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Xu W, Yu F, Addison O, Zhang B, Guan F, Zhang R, Hou B, Sand W. Microbial corrosion of metallic biomaterials in the oral environment. Acta Biomater 2024; 184:22-36. [PMID: 38942189 DOI: 10.1016/j.actbio.2024.06.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 05/29/2024] [Accepted: 06/21/2024] [Indexed: 06/30/2024]
Abstract
A wide variety of microorganisms have been closely linked to metal corrosion in the form of adherent surface biofilms. Biofilms allow the development and maintenance of locally corrosive environments and/or permit direct corrosion including pitting corrosion. The presence of numerous genetically distinct microorganisms in the oral environment poses a threat to the integrity and durability of the surface of metallic prostheses and implants used in routine dentistry. However, the association between oral microorganisms and specific corrosion mechanisms is not clear. It is of practical importance to understand how microbial corrosion occurs and the associated risks to metallic materials in the oral environment. This knowledge is also important for researchers and clinicians who are increasingly concerned about the biological activity of the released corrosion products. Accordingly, the main goal was to comprehensively review the current literature regarding oral microbiologically influenced corrosion (MIC) including characteristics of biofilms and of the oral environment, MIC mechanisms, corrosion behavior in the presence of oral microorganisms and potentially mitigating technologies. Findings included that oral MIC has been ascribed mostly to aggressive metabolites secreted during microbial metabolism (metabolite-mediated MIC). However, from a thermodynamic point of view, extracellular electron transfer mechanisms (EET-MIC) through pili or electron transfer compounds cannot be ruled out. Various MIC mitigating methods have been demonstrated to be effective in short term, but long term evaluations are necessary before clinical applications can be considered. Currently most in-vitro studies fail to simulate the complexity of intraoral physiological conditions which may either reduce or exacerbate corrosion risk, which must be addressed in future studies. STATEMENT OF SIGNIFICANCE: A thorough analysis on literature regarding oral MIC (microbiologically influenced corrosion) of biomedical metallic materials has been carried out, including characteristics of oral environment, MIC mechanisms, corrosion behaviors in the presence of typical oral microorganisms and potential mitigating methods (materials design and surface design). There is currently a lack of mechanistic understanding of oral MIC which is very important not only to corrosion researchers but also to dentists and clinicians. This paper discusses the significance of biofilms from a biocorrosion perspective and summarizes several aspects of MIC mechanisms which could be caused by oral microorganisms. Oral MIC has been closely associated with not only the materials research but also the dental/clinical research fields in this work.
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Affiliation(s)
- Weichen Xu
- Key Laboratory of Advanced Marine Materials, Key Laboratory of Marine Environmental Corrosion and Bio-fouling, Institute of Oceanology, Chinese Academy of Sciences, 7 Nanhai Road, Qingdao 266071, China; Institute of Marine Corrosion Protection, Guangxi Academy of Sciences, 98 Daling Road, Nanning 530007, China.
| | - Fei Yu
- School of Basic Medicine, Qingdao Medical College, Qingdao University, 308 Ningxia Road, Qingdao 266021, China.
