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Delucchi F, Ingegnieros L, Pesce P, Baldi D, Canullo L, Bagnasco F, Zunino P, Menini M. Efficacy and safety of erythritol air-polishing in implant dentistry: A systematic review. Int J Dent Hyg 2024. [PMID: 38825804 DOI: 10.1111/idh.12836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Revised: 05/09/2024] [Accepted: 05/11/2024] [Indexed: 06/04/2024]
Abstract
OBJECTIVES Professional oral hygiene is essential to prevent peri-implant disease. Appropriate instruments should be employed for implant-supported restorations: they should effectively remove deposits without damaging dental implant surface. The aim of the present systematic review is to investigate the efficacy and safety of erythritol air-polishing in implant-supported rehabilitations, compared to alternative hygienic techniques. MATERIALS AND METHODS The guidelines reported in the indications of the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) were employed for this systematic review. The focused question was: 'what is the effect of erythritol air-polishing on dental implant surfaces regarding its cleansing efficacy and/or safety?' The final online search was conducted on 13 August 2023; MEDLINE-PubMed, Scopus and Cochrane Library were employed. Comparative in vitro or in vivo original studies were included. RESULTS The initial database search yielded 128 entries; the final selection comprised 15 articles. The risk of bias was evaluated using the Newcastle Ottawa scale (NOS), the Cochrane Handbook for Systematic Reviews of Interventions, GRADE method. Ultrasonic scaling with PEEK tips, glycine air-polishing and cold atmospheric plasma were the devices most frequently compared to erythritol powder in the included studies. Erythritol air-polishing appeared to be significantly more effective in reducing biofilm compared to other treatments, without causing any significant damage to the implant surface and peri-implant tissues, promoting a good biological response. CONCLUSION Erythritol air-polishing showed promising results for professional oral hygiene in implant-supported restorations. According to this systematic review, it is effective and safe for removing biofilm from titanium dental implants.
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Affiliation(s)
- F Delucchi
- Division of Prosthetic Dentistry, Department of Surgical Sciences (DISC), University of Genoa, Genoa, Italy
| | - L Ingegnieros
- Division of Prosthetic Dentistry, Department of Surgical Sciences (DISC), University of Genoa, Genoa, Italy
| | - P Pesce
- Division of Prosthetic Dentistry, Department of Surgical Sciences (DISC), University of Genoa, Genoa, Italy
| | - D Baldi
- Division of Prosthetic Dentistry, Department of Surgical Sciences (DISC), University of Genoa, Genoa, Italy
| | - L Canullo
- Division of Prosthetic Dentistry, Department of Surgical Sciences (DISC), University of Genoa, Genoa, Italy
| | - F Bagnasco
- Division of Prosthetic Dentistry, Department of Surgical Sciences (DISC), University of Genoa, Genoa, Italy
| | - P Zunino
- Division of Prosthetic Dentistry, Department of Surgical Sciences (DISC), University of Genoa, Genoa, Italy
| | - M Menini
- Division of Prosthetic Dentistry, Department of Surgical Sciences (DISC), University of Genoa, Genoa, Italy
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Haude S, Matthes R, Pitchika V, Holtfreter B, Schlüter R, Gerling T, Kocher T, Jablonowski L. In-vitro biofilm removal from TiUnite® implant surface with an air polishing and two different plasma devices. BMC Oral Health 2024; 24:558. [PMID: 38741081 DOI: 10.1186/s12903-024-04230-9] [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: 03/16/2023] [Accepted: 04/04/2024] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND We investigated the efficacy of two different cold atmospheric pressure jet plasma devices (CAP09 and CAPmed) and an air polishing device with glycine powder (AP) either applied as monotherapies or combined therapies (AP + CAP09; AP + CAPmed), in microbial biofilm removal from discs with anodised titanium surface. METHODS Discs covered with 7-day-old microbial biofilm were treated either with CAP09, CAPmed, AP, AP + CAP09 or AP + CAPmed and compared with negative and positive controls. Biofilm removal was assessed with flourescence and electron microscopy immediately after treatment and after 5 days of reincubation of the treated discs. RESULTS Treatment with CAP09 or CAPmed did not lead to an effective biofilm removal, whereas treatment with AP detached the complete biofilm, which however regrew to baseline magnitude after 5 days of reincubation. Both combination therapies (AP + CAP09 and AP + CAPmed) achieved a complete biofilm removal immediately after cleaning. However, biofilm regrew after 5 days on 50% of the discs treated with the combination therapy. CONCLUSION AP treatment alone can remove gross biofilm immediately from anodised titanium surfaces. However, it did not impede regrowth after 5 days, because microorganisms were probably hidden in holes and troughs, from which they could regrow, and which were inaccessible to AP. The combination of AP and plasma treatment probably removed or inactivated microorganisms also from these hard to access spots. These results were independent of the choice of plasma device.
