dental biomaterials. Future investigations may lead to rationally designed dental biomaterials to control the salivary pellicle and enhance material function and patient outcomes.

THE ROLE OF NEW TECHNOLOGIES IN DEFINING SALIVARY PROTEIN COMPOSITION FOLLOWING PLACEMENT OF FIXED ORTHODONTIC APPLIANCES - BREAKTHROUGH IN THE DEVELOPMENT OF NOVEL DIAGNOSTIC AND THERAPEUTIC PROCEDURES

Human saliva is rich in proteins of variable functions (e.g., enzymes, immunoglobulins, cytokines) and origin (blood plasma, salivary glands, or oral microflora). Circadian dynamics, volume and composition (electrolytes, pH, protein, etc.) of secreted saliva vary with local and systemic physiological and pathophysiological conditions. Therefore, the composition of saliva, protein in particular, has been intensively investigated to identify the potential markers and/or mechanisms of systemic and local diseases. Proteomic techniques used for the analysis of biological fluids have enabled great advances in salivary protein stabilization (as the main precondition for their analysis) and detection of those found in saliva in very low concentrations, including small proteins and peptides. This review brings the main characteristics of current proteomic techniques such as liquid chromatography-mass spectrometry, two-dimensional electrophoresis-mass spectrometry, and surface-enhanced laser desorption ionization/time of flight/mass spectrometry. These techniques enable simultaneous identification of hundreds and thousands of protein molecules, as well as identifying those of a potential biological value in particular states. This literature review is focused on the state-of-the-art and possibilities offered by proteomic techniques in analyzing the effects of orthodontic appliances on salivary protein composition and searching for potential markers of therapeutic success/failure or for the molecules by which therapeutic effects are achieved.

Orthodontic bracket designs and their impact on microbial profile and periodontal disease: A clinical trial

Aim:

The aim of the present study was to compare the undisturbed plaque formation on teeth bonded with Preadjusted (Captain Ortho, Libral Traders, Mumbai, India) and Begg Brackets (Captain Ortho, Libral Traders, Mumbai, India) with nonbonded control sites via a de novo plaque growth over a period of 7 days.

Materials and Methods:

A clinical trial with the split-mouth design was set up enrolling 10 dental students. Within each subject sites with (Preadjusted) (P-site), Begg brackets (B-site) and control sites were followed. Plaque index and gingival index were recorded on days 3 and 7. Supra-gingival and sub-gingival plaque samples were taken from the brackets and the teeth on days 3 and 7, and were sent for aerobic and anaerobic culturing. The total number of bacterial colony forming units (CFU) was assessed for each sample using a colony counter. Tukeys and Dunnett test then statistically analyzed data.

Results:

The mean plaque index and gingival index increased on P-site and B-site on the third and 7^th day. The shift from aerobic to anaerobic species was observed earlier in P-sites than in B-sites. The CFU were significantly higher for all sites on day 7 when compared with day 3. The aerobe/anaerobe CFU ratio was significantly lower in P-sites than in B-sites and then control showing an increase in the number of anaerobic species on the 3^rd and 7^th day (P < 0.05). Based on observed means, the mean difference was significant (P < 0.05).

Conclusion:

The present data suggest that Preadjusted brackets accumulated more plaque than Begg brackets. Bracket design can have a significant impact on bacterial load and on periodontal parameters.

The influence of different types of fixed orthodontic appliance on the growth and adherence of microorganisms (in vitro study)

Orthodontic appliances serve as different impact zones and modify microbial adherence and colonization, acting as foreign reserves and possible sources of infection. This study was conducted to investigate the effect of different types of fixed orthodontic appliances on the growth and adherence of microorganisms in oral flora which are Streptococcus mutans (S. mutans) and Candida albicans. Sixty-four of four different fixed orthodontic appliance-samples were used, divided into four groups of sixteen. Type I: Sapphire brackets- Coated wires, type II: Sapphire brackets- Stainless steel wires, type III: Stainless steel brackets- Coated wires and type IV: Stainless steel brackets- Stainless steel wires. Oral strains of S. mutans and Candida albicans were studied in the present study using biochemical test then microbial suspensions were prepared to do the tests of each microorganism including the antimicrobial effects of different appliance-samples on the growth of microorganisms and their adhesion tests. The results showed significant differences between the different appliances in terms of inhibition zone formation (P<0.001). The adhesion test, which is classified into low, medium and high, showed the adhesion of S. mutans, is low with type I and II, medium with type III and high with type IV, whereas the adhesion of Candida albicans is medium with both type I and II and high with both type III and IV with high significant differences (P<0.001). Appliance with high esthetic appearance, sapphire brackets and coated arch wire, showed the least adherence of S. mutans and Candida albicans in comparison to other appliances with less esthetic and more metal components.

Key words:Orthodontic appliance, Adherence, Streptococcus mutans, Candida albicans.