| | - Owen Addison
- Centre for Oral Clinical Translational Science, Faculty of Dentistry Oral and Craniofacial Sciences, King's College London, Strand, London WC2R 2LS, United Kingdom
| | - Binbin Zhang
- Key Laboratory of Advanced Marine Materials, Key Laboratory of Marine Environmental Corrosion and Bio-fouling, Institute of Oceanology, Chinese Academy of Sciences, 7 Nanhai Road, Qingdao 266071, China; Institute of Marine Corrosion Protection, Guangxi Academy of Sciences, 98 Daling Road, Nanning 530007, China
| | - Fang Guan
- Key Laboratory of Advanced Marine Materials, Key Laboratory of Marine Environmental Corrosion and Bio-fouling, Institute of Oceanology, Chinese Academy of Sciences, 7 Nanhai Road, Qingdao 266071, China; Institute of Marine Corrosion Protection, Guangxi Academy of Sciences, 98 Daling Road, Nanning 530007, China
| | - Ruiyong Zhang
- Key Laboratory of Advanced Marine Materials, Key Laboratory of Marine Environmental Corrosion and Bio-fouling, Institute of Oceanology, Chinese Academy of Sciences, 7 Nanhai Road, Qingdao 266071, China; Institute of Marine Corrosion Protection, Guangxi Academy of Sciences, 98 Daling Road, Nanning 530007, China
| | - Baorong Hou
- Key Laboratory of Advanced Marine Materials, Key Laboratory of Marine Environmental Corrosion and Bio-fouling, Institute of Oceanology, Chinese Academy of Sciences, 7 Nanhai Road, Qingdao 266071, China; Institute of Marine Corrosion Protection, Guangxi Academy of Sciences, 98 Daling Road, Nanning 530007, China
| | - Wolfgang Sand
- Key Laboratory of Advanced Marine Materials, Key Laboratory of Marine Environmental Corrosion and Bio-fouling, Institute of Oceanology, Chinese Academy of Sciences, 7 Nanhai Road, Qingdao 266071, China; Biofilm Centre, University of Duisburg-Essen, 45141 Essen, Germany
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Šístková J, Fialová T, Svoboda E, Varmužová K, Uher M, Číhalová K, Přibyl J, Dlouhý A, Pávková Goldbergová M. Insight into antibacterial effect of titanium nanotubular surfaces with focus on Staphylococcus aureus and Pseudomonas aeruginosa. Sci Rep 2024; 14:17303. [PMID: 39068252 PMCID: PMC11283573 DOI: 10.1038/s41598-024-68266-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Accepted: 07/22/2024] [Indexed: 07/30/2024] Open
Abstract
Materials used for orthopedic implants should not only have physical properties close to those of bones, durability and biocompatibility, but should also exhibit a sufficient degree of antibacterial functionality. Due to its excellent properties, titanium is still a widely used material for production of orthopedic implants, but the unmodified material exhibits poor antibacterial activity. In this work, the physicochemical characteristics, such as chemical composition, crystallinity, wettability, roughness, and release of Ti ions of the titanium surface modified with nanotubular layers were analyzed and its antibacterial activity against two biofilm-forming bacterial strains responsible for prosthetic joint infection (Staphylococcus aureus and Pseudomonas aeruginosa) was investigated. Electrochemical anodization (anodic oxidation) was used to prepare two types of nanotubular arrays with nanotubes differing in dimensions (with diameters of 73 and 118 nm and lengths of 572 and 343 nm, respectively). These two surface types showed similar chemistry, crystallinity, and surface energy. The surface with smaller nanotube diameter (TNT-73) but larger values of roughness parameters was more effective against S. aureus. For P. aeruginosa the sample with a larger nanotube diameter (TNT-118) had better antibacterial effect with proven cell lysis. Antibacterial properties of titanium nanotubular surfaces with potential in implantology, which in our previous work demonstrated a positive effect on the behavior of human gingival fibroblasts, were investigated in terms of surface parameters. The interplay between nanotube diameter and roughness appeared critical for the bacterial fate on nanotubular surfaces. The relationship of nanotube diameter, values of roughness parameters, and other surface properties to bacterial behavior is discussed in detail. The study is believed to shed more light on how nanotubular surface parameters and their interplay affect antibacterial activity.