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Affiliation(s)
- Sandra Haude
- Department of Restorative Dentistry, Periodontology, Endodontology, Preventive Dentistry and Paediatric Dentistry, Dental School, University Medicine Greifswald, Walther-Rathenau-Str. 42a, Greifswald, D - 17475, Germany
| | - Rutger Matthes
- Department of Restorative Dentistry, Periodontology, Endodontology, Preventive Dentistry and Paediatric Dentistry, Dental School, University Medicine Greifswald, Walther-Rathenau-Str. 42a, Greifswald, D - 17475, Germany
| | - Vinay Pitchika
- Department of Restorative Dentistry, Periodontology, Endodontology, Preventive Dentistry and Paediatric Dentistry, Dental School, University Medicine Greifswald, Walther-Rathenau-Str. 42a, Greifswald, D - 17475, Germany
| | - Birte Holtfreter
- Department of Restorative Dentistry, Periodontology, Endodontology, Preventive Dentistry and Paediatric Dentistry, Dental School, University Medicine Greifswald, Walther-Rathenau-Str. 42a, Greifswald, D - 17475, Germany
| | - Rabea Schlüter
- Imaging Center of the Department of Biology, University of Greifswald, Greifswald, Germany
| | - Torsten Gerling
- ZIK Plasmatis, Leibniz-Institute for Plasma Science and Technology e.V. (INP), a member of the Leibniz Research Alliance Leibniz Health Technology, Greifswald, Germany
| | - Thomas Kocher
- Department of Restorative Dentistry, Periodontology, Endodontology, Preventive Dentistry and Paediatric Dentistry, Dental School, University Medicine Greifswald, Walther-Rathenau-Str. 42a, Greifswald, D - 17475, Germany
| | - Lukasz Jablonowski
- Department of Restorative Dentistry, Periodontology, Endodontology, Preventive Dentistry and Paediatric Dentistry, Dental School, University Medicine Greifswald, Walther-Rathenau-Str. 42a, Greifswald, D - 17475, Germany.
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Canullo L, Donato A, Savadori P, Radovanovic S, Iacono R, Rakic M. Effect of argon plasma abutment activation on soft tissue healing: RCT with histological assessment. Clin Implant Dent Relat Res 2024; 26:226-236. [PMID: 37853303 DOI: 10.1111/cid.13286] [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: 06/11/2023] [Revised: 09/27/2023] [Accepted: 09/30/2023] [Indexed: 10/20/2023]
Abstract
OBJECTIVE To assess the peri-implant soft tissue profiles between argon plasma treatment (PT) and non-treated (NPT) healing abutments by comparing clinical and histological parameters 2 months following abutment placement. MATERIALS AND METHODS Thirty participants were randomly assigned to argon-plasma treatment abutments group (PT) or non-treated abutments (NPT) group. Two months after healing abutment placement, soft peri-implant tissues and abutment were harvested, and histological and clinical parameters including plaque index, bleeding on probing, and keratinized mucosa diameter (KM) were assessed. Specialized stainings (hematoxylin-eosin and picrocirious red) coupled with immunohistochemistry (vimentin, collagen, and CK10) were performed to assess soft tissue inflammation and healing, and the collagen content keratinization. In addition to standard statistical methods, machine learning algorithms were applied for advanced soft tissue profiling between the test and control groups. RESULTS PT group showed lower plaque accumulation and inflammation grade (6.71% vs. 13.25%, respectively; p-value 0.02), and more advanced connective tissue healing and integration compared to NPT (31.77% vs. 23.3%, respectively; p = 0.009). In the control group, more expressed keratinization was found compared to the PT group, showing significantly higher CK10 (>47.5%). No differences in KM were found between the groups. SIGNIFICANCE PT seems to be a promising protocol for guided peri-implant soft tissue morphogenesis reducing plaque accumulation and inflammation, and stimulating collagen and soft tissue but without effects on epithelial tissues and keratinization.
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Affiliation(s)
- Luigi Canullo
- Department of Surgical Sciences (DISC), University of Genoa, Genova, Italy
- Department of Periodontology, University of Bern, Bern, Switzerland
| | | | - Paolo Savadori
- Department of Biomedical, Surgical and Dental Sciences, Università Degli Studi di Milano, Milan, Italy
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Maxillo-Facial Surgery and Dental Unit, Milan, Italy
| | - Sandro Radovanovic
- Faculty of Organizational Sciences, University of Belgrade, Belgrade, Serbia
| | - Roberta Iacono
- Department of Oral and Maxillo-facial Sciences, Sapienza University of Rome, Rome, Italy
| | - Mia Rakic
- Facultad de Odontologia, Etiology and Therapy of Periodontal Diseases (ETEP) Research Group, Universidad Complutense de Madrid, Madrid, Spain
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Maquera-Huacho PM, de Carvalho GG, Jafelicci M, Marcantonio E, Spolidorio DMP. Physical-chemical influences and cell behavior of natural compounds on titanium dental surfaces. Braz Dent J 2023; 34:53-62. [PMID: 38133473 PMCID: PMC10759949 DOI: 10.1590/0103-6440202305582] [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: 05/11/2023] [Accepted: 10/30/2023] [Indexed: 12/23/2023] Open
Abstract
The present study evaluated the influence of carvacrol, terpinene-4-ol, and chlorhexidine on the physical-chemical properties of titanium surfaces, cell viability, proliferation, adhesion, and spreading of fibroblasts and osteoblasts in vitro. Titanium surfaces (Ti) were treated with Carvacrol (Cvc), Terpinen-4-ol (T4ol), Chlorhexidine (CHX), DMSO, and ultrapure water (Control group). Physical-chemical modifications were evaluated by surface wettability, the surface free energy (SFE) calculated from the contact angle values using the Owens-Wendt-Rabel-Kaeble (OWRK) equation, scanning electron microscopy (SEM) and energy dispersive spectrometry probe (EDS) system. Cells were seeded onto Ti-treated surfaces and incubated for 24 h and 72 h, then evaluated by Alamar blue assay and fluorescence microscopy. Surfaces treated with Cvc and T4ol showed the presence of Na, O, and Cl. All surfaces showed hydrophilic characteristics and SFE values between 5.5 mN/m and 3.4 mN/m. On the other hand, EDS peaks demonstrated the presence of O and Cl after CHX treatment. A reduction of cell viability and adhesion was noted on titanium surfaces treated with CHX after 24 and 72h. In conclusion, the results indicate that the decontamination with Cvc and T4ol on Ti surfaces does not alter the surface proprieties and allows an adequate interaction with cells involved in the re-osseointegration process such as fibroblasts and osteoblasts.