Adherence of Streptococcus mutans and Candida albicans to different bracket materials

Objective:

To quantify the adherence of Streptococcus mutans and Candida albicans on brackets made of stainless steel, plastic, ceramic, titanium, and gold, and to evaluate the various sites of adherence of these microorganisms with scanning electron microscopy (SEM).

Materials and Methods:

Brackets made of stainless steel, plastic, ceramic, titanium, and gold were used. The adherence of S. mutans and C. albicans were studied. The brackets were placed in flat-bottomed vials containing basal medium with 20% sucrose added; the flasks were inoculated with each of the microbial suspensions. The samples were incubated at 37°C for 48 h, after which the brackets were removed. The cells adhering to the glass were counted and the brackets were studied with SEM.

Results:

When evaluated together, the adherence of S. mutans and C. albicans was increased in the ceramic bracket group. When evaluated separately, metallic brackets had increased number of colony-forming units (CFUs) of S. mutans and the use of titanium brackets increased the CFUs of C. albicans. SEM demonstrated that the adherence of S. mutans and C. albicans together varied according to the bracket materials, with ceramic having the greatest and stainless steel having the least adherence.

Conclusions:

Oral hygiene may be of greater concern with esthetic brackets since this study shows that microbial adhesion is greater with these brackets.

Microbiological evaluation of elastomeric chains

OBJECTIVES

To evaluate in vitro the surface of elastomeric chains of different manufacturers to verify the presence of pathogenic microorganisms at the moment of unpacking and analyze a possible inhibitory effect of the elastomeric chain when exposed to microorganisms of the oral cavity, for example, Streptococcus mutans, Lactobacillus casei, and Candida albicans.

MATERIALS AND METHODS

Elastomeric chains from Ortho-Organizers Inc, 3M Unitek, and Dental Morelli were placed in petri plates with brain heart infusion agar medium and in sterile test tubes with brain heart infusion broth. The samples were incubated at 37 degrees C and analyzed at 24 hours, 48 hours, 3 days, and 7 days. In addition, elastomeric chains from the three manufacturers were placed in dishes, inoculated with microorganisms, incubated at 37 degrees C, and analyzed after 24 and 72 hours.

RESULTS

No microorganism growth was detected after all incubation periods. No inhibition zones were identified surrounding the elastomeric chain.

CONCLUSIONS

The results suggest that the fabrication of elastomeric chain is in accordance with biohazard concepts. However, careful manipulation is necessary to avoid colonization of pathogenic microorganisms since the composition of the elastomeric chains analyzed do not include antimicrobial agents.

Influence of Different Orthodontic Brackets on Adherence of Microorganisms In Vitro

OBJECTIVE

To define the capacity of different bracket materials to modify the growth and adherence of microorganisms.

METHODS

Three types of brackets from the right upper central incisor were used: metallic, ceramic, and composite. Streptococcus mutans and Candida albicans were studied. The association of both species was also evaluated. The brackets were placed in flat-bottomed vials containing basal medium with 20% sucrose added; the flasks were inoculated with each of the microbial suspensions. The samples were incubated at 37 degrees C for 48 hours, after which the brackets were removed. The supernatant was removed from the flasks, the cells adhering to the glass were counted, and the brackets were studied with electron microscopy.

RESULTS

The adherence of Streptococcus mutans was not modified by the different brackets. The adherence of Candida albicans was increased by the composite bracket, whereas the use of metallic brackets decreased the number of colony-forming units (CFUs). By electron microscopy we demonstrated that the adherence of Streptococcus mutans plus Candida albicans together varied according to the bracket materials with composite > ceramic > metallic.

CONCLUSIONS

Orthodontic appliances serve as different impact zones and modify microbial adherence and colonization, acting as foreign reserves and possible sources of infection.

Influence of salivary organic substances on the discoloration of esthetic dental materials-a review

The objective of this article was to review the articles on the interaction of salivary organic substances with resin-based dental materials and on the interaction of these organic substances with exogenous chemical agents, which results in discoloration. Original scientific articles or reviews on the saliva, acquired pellicle, and the interaction with pellicle and chemical agents related to dental resin-based materials were reviewed. Salivary esterases can increase or decrease the internal and external discoloration. The formation of acquired pellicle on the surface of a material varies by the properties of material, and the pellicle interacts with denaturation agents, such as tannin and chlorhexidine, to form stains and also adsorbs staining substances. Therefore, for the quality and longevity of restorations, protocols for the evaluation of the influence of organic substances on the extrinsic staining of restorative materials should be included in the evaluation of aesthetic restorative materials.

Photocoupling of fibronectin to titanium surfaces influences keratinocyte adhesion, pellicle formation and thrombogenicity

OBJECTIVES

Coating of implant surfaces with biomolecules can influence basic host responses and enhance subsequent tissue integration. The biological factors have to be immobilized on the implant material. Human fibronectin (Fn) was used as a model protein and covalently coupled to titanium (Ti) surfaces via silanization and an anthraquinone linker. The impact on several aspects of initial host/biomaterial interactions (keratinocyte adhesion, platelet interactions and pellicle formation) was studied.