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Affiliation(s)
- Jana Šístková
- Department of Pathological Physiology, Faculty of Medicine, Masaryk University, Kamenice 5, Brno, 625 00, Czech Republic
| | - Tatiana Fialová
- Department of Chemistry and Biochemistry, Mendel University in Brno, Zemědělská 1, Brno, 613 00, Czech Republic
| | - Emil Svoboda
- Department of Mechanical Engineering, Faculty of Military Technology, University of Defence, Kounicova 65, Brno, 662 10, Czech Republic
| | - Kateřina Varmužová
- Department of Pathological Physiology, Faculty of Medicine, Masaryk University, Kamenice 5, Brno, 625 00, Czech Republic
| | - Martin Uher
- Department of Pathological Physiology, Faculty of Medicine, Masaryk University, Kamenice 5, Brno, 625 00, Czech Republic
| | - Kristýna Číhalová
- Department of Chemistry and Biochemistry, Mendel University in Brno, Zemědělská 1, Brno, 613 00, Czech Republic
| | - Jan Přibyl
- Central European Institute for Technology, Masaryk University, Kamenice 5, Brno, 625 00, Czech Republic
| | - Antonín Dlouhý
- Institute of Physics of Materials, Czech Academy of Sciences, v. v. i., Žižkova 513/22, Brno, 616 62, Czech Republic
| | - Monika Pávková Goldbergová
- Department of Pathological Physiology, Faculty of Medicine, Masaryk University, Kamenice 5, Brno, 625 00, Czech Republic.
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Carvalho FS, Tarabal VS, Livio DF, Cruz LF, Monteiro APF, Parreira AG, Guimarães PPG, Scheuerman K, Chagas RCR, da Silva JA, Gonçalves DB, Granjeiro JM, Sinisterra RD, Segura MEC, Granjeiro PA. Production and characterization of the lipopeptide with anti-adhesion for oral biofilm on the surface of titanium for dental implants. Arch Microbiol 2024; 206:354. [PMID: 39017726 DOI: 10.1007/s00203-024-04078-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Accepted: 07/02/2024] [Indexed: 07/18/2024]
Abstract
Titanium implants are subject to bacterial adhesion and peri-implantitis induction, and biosurfactants bring a new alternative to the fight against infections. This work aimed to produce and characterize the biosurfactant from Bacillus subtilis ATCC 19,659, its anti-adhesion and antimicrobial activity, and cell viability. Anti-adhesion studies were carried out against Streptococcus sanguinis, Staphylococcus aureus, Fusobacterium nucleatum, Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, and Proteus mirabilis as the minimum inhibitory concentration and the minimum bactericidal concentration. Cell viability was measured against osteoblast and fibroblast cells. The biosurfactant was classified as lipopeptide, with critical micelle concentration at 40 µg mL- 1, and made the titanium surface less hydrophobic. The anti-adhesion effect was observed for Staphylococcus aureus and Streptococcus sanguinis with 54% growth inhibition and presented a minimum inhibitory concentration of 15.7 µg mL- 1 for Streptococcus sanguinis and Aggregatibacter actinomycetemcomitans. The lipopeptide had no cytotoxic effect and demonstrated high potential application against bacterial biofilms.