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Affiliation(s)
- Patricia Milagros Maquera-Huacho
- Department of Physiology and Pathology, School of Dentistry, São Paulo State University(Unesp), Araraquara, SP, Brazil
- Department of Diagnosis and Surgery, School of Dentistry, São Paulo State University(Unesp), Araraquara, São Paulo, Brazil
| | - Gabriel Garcia de Carvalho
- Department of Physiology and Pathology, School of Dentistry, São Paulo State University(Unesp), Araraquara, SP, Brazil
- Department of Diagnosis and Surgery, School of Dentistry, São Paulo State University(Unesp), Araraquara, São Paulo, Brazil
| | - Miguel Jafelicci
- Institute of Chemistry, Laboratory of Magnetic Materials and Colloids, São Paulo State University(Unesp), Araraquara, SP, Brazil
| | - Elcio Marcantonio
- Department of Diagnosis and Surgery, School of Dentistry, São Paulo State University(Unesp), Araraquara, São Paulo, Brazil
| | - Denise Madalena Palomari Spolidorio
- Department of Physiology and Pathology, School of Dentistry, São Paulo State University(Unesp), Araraquara, SP, Brazil
- Department of Diagnosis and Surgery, School of Dentistry, São Paulo State University(Unesp), Araraquara, São Paulo, Brazil
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Rovetta-Nogueira SDM, Borges AC, de Oliveira Filho M, Nishime TMC, Hein LRDO, Kostov KG, Koga-Ito CY. Helium Cold Atmospheric Plasma Causes Morphological and Biochemical Alterations in Candida albicans Cells. Molecules 2023; 28:7919. [PMID: 38067648 PMCID: PMC10707892 DOI: 10.3390/molecules28237919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 11/15/2023] [Accepted: 11/27/2023] [Indexed: 12/18/2023] Open
Abstract
(1) Background: Previous studies reported the promising inhibitory effect of cold atmospheric plasma (CAP) on Candida albicans. However, the exact mechanisms of CAP's action on the fungal cell are still poorly understood. This study aims to elucidate the CAP effect on C. albicans cell wall, by evaluating the alterations on its structure and biochemical composition; (2) Methods: C. albicans cells treated with Helium-CAP were analyzed by atomic force microscopy (AFM) and Fourier transform infrared spectroscopy (FTIR) in order to detect morphological, topographic and biochemical changes in the fungal cell wall. Cells treated with caspofungin were also analyzed for comparative purposes; (3) Results: Expressive morphological and topographic changes, such as increased roughness and shape modification, were observed in the cells after CAP exposure. The alterations detected were similar to those observed after the treatment with caspofungin. The main biochemical changes occurred in polysaccharides content, and an overall decrease in glucans and an increase in chitin synthesis were detected; (4) Conclusions: Helium-CAP caused morphological and topographic alterations in C. albicans cells and affected the cell wall polysaccharide content.
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Affiliation(s)
- Sabrina de Moura Rovetta-Nogueira
- Oral Biopathology Graduate Program, Department of Environment Engineering, São José dos Campos Institute of Science & Technology, São Paulo State University (UNESP), São José dos Campos 12247-016, SP, Brazil; (S.d.M.R.-N.); (A.C.B.)
| | - Aline Chiodi Borges
- Oral Biopathology Graduate Program, Department of Environment Engineering, São José dos Campos Institute of Science & Technology, São Paulo State University (UNESP), São José dos Campos 12247-016, SP, Brazil; (S.d.M.R.-N.); (A.C.B.)
| | - Maurício de Oliveira Filho
- Department of Materials and Technology, Guaratinguetá Faculty of Engineering and Sciences, São Paulo State University (UNESP), Guaratinguetá 12516-410, SP, Brazil; (M.d.O.F.); (L.R.d.O.H.)
| | | | - Luis Rogerio de Oliveira Hein
- Department of Materials and Technology, Guaratinguetá Faculty of Engineering and Sciences, São Paulo State University (UNESP), Guaratinguetá 12516-410, SP, Brazil; (M.d.O.F.); (L.R.d.O.H.)
| | - Konstantin Georgiev Kostov
- Department of Physics, Guaratinguetá Faculty of Engineering, São Paulo State University (UNESP), Guaratinguetá 12516-410, SP, Brazil;
| | - Cristiane Yumi Koga-Ito
- Oral Biopathology Graduate Program, Department of Environment Engineering, São José dos Campos Institute of Science & Technology, São Paulo State University (UNESP), São José dos Campos 12247-016, SP, Brazil; (S.d.M.R.-N.); (A.C.B.)