METHODS

Coupling efficiency was characterized by immunological techniques. The effects of coupled Fn on initial host/biomaterial interactions were assessed. Cell adhesion and spreading were investigated by fluorescent staining, pellicle formation by an acoustic sensor system (quartz crystal microbalance with dissipation, QCM-D), and platelet adhesion as one parameter mediating the inflammatory response by scanning electron microscopy (SEM) and immunological assays.

RESULTS

Coupling efficiency was related to irradiation time used for photochemical coupling of the UV-activated anthraquinone to the silanized Ti surface. With an optimized protocol, the amount of Fn coupled to the surface could be almost doubled compared to standard dip-coating methods. On the anthraquinone-coupled Fn coatings, cell adhesion and spreading of human keratinocytes was significantly enhanced. Online detection of pellicle formation revealed strong reversibility of saliva protein adhesion on Fn coated surfaces compared to the pure Ti surface. Furthermore, the Fn coated Ti showed a low thrombogenicity.

SIGNIFICANCE

This study suggests that anthraquinone-coupled biological coatings may be useful for biofunctionalization of Ti dental implants by enhancement of soft tissue re-integration (restoration of the epithelial seal) combined with diminished pellicle formation.

Adhesion of oral streptococci to experimental bracket pellicles from glandular saliva

The aim of this study was to evaluate the functions of bracket pellicles as the binding receptors for Streptococcus mutans and Streptococcus gordonii. Four different types of orthodontic brackets were used: stainless steel, monocrystalline sapphire, polycrystalline alumina, and plastic. The bracket pellicles were formed by incubating orthodontic brackets with fresh submandibular-sublingual saliva or parotid saliva for 2 hours. The pellicles were extracted, and their components were confirmed by gel electrophoresis, immunodetection, and amino acid composition analysis. The roles of the bracket pellicles in the adhesion of oral streptococci were evaluated by incubating tritium-labeled streptococci with pellicle-transfer blots. The results showed that the salivary components adhered selectively according to type of bracket and glandular saliva. The selective adsorption was also proven by the amino acid composition profiles. Among the several salivary proteins, MG2, alpha-amylase, and the acidic proline-rich proteins provided the binding sites for S gordonii. However, none of these proteins in the bracket pellicles contributed to the adhesion of S mutans. These findings suggest that numerous salivary proteins can adhere selectively to the orthodontic brackets, and some of them contribute to the binding of S gordonii.

Experimental salivary pellicles formed on the surface of self-curing resin

The aim of this study was to identify the salivary components present in the pellicles formed on self-curing resin and to investigate the qualitative variations in adsorbed salivary pellicle compositions according to different exposure time to saliva. Experimental pellicles were formed by the incubation of polymerized resin particles with fresh human parotid or submandibular-sublingual saliva for either 20 min or 2 h. Pellicles were extracted using formic acid and lyophilized, they were then subjected to sodium dodecyl sulphate-polyacrylamide gel electrophoresis and immunoblotting to identify the adsorbed salivary components. The amino acid profiles of the 2 h-pellicles were analysed and compared with those of fresh glandular salivas. There was a difference in the 2 h-pellicle components on the self-curing resin compared with those of other dental materials as well as tooth enamel. The amino acid profiles of the 2 h-pellicles were also different from those of fresh glandular salivas. In the case of submandibular-sublingual saliva, the components of the 2 h-pellicle showed a different pattern compared with those of the 20 min-pellicle. However, there was no significant difference between the components of the 2 h- and 20 min-pellicles in the case of parotid saliva. A distinct difference was found in the surface binding affinities of immunoglobulin (IgA) from different glandular salivas. The findings of this study provide information concerning the initial bacterial adhesion on the surfaces of self-curing resin.

Roles of salivary proteins in the adherence of oral streptococci to various orthodontic brackets

Knowledge of salivary pellicles on orthodontic brackets provides a better understanding of microbial adherence. The aim of this study was to analyze the effects of bracket pellicles on the adherence of Streptococcus gordonii and Streptococcus mutans. Bracket pellicles were formed by the incubation of 4 kinds of orthodontic brackets with unstimulated whole saliva for 2 hrs, and analyzed by electrophoresis, immunodetection, and amino acid analysis. Binding assays were then performed by the incubation of tritium-labeled streptococci with the pellicle-transfer blots and orthodontic brackets. The results showed that low-molecular-weight mucin, alpha-amylase, secretory IgA, acidic proline-rich proteins, and cystatins adhered to all kinds of brackets, though the amino acid composition of pellicles differed between bracket types. Some of these proteins increased the binding of S. gordonii to saliva-coated brackets. However, salivary pellicles decreased the binding of S. mutans. Collectively, salivary pellicles were found to play a significant role in the initial adhesion of oral streptococci to orthodontic brackets.