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Affiliation(s)
- Fernanda Souza Carvalho
- Biotechnological Processes and Macromolecules Purification Laboratory, Campus Centro Oeste, Federal University of São João del-Rei, Divinópolis, MG, 35501-296, Brazil
| | - Vinícius Souza Tarabal
- Biotechnological Processes and Macromolecules Purification Laboratory, Campus Centro Oeste, Federal University of São João del-Rei, Divinópolis, MG, 35501-296, Brazil
| | - Diego Fernandes Livio
- Biotechnological Processes and Macromolecules Purification Laboratory, Campus Centro Oeste, Federal University of São João del-Rei, Divinópolis, MG, 35501-296, Brazil
| | - Luísa F Cruz
- Biotechnological Processes and Macromolecules Purification Laboratory, Campus Centro Oeste, Federal University of São João del-Rei, Divinópolis, MG, 35501-296, Brazil
| | - Ana P F Monteiro
- Chemistry Department, Federal University of Minas Gerais, Presidente Antônio Carlos Ave., 6627, Belo Horizonte, MG, 31270901, Brazil
| | - Adriano Guimarães Parreira
- Microbiology Laboratory, State University of Minas Gerais, Paraná Ave., 3001, Divinópolis, MG, 35501-179, Brazil
| | - Pedro P G Guimarães
- Department of Physiology and Biophysics, Federal University of Minas Gerais, Presidente Antônio Carlos Ave., 6627, Belo Horizonte, MG, 31270901, Brazil
| | - Karina Scheuerman
- Restorative Dentistry Department, Faculty of Dentistry, Federal University of Minas Gerais, Presidente Antônio Carlos Ave., 6627, Belo Horizonte, MG, 31270901, Brazil
| | - Rafael Cesar Russo Chagas
- Laboratory of Bioactive and Catalytic Compounds, Federal University of São João Del-Rei, Campus Centro Oeste, Sebastião Gonçalves Coelho St., 400, Divinópolis, MG, 35501-296, Brazil
| | - José Antônio da Silva
- Biotechnological Processes and Macromolecules Purification Laboratory, Campus Centro Oeste, Federal University of São João del-Rei, Divinópolis, MG, 35501-296, Brazil
| | - Daniel Bonoto Gonçalves
- Department of Biosystems Engineering, Federal University of São João del-Rei, Campus Dom Bosco, Padre João Pimentel St., 80, São João del Rei, MG, 36301-158, Brazil
| | - José Mauro Granjeiro
- Bioengineering Laboratory, National Institute of Metrology, Quality and Technology, Nossa Senhora das Graças Ave., 50, Duque de Caxias, RJ, 25250020, Brazil
- Dental Clinical Research, Dentistry School, Fluminense Federal University, Mario Santos Braga St., 28, Niterói, RJ, 24020140, Brazil
| | - Ruben Dario Sinisterra
- Chemistry Department, Federal University of Minas Gerais, Presidente Antônio Carlos Ave., 6627, Belo Horizonte, MG, 31270901, Brazil
| | - Maria E C Segura
- Restorative Dentistry Department, Faculty of Dentistry, Federal University of Minas Gerais, Presidente Antônio Carlos Ave., 6627, Belo Horizonte, MG, 31270901, Brazil
| | - Paulo Afonso Granjeiro
- Biotechnological Processes and Macromolecules Purification Laboratory, Campus Centro Oeste, Federal University of São João del-Rei, Divinópolis, MG, 35501-296, Brazil.
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Wang D, Yue Y, Liu H, Zhang T, Haney EF, Hancock REW, Yu J, Shen Y. Antibiofilm peptides enhance the corrosion resistance of titanium in the presence of Streptococcus mutans. Front Bioeng Biotechnol 2024; 11:1339912. [PMID: 38274010 PMCID: PMC10809395 DOI: 10.3389/fbioe.2023.1339912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 12/29/2023] [Indexed: 01/27/2024] Open
Abstract
Titanium alloys have gained popularity in implant dentistry for the restoration of missing teeth and related hard tissues because of their biocompatibility and enhanced strength. However, titanium corrosion and infection caused by microbial biofilms remains a significant clinical challenge leading to implant failure. This study aimed to evaluate the effectiveness of antibiofilm peptides 1018 and DJK-5 on the corrosion resistance of titanium in the presence of Streptococcus mutans. Commercially pure titanium disks were prepared and used to form biofilms. The disks were randomly assigned to different treatment groups (exposed to S. mutans supplied with sucrose) including a positive control with untreated biofilms, peptides 1018 or DJK-5 at concentrations of 5 μg/mL or 10 μg/mL, and a negative control with no S. mutans. Dynamic biofilm growth and pH variation of all disks were measured after one or two treatment periods of 48 h. After incubation, the dead bacterial proportion, surface morphology, and electrochemical behaviors of the disks were determined. The results showed that peptides 1018 and DJK-5 exhibited significantly higher dead bacterial proportions than the positive control group in a concentration dependent manner (p < 0.01), as well as far less defects in microstructure. DJK-5 at 10 μg/mL killed 84.82% of biofilms and inhibited biofilm growth, preventing acidification due to S. mutans and maintaining a neutral pH. Potential polarization and electrochemical impedance spectroscopy data revealed that both peptides significantly reduced the corrosion and passive currents on titanium compared to titanium surfaces with untreated biofilms, and increased the resistance of the passive film (p < 0.05), with 10 μg/mL of DJK-5 achieving the greatest effect. These findings demonstrated that antibiofilm peptides are effective in promoting corrosion resistance of titanium against S. mutans, suggesting a promising strategy to enhance the stability of dental implants by endowing them with antibiofilm and anticorrosion properties.