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Bi J, Khoshkam V, Hunter M, Cho C, Kar K. Effect of Air Polishing on the Treatment of Peri-Implant Diseases: A Systematic Review and Meta-Analysis. J ORAL IMPLANTOL 2023; 49:616-628. [PMID: 38258587 DOI: 10.1563/aaid-joi-d-23-00114] [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: 01/24/2024]
Abstract
Peri-implant diseases have become one of the notable biological complications of postrehabilitation with implant-supported restorations. Effective modalities for decontamination of biofilm deposits around implant surfaces are critical for resolution of the inflammation. Air polishing is one of the recommended clinical methods for treating peri-implant diseases. This systematic review assessed clinical evidence on efficacy of using air polishing technology for the management of peri-implant diseases, including peri-implant mucositis and peri-implantitis. Four electronic databases from January 1990 to December 2022 were searched to identify the relative human randomized clinical trials that applied air polishing for nonsurgical and surgical treatment of peri-implant mucositis and peri-implantitis. Twelve articles were selected. For treating peri-implant mucositis, air polishing showed a comparable effect to ultrasonic scaling in the reduction of bleeding on probing (BOP) and probing pocket depth (PPD). The nonsurgical approach of air polishing in treating peri-implantitis varied in the reduction of BOP, PPD, and clinical attachment level (CAL) in evaluated studies. Air polishing in the surgical treatment of peri-implantitis was comparable to mechanical cleaning, implantoplasty, and the use of Ti-brush, in regards to the significant reduction of BOP, PPD, and CAL, as well as the improvement of the bone level between baseline and follow-ups. The standardized mean difference with a 95% confidence interval of the studied parameters was estimated using the random effect model; however, statistical differences were not detected between air polishing and comparative modalities in the treatment of peri-implantitis. Within the limitations of this review, the application of air polishing did not result in more favorable outcomes in the treatment of peri-implant diseases compared to other modalities.
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Affiliation(s)
- Jiarui Bi
- Department of Endodontics and Periodontics; Center for Craniofacial Molecular Biology, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, CA, USA
- Center for Craniofacial Molecular Biology, University of Southern California, Los Angeles, CA, USA
| | - Vahid Khoshkam
- Department of Endodontics and Periodontics, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, CA, USA
- Private practice, El Paso, TX, USA
| | - Mylea Hunter
- Department of Endodontics and Periodontics, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, CA, USA
- Private practice, Fullerton, CA, USA
| | - Christopher Cho
- Department of Endodontics and Periodontics, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, CA, USA
| | - Kian Kar
- Department of Endodontics and Periodontics, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, CA, USA
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Alqutaibi AY, Aljohani A, Alduri A, Masoudi A, Alsaedi AM, Al-Sharani HM, Farghal AE, Alnazzawi AA, Aboalrejal AN, Mohamed AAH, Zafar MS. The Effectiveness of Cold Atmospheric Plasma (CAP) on Bacterial Reduction in Dental Implants: A Systematic Review. Biomolecules 2023; 13:1528. [PMID: 37892210 PMCID: PMC10604822 DOI: 10.3390/biom13101528] [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: 09/09/2023] [Revised: 09/27/2023] [Accepted: 10/06/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND The emergence of dental implants has revolutionized the management of tooth loss. However, the placement of clinical implants exposes them to complex oral environment and numerous microscopic entities, such as bacteria. Cold atmospheric plasma (CAP) is often used to treat the surfaces of dental implants, which alters morphological features and effectively reduces bacterial load. PURPOSE This systematic review aims to assess the existing literature on the bactericidal properties of CAP when used on various kinds of dental implant surfaces. REVIEW METHOD An in-depth examination of MEDLINE/PubMed and EMBASE was performed to identify relevant studies, with the most recent search conducted in May 2023. Studies were selected based on their exploration of CAP's effects on dental implants compared to control groups, focusing on CAP's bactericidal efficacy. However, studies that lacked a control group or that failed to measure bactericidal effects were excluded. RESULTS After applying the selection criteria, 15 studies were ultimately included in the systematic review. The collected data suggest that CAP can effectively reduce bacterial loads on dental implant surfaces, including pathogens like Streptococcus mitis and Staphylococcus aureus. Furthermore, CAP appears to combat biofilms and plaques that are key contributors to periimplantitis. CONCLUSION CAP emerges as a promising treatment option, exhibiting significant bactericidal activity on dental implant surfaces. CAP can decrease the rates of bacterial biofilm and plaque formation, leading to improved outcomes for dental implant patients.
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Affiliation(s)
- Ahmed Yaseen Alqutaibi
- Department of Substitutive Dental Science, College of Dentistry, Taibah University, Al Madinah 41311, Saudi Arabia; (A.E.F.); (A.A.A.)
- Prosthodontics Department, College of Dentistry, Ibb University, Ibb 70270, Yemen
| | - Abdulbari Aljohani
- College of Dentistry, Taibah University, Al Madinah 41311, Saudi Arabia; (A.A.); (A.A.); (A.M.); (A.M.A.)
| | - Abdullah Alduri
- College of Dentistry, Taibah University, Al Madinah 41311, Saudi Arabia; (A.A.); (A.A.); (A.M.); (A.M.A.)
| | - Abdulmajid Masoudi
- College of Dentistry, Taibah University, Al Madinah 41311, Saudi Arabia; (A.A.); (A.A.); (A.M.); (A.M.A.)
| | - Anas M. Alsaedi
- College of Dentistry, Taibah University, Al Madinah 41311, Saudi Arabia; (A.A.); (A.A.); (A.M.); (A.M.A.)
| | - Hesham Mohammed Al-Sharani
- National Center for Epidemiology and Population Health, ANU College of Health and Medicine, Canberra 2601, Australia;
| | - Ahmed E. Farghal
- Department of Substitutive Dental Science, College of Dentistry, Taibah University, Al Madinah 41311, Saudi Arabia; (A.E.F.); (A.A.A.)