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Affiliation(s)
- Dan Wang
- Department of Stomatology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Division of Endodontics, Department of Oral Biological and Medical Sciences, Faculty of Dentistry, University of British Columbia, Vancouver, BC, Canada
| | - Yingying Yue
- Liaoning Institute of Science and Technology, Benxi, China
| | - He Liu
- Division of Endodontics, Department of Oral Biological and Medical Sciences, Faculty of Dentistry, University of British Columbia, Vancouver, BC, Canada
| | - Tian Zhang
- School of Medicine, Vanderbilt University, Nashville, TN, United States
| | - Evan F. Haney
- Centre for Microbial Diseases and Immunity Research, Department of Microbiology and Immunology, University of British Columbia, Vancouver, BC, Canada
| | - Robert E. W. Hancock
- Centre for Microbial Diseases and Immunity Research, Department of Microbiology and Immunology, University of British Columbia, Vancouver, BC, Canada
| | - Jian Yu
- Division of Endodontics, Department of Oral Biological and Medical Sciences, Faculty of Dentistry, University of British Columbia, Vancouver, BC, Canada
- State Key Laboratory of Oral and Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School and Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Ya Shen
- Division of Endodontics, Department of Oral Biological and Medical Sciences, Faculty of Dentistry, University of British Columbia, Vancouver, BC, Canada
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Chen L, Tong Z, Luo H, Qu Y, Gu X, Si M. Titanium particles in peri-implantitis: distribution, pathogenesis and prospects. Int J Oral Sci 2023; 15:49. [PMID: 37996420 PMCID: PMC10667540 DOI: 10.1038/s41368-023-00256-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 10/25/2023] [Accepted: 10/30/2023] [Indexed: 11/25/2023] Open
Abstract
Peri-implantitis is one of the most important biological complications in the field of oral implantology. Identifying the causative factors of peri-implant inflammation and osteolysis is crucial for the disease's prevention and treatment. The underlying risk factors and detailed pathogenesis of peri-implantitis remain to be elucidated. Titanium-based implants as the most widely used implant inevitably release titanium particles into the surrounding tissue. Notably, the concentration of titanium particles increases significantly at peri-implantitis sites, suggesting titanium particles as a potential risk factor for the condition. Previous studies have indicated that titanium particles can induce peripheral osteolysis and foster the development of aseptic osteoarthritis in orthopedic joint replacement. However, it remains unconfirmed whether this phenomenon also triggers inflammation and bone resorption in peri-implant tissues. This review summarizes the distribution of titanium particles around the implant, the potential roles in peri-implantitis and the prevalent prevention strategies, which expects to provide new directions for the study of the pathogenesis and treatment of peri-implantitis.
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Affiliation(s)
- Long Chen
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Engineering Research Center of Oral Biomaterials and Devices of Zhejiang Province, Hangzhou, China
- Department of Stomatology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Zian Tong
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Engineering Research Center of Oral Biomaterials and Devices of Zhejiang Province, Hangzhou, China
| | - Hongke Luo
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Engineering Research Center of Oral Biomaterials and Devices of Zhejiang Province, Hangzhou, China
| | - Yuan Qu
- Zhejiang University-University of Edinburgh Institute, International Campus, Zhejiang University, Haining, China
| | - Xinhua Gu
- Department of Stomatology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
| | - Misi Si
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Engineering Research Center of Oral Biomaterials and Devices of Zhejiang Province, Hangzhou, China.