| | - Ahmad Abdulkareem Alnazzawi
- Department of Substitutive Dental Science, College of Dentistry, Taibah University, Al Madinah 41311, Saudi Arabia; (A.E.F.); (A.A.A.)
| | | | - Abdel-Aleam H. Mohamed
- Physics Department, College of Science, Taibah University, Al Madinah 42353, Saudi Arabia;
- Physics Department, Faculty of Science, Beni-Suef University, Beni-Suef 62521, Egypt
| | - Muhammad Sohail Zafar
- Department of Restorative Dentistry, College of Dentistry, Taibah University, Al Madinah 41311, Saudi Arabia
- School of Dentistry, University of Jordan, Amman 11942, Jordan
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Ichioka Y, Virto L, Nuevo P, Gamonal JD, Derks J, Larsson L, Sanz M, Berglundh T. Decontamination of biofilm-contaminated implant surfaces: An in vitro evaluation. Clin Oral Implants Res 2023; 34:1058-1072. [PMID: 37469250 DOI: 10.1111/clr.14136] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 06/17/2023] [Accepted: 07/04/2023] [Indexed: 07/21/2023]
Abstract
OBJECTIVES The aim of the present study was to evaluate the cleaning efficacy of two mechanical and two chemical protocols in the decontamination of implant surfaces. METHODS In total, 123 commercially available implants were mounted in plastic models mimicking peri-implant circumferential intra-bony defects. A multispecies biofilm was grown on implant surfaces. Mechanical (air-polishing (AP), rotating titanium brush (TiB)) and chemical decontamination (alkaline electrolyzed water, N-acetyl-L-cysteine) protocols were used. Cleaning efficacy in terms of residual biofilm area, chemical surface properties, and bacterial counts were analyzed by scanning electron microscopy, energy-dispersive X-ray spectroscopy, and quantitative polymerase chain reaction. RESULTS Surface decontamination protocols including use of an AP device or a rotating TiB were superior in terms of biofilm removal and in reducing atomic% of Carbon on implant surfaces when compared to methods restricted to wiping with gauze. The use of chemical agents as adjuncts to the mechanical cleaning protocols provided no relevant overall benefit over saline. No treatment modality, however, resulted in complete biofilm removal. CONCLUSION Air-polishing and rotating TiB were more effective implant surface decontamination protocols than wiping with gauzes. Use of chemical agents did not improve cleaning efficacy.
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Affiliation(s)
- Yuki Ichioka
- Department of Periodontology, Institute of Odontology, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Leire Virto
- ETEP (Etiology and Therapy of Periodontal and Peri-implant Diseases) Research Group, Faculty of Dentistry, Complutense University, Madrid, Spain
- Department of Anatomy and Embryology, Faculty of Optics, Complutense University, Madrid, Spain
| | - Paula Nuevo
- Research Laboratory, Faculty of Odontology, Complutense University, Madrid, Spain
| | - Juan Daniel Gamonal
- ETEP (Etiology and Therapy of Periodontal and Peri-implant Diseases) Research Group, Faculty of Dentistry, Complutense University, Madrid, Spain
| | - Jan Derks
- Department of Periodontology, Institute of Odontology, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Lena Larsson
- Department of Periodontology, Institute of Odontology, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Mariano Sanz
- ETEP (Etiology and Therapy of Periodontal and Peri-implant Diseases) Research Group, Faculty of Dentistry, Complutense University, Madrid, Spain
| | - Tord Berglundh
- Department of Periodontology, Institute of Odontology, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
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Liu X, Deng S, Xie J, Xu C, Huang Z, Huang B, Chen Z, Chen S. 2-DG Regulates Immune Imbalance on the Titanium Surface after Debridement. Int J Mol Sci 2023; 24:11431. [PMID: 37511190 PMCID: PMC10380309 DOI: 10.3390/ijms241411431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 06/30/2023] [Accepted: 07/10/2023] [Indexed: 07/30/2023] Open
Abstract
Peri-implantitis requires clinical treatments comprised of mechanical and chemical debridement to remove bacterial biofilms. Bone regeneration on the titanium surface after debridement has been a topical issue of peri-implantitis treatments. Increasing evidence has revealed that the immune microenvironment plays a key role in regulating the bone regeneration process. However, it remains unclear what kind of immune microenvironment the titanium surface induces after debridement. In the study, model titanium surface after debridement was prepared via biofilm induction and mechanical and chemical debridement in vitro. Then, the macrophages and naïve CD4+ T lymphocytes were cultured on the titanium surface after debridement for immune microenvironment evaluation, with the original titanium surface as the control. Next, to regulate the immune microenvironment, 2-DG, a glycolysis inhibitor, was further incorporated to regulate macrophages and CD4+ T lymphocytes at the same time. Surface characterization results showed that the bacterial biofilms were completely removed, while the micro-morphology of titanium surface altered after debridement, and the element composition did not change. Compared with the original titanium disc, titanium surface after debridement can lead to the inflammatory differentiation of macrophages and CD4+ T lymphocytes. The percentage of M1 and Th17 inflammatory cells and the expression of their inflammatory factor genes are upregulated. However, 0.3 mmol of 2-DG can significantly reduce the inflammatory differentiation of both macrophages and CD4+ T lymphocytes and inhibit their expression of inflammatory genes. In conclusion, although bacterial biofilms were removed from titanium surface after debridement, the surface topography changes could still induce immune imbalance and form an inflammatory immune microenvironment. However, this inflammatory immune microenvironment can be effectively reversed by 2-DG in vitro, thus creating an immune microenvironment conducive to osteogenesis, which might provide a new perspective for future therapy of peri-implantitis.
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Affiliation(s)
- Xingchen Liu
- Hospital of Stomatology, Sun Yat-sen University, Guangzhou 510055, China
- Guangdong Provincial Key Laboratory of Stomatology, Guangzhou 510055, China
- Guanghua School of Stomatology, Sun Yat-sen University, Guangzhou 510055, China
- Guangdong Research Center for Dental and Cranial Rehabilitation and Material Engineering, Guangzhou 510055, China
| | - Shudan Deng
- Hospital of Stomatology, Sun Yat-sen University, Guangzhou 510055, China
- Guangdong Provincial Key Laboratory of Stomatology, Guangzhou 510055, China
- Guanghua School of Stomatology, Sun Yat-sen University, Guangzhou 510055, China
- Guangdong Research Center for Dental and Cranial Rehabilitation and Material Engineering, Guangzhou 510055, China
| | - Jiaxin Xie
- Hospital of Stomatology, Sun Yat-sen University, Guangzhou 510055, China
- Guangdong Provincial Key Laboratory of Stomatology, Guangzhou 510055, China
- Guanghua School of Stomatology, Sun Yat-sen University, Guangzhou 510055, China
- Guangdong Research Center for Dental and Cranial Rehabilitation and Material Engineering, Guangzhou 510055, China
| | - Chunxin Xu
- Hospital of Stomatology, Sun Yat-sen University, Guangzhou 510055, China
- Guangdong Provincial Key Laboratory of Stomatology, Guangzhou 510055, China
- Guanghua School of Stomatology, Sun Yat-sen University, Guangzhou 510055, China
- Guangdong Research Center for Dental and Cranial Rehabilitation and Material Engineering, Guangzhou 510055, China
| | - Zhuwei Huang
- Hospital of Stomatology, Sun Yat-sen University, Guangzhou 510055, China
- Guangdong Provincial Key Laboratory of Stomatology, Guangzhou 510055, China
- Guanghua School of Stomatology, Sun Yat-sen University, Guangzhou 510055, China
- Guangdong Research Center for Dental and Cranial Rehabilitation and Material Engineering, Guangzhou 510055, China
| | - Baoxin Huang
- Hospital of Stomatology, Sun Yat-sen University, Guangzhou 510055, China
- Guangdong Provincial Key Laboratory of Stomatology, Guangzhou 510055, China
- Guanghua School of Stomatology, Sun Yat-sen University, Guangzhou 510055, China
- Guangdong Research Center for Dental and Cranial Rehabilitation and Material Engineering, Guangzhou 510055, China
| | - Zhuofan Chen
- Hospital of Stomatology, Sun Yat-sen University, Guangzhou 510055, China
- Guangdong Provincial Key Laboratory of Stomatology, Guangzhou 510055, China
- Guanghua School of Stomatology, Sun Yat-sen University, Guangzhou 510055, China
- Guangdong Research Center for Dental and Cranial Rehabilitation and Material Engineering, Guangzhou 510055, China
| | - Shoucheng Chen
- Hospital of Stomatology, Sun Yat-sen University, Guangzhou 510055, China
- Guangdong Provincial Key Laboratory of Stomatology, Guangzhou 510055, China
- Guanghua School of Stomatology, Sun Yat-sen University, Guangzhou 510055, China
- Guangdong Research Center for Dental and Cranial Rehabilitation and Material Engineering, Guangzhou 510055, China
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10
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Selimović A, Bunæs DF, Lie SA, Lobekk MA, Leknes KN. Non-surgical treatment of peri-implantitis with and without erythritol air-polishing a 12-month randomized controlled trial. BMC Oral Health 2023; 23:240. [PMID: 37095488 PMCID: PMC10125257 DOI: 10.1186/s12903-023-02973-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Accepted: 04/17/2023] [Indexed: 04/26/2023] Open
Abstract
BACKGROUND A variety of interventions have been explored in the non-surgical management of peri-implantitis. In spite of extensive testing of various study protocols, effective treatments largely remain unavailable. The objective of the present 12-month single-centre, examiner-masked, randomized controlled clinical trial was to explore whether a low-abrasive erythritol air-polishing system produces added clinical benefit when used adjunctive to conventional non-surgical management of peri-implantitis and to record any associated patient-centered outcomes. METHODS Forty-three patients with mild to severe peri-implantitis including at least one implant either received ultrasonic/curette subgingival instrumentation and erythritol air-polishing (test) or ultrasonic/curette instrumentation only (control) at baseline and at 3, 6, 9, and 12 months. Probing depth (PD), bleeding on probing (BoP), dental plaque, suppuration (SUP), crestal bone level (CBL), and peri-implant crevicular fluid (PCF) were recorded at baseline, 6 and 12 months. Visual Analogue Scale (VAS) scores were collected immediately following subgingival interventions at all time-points. RESULTS A reduction in PD was observed from baseline to 6 months for the test (p = 0.006) and control (p < 0.001) and from baseline to 12 months for the control (p < 0.001). No intergroup differences were observed for primary outcome variables PD or CBL over time (p > 0.05). At 6 months, a intergroup difference in PCF was observed in favor of the test (p = 0.042). Moreover, a reduction in SUP from baseline to 6 and 12 months was observed in the test (p = 0.019). Overall, patients in the control group experienced less pain/discomfort compared with the test (p < 0.05), females reporting more pain/discomfort than males (p = 0.005). CONCLUSIONS This study confirms that conventional non-surgical management of peri-implantitis produces limited clinical improvement. It is shown that an erythritol air-polishing system may not produce added clinical benefits when used adjunctive to conventional non-surgical management. In other words, neither approach effectively resolved peri-implantitis. Moreover, the erythritol air-polishing system produced added pain/discomfort particularly in female patients. TRIAL REGISTRATION The clinical trial was prospectively registered in ClinicalTrials.gov with registration NCT04152668 (05/11/2019).