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Shigematsu M, Takeda K, Matsunaga S, Sendai Y, Matsuura N, Suzuki R, Azuma T, Sasaki H, Okumura K, Sekine H, Yajima Y, Ohno T. Subgingival titanium wire implantation induces weak inflammatory responses but does not promote substantial T cell activation. Dent Mater J 2023; 42:633-640. [PMID: 37423721 DOI: 10.4012/dmj.2022-258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/11/2023]
Abstract
Titanium is a biocompatible material commonly used for dental treatments. However, the detailed mechanism underlying the weak biological activity of titanium has not been elucidated. We investigated both the inflammatory responses and T cell activation induced by solid titanium in the gingiva in mice. Both titanium and nickel wire implantation promoted neutrophil infiltration into the gingiva on day 2. Nickel, but not titanium, wire implantation enhanced proinflammatory cytokine expression and dendritic cell activity in gingival tissue by day 2. Nickel wire implantation enhanced the activity of T cells in draining lymph nodes on day 5. Moreover, T cell and neutrophil infiltration and elevated proinflammatory cytokine expression in the gingival tissue were still observed on day 5. However, no such augmented biological responses were observed after titanium wire implantation. These findings suggest that, unlike nickel, solid titanium does not induce sufficient inflammatory responses leading to T cell activation in gingival tissue.
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Affiliation(s)
- Masaki Shigematsu
- Department of Oral and Maxillofacial Implantology, Tokyo Dental College
- Tokyo Dental College Research Branding Project, Tokyo Dental College
- Oral Health Science Center, Tokyo Dental College
| | - Kazuyoshi Takeda
- Department of Biofunctional Microbiota, Graduate School of Medicine, Juntendo University
- Laboratory of Cell Biology, Biomedical Research Core Facilities, Graduate School of Medicine, Juntendo University
| | - Satoru Matsunaga
- Tokyo Dental College Research Branding Project, Tokyo Dental College
- Department of Anatomy, Tokyo Dental College
| | - Yuka Sendai
- Tokyo Dental College Research Branding Project, Tokyo Dental College
- Oral Health Science Center, Tokyo Dental College
- Department of Dental Anesthesiology, Tokyo Dental College
| | - Nobutaka Matsuura
- Tokyo Dental College Research Branding Project, Tokyo Dental College
- Oral Health Science Center, Tokyo Dental College
- Department of Dental Anesthesiology, Tokyo Dental College
| | - Reiya Suzuki
- Department of Oral and Maxillofacial Implantology, Tokyo Dental College
- Tokyo Dental College Research Branding Project, Tokyo Dental College
- Oral Health Science Center, Tokyo Dental College
| | - Toshifumi Azuma
- Tokyo Dental College Research Branding Project, Tokyo Dental College
- Oral Health Science Center, Tokyo Dental College
- Department of Biochemistry, Tokyo Dental College
| | - Hodaka Sasaki
- Department of Oral and Maxillofacial Implantology, Tokyo Dental College
- Tokyo Dental College Research Branding Project, Tokyo Dental College
| | - Ko Okumura
- Department of Biofunctional Microbiota, Graduate School of Medicine, Juntendo University
- Atopy Research Center, Graduate School of Medicine, Juntendo University
| | - Hideshi Sekine
- Tokyo Dental College Research Branding Project, Tokyo Dental College
- Department of Fixed Prosthodontics, Tokyo Dental College
| | - Yasutomo Yajima
- Department of Oral and Maxillofacial Implantology, Tokyo Dental College
| | - Tatsukuni Ohno
- Tokyo Dental College Research Branding Project, Tokyo Dental College
- Oral Health Science Center, Tokyo Dental College
- Department of Biofunctional Microbiota, Graduate School of Medicine, Juntendo University
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