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Affiliation(s)
- Armin Selimović
- Department of Clinical Dentistry, Faculty of Medicine, University of Bergen, Aarstadveien 19, N-5009, Bergen, Norway
| | - Dagmar F Bunæs
- Department of Clinical Dentistry, Faculty of Medicine, University of Bergen, Aarstadveien 19, N-5009, Bergen, Norway
| | - Stein Atle Lie
- Department of Clinical Dentistry, Faculty of Medicine, University of Bergen, Aarstadveien 19, N-5009, Bergen, Norway
| | | | - Knut N Leknes
- Department of Clinical Dentistry, Faculty of Medicine, University of Bergen, Aarstadveien 19, N-5009, Bergen, Norway.
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11
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Canullo L, Rakic M, Corvino E, Burton M, Krumbeck JA, Chittoor Prem A, Ravidà A, Ignjatović N, Sculean A, Menini M, Pesce P. Effect of argon plasma pre-treatment of healing abutments on peri-implant microbiome and soft tissue integration: a proof-of-concept randomized study. BMC Oral Health 2023; 23:27. [PMID: 36650477 PMCID: PMC9843976 DOI: 10.1186/s12903-023-02729-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 01/10/2023] [Indexed: 01/18/2023] Open
Abstract
PURPOSE Biofilm-free implant surface is ultimate prerequisite for successful soft and bone tissue integration. Objective of the study was to estimate the effects of argon plasma healing abutment pre-treatment (PT) on peri-implant soft-tissue phenotype (PiSP), inflammation, plaque accumulation and the microbiome (PiM) between non-treated (NPT) and treated (PT) abutments following 3-months healing period. The hypothesis was that cell-conductive and antimicrobial properties of PT would yield optimal conditions for soft tissue integration. MATERIAL AND METHODS Two months following second-phase surgery, microbiological and clinical parameters were assessed around thirty-six healing abutments with two types of microtopography, smooth surface (MACHINED) and ultrathin threaded microsurface (ROUGH). A two level randomization schema was used to achieve equal distribution and abutments were randomly divided into rough and machined groups, and then divided into PT and NPT groups. PiM was assessed using next-generation DNA sequencing. RESULTS PiM bacterial composition was highly diverse already two months post-implantation, consisting of key-stone pathogens, early and late colonizers, while the mycobiome was less diverse. PT was associated with lower plaque accumulation and inflammation without significant impact on PiSP, while in NPT clinical parameters were increased and associated with periopathogens. NPT mostly harbored late colonizers, while PT exerted higher abundance of early colonizers suggesting less advanced plaque formation. Interaction analysis in PT demonstrated S. mitis co-occurrence with pro-healthy Rothia dentocariosa and co-exclusion with Parvimonas micra, Porphyromonas endodontalis and Prevotella oris. PiSP parameters were generally similar between the groups, but significant association between PiM and keratinized mucosa width was observed in both groups, with remarkably more expressed diversity in NPT compared to PT. PT resulted in significantly lower BOP and PI around rough and machined abutments, respectively, without specific effect on PiM and PiSP. CONCLUSIONS PT contributed to significantly the less advanced biofilm accumulation and inflammation without specific effects on PiSP.
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Affiliation(s)
- Luigi Canullo
- grid.5734.50000 0001 0726 5157Department of Periodontology, University of Bern, Bern, Switzerland ,grid.5606.50000 0001 2151 3065Department of Surgical Sciences (DISC), University of Genoa, Genoa, Italy
| | - Mia Rakic
- grid.4795.f0000 0001 2157 7667ETEP (Etiology and Therapy of Periodontal Diseases) Research Group, University Complutense of Madrid, Madrid, Spain
| | - Emilio Corvino
- grid.8404.80000 0004 1757 2304University of Florence, Florence, Italy
| | - Maria Burton
- Zymo Research Corporation, 17062 Murphy Ave, Irvine, CA 92614 USA
| | - Janina A. Krumbeck
- Zymo Research Corporation, 17062 Murphy Ave, Irvine, CA 92614 USA ,Pangea Laboratory, 14762 Bentley Cir., Tustin, CA 92780 USA
| | | | | | - Nenad Ignjatović
- grid.419857.60000 0001 2221 9722Institute of Technical Science of the Serbian Academy of Sciences and Arts, 11000 Belgrade, Serbia
| | - Anton Sculean
- grid.5734.50000 0001 0726 5157Department of Periodontology, University of Bern, Bern, Switzerland
| | - Maria Menini
- grid.5606.50000 0001 2151 3065Department of Surgical Sciences (DISC), University of Genoa, Genoa, Italy
| | - Paolo Pesce
- grid.5606.50000 0001 2151 3065Department of Surgical Sciences (DISC), University of Genoa, Genoa, Italy
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12
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In-Vitro Biofilm Removal Efficacy Using Water Jet in Combination with Cold Plasma Technology on Dental Titanium Implants. Int J Mol Sci 2023; 24:ijms24021606. [PMID: 36675120 PMCID: PMC9867126 DOI: 10.3390/ijms24021606] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 12/22/2022] [Accepted: 12/29/2022] [Indexed: 01/15/2023] Open
Abstract
Peri-implantitis-associated inflammation can lead to bone loss and implant failure. Current decontamination measures are ineffective due to the implants' complex geometry and rough surfaces providing niches for microbial biofilms. A modified water jet system (WaterJet) was combined with cold plasma technology (CAP) to achieve superior antimicrobial efficacy compared to cotton gauze treatment. Seven-day-old multi-species-contaminated titanium discs and implants were investigated as model systems. The efficacy of decontamination on implants was determined by rolling the implants over agar and determining colony-forming units supported by scanning electron microscopy image quantification of implant surface features. The inflammatory consequences of mono and combination treatments were investigated with peripheral blood mononuclear cell surface marker expression and chemokine and cytokine release profiles on titanium discs. In addition, titanium discs were assayed using fluorescence microscopy. Cotton gauze was inferior to WaterJet treatment according to all types of analysis. In combination with the antimicrobial effect of CAP, decontamination was improved accordingly. Mono and CAP-combined treatment on titanium surfaces alone did not unleash inflammation. Simultaneously, chemokine and cytokine release was dramatically reduced in samples that had benefited from additional antimicrobial effects through CAP. The combined treatment with WaterJet and CAP potently removed biofilm and disinfected rough titanium implant surfaces. At the same time, non-favorable rendering of the surface structure or its pro-inflammatory potential through CAP was not observed.
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13
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Citterio F, Zanotto E, Pellegrini G, Annaratore L, Barbui AM, Dellavia C, Baima G, Romano F, Aimetti M. Comparison of Different Chemical and Mechanical Modalities for Implant Surface Decontamination: Activity against Biofilm and Influence on Cellular Regrowth—An In Vitro Study. Front Surg 2022; 9:886559. [PMID: 36248376 PMCID: PMC9562851 DOI: 10.3389/fsurg.2022.886559] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 03/05/2022] [Indexed: 11/14/2022] Open
Abstract
Objectives The aim of this in vitro study was to compare the efficacy of chemical and mechanical methods for decontamination of titanium dental implant surfaces previously infected with polymicrobial biofilms in a model simulating a peri-implant defect. Furthermore, the effect of each decontamination protocol on MG-63 osteoblast-like cells morphology and adhesion to the treated implants was assessed. Background Peri-implantitis is a growing issue in dentistry, and evidence about implant surface decontamination procedures is lacking and inconclusive. Methods A total of 40 previously biofilm-contaminated implants were placed into a custom-made model simulating a peri-implant defect and randomly assigned to five treatment groups: (C) control (no treatment); (AW) air abrasion without any powder; (ESC) air abrasion with powder of erythritol, amorphous silica, and 0.3% chlorhexidine; (HBX) decontamination with a sulfonic/sulfuric acid solution in gel; and (HBX + ESC) a combination of HBX and ESC. Microbiological analysis was performed on five implants per treatment group, and the residual viable bacterial load measured in log 10 CFU/mL was counted for each bacterial strain and for the total number of colonies. The remaining three implants per group and three noncontaminated (NC) implants were used to assess surface biocompatibility using a scanning electron microscope and a backscattered electron microscope after seeding with MG-63 cells. Results A significant decontaminant effect was achieved using HBX or HBX + ESC, while no differences were observed among other groups. The percentage of implant surface covered by adherent MG-63 cells was influenced by the treatment method. Progressive increases in covered surfaces were observed in groups C, AW, ESC, HBX, HBX + ESC, and NC. Conclusions A combination of mechanical and chemical decontamination may provide more predictable results than mechanical cleaning alone.
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Affiliation(s)
- Filippo Citterio
- Department of Surgical Sciences, Section of Periodontology, C.I.R. Dental School, Università di Torino, Turin, Italy
- Correspondence: Filippo Citterio
| | - Elisa Zanotto
- Microbiology and Virology Unit, University Hospital City of Health and Science of Turin, Turin, Italy
| | - Gaia Pellegrini
- Department of Biomedical Surgical and Dental Sciences, Università degli Studi di Milano, Milan, Italy
| | - Laura Annaratore
- Department of Medical Sciences, Pathology Unit, Università degli Studi di Torino, Turin, Italy
- Pathology Unit, Candiolo Cancer Institute, FPO IRCCS, Candiolo, Italy
| | - Anna Maria Barbui
- Microbiology and Virology Unit, University Hospital City of Health and Science of Turin, Turin, Italy
| | - Claudia Dellavia
- Department of Biomedical Surgical and Dental Sciences, Università degli Studi di Milano, Milan, Italy
| | - Giacomo Baima
- Department of Surgical Sciences, Section of Periodontology, C.I.R. Dental School, Università di Torino, Turin, Italy
| | - Federica Romano
- Department of Surgical Sciences, Section of Periodontology, C.I.R. Dental School, Università di Torino, Turin, Italy
| | - Mario Aimetti
- Department of Surgical Sciences, Section of Periodontology, C.I.R. Dental School, Università di Torino, Turin, Italy
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14
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Wang Z, Li B, Cai Q, Li X, Yin Z, Li B, Li Z, Meng W. Advances and Prospects in Antibacterial-Osteogenic Multifunctional Dental Implant Surface. Front Bioeng Biotechnol 2022; 10:921338. [PMID: 35685091 PMCID: PMC9171039 DOI: 10.3389/fbioe.2022.921338] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 05/06/2022] [Indexed: 11/24/2022] Open
Abstract
In recent years, dental implantation has become the preferred protocol for restoring dentition defects. Being the direct contact between implant and bone interface, osseointegration is the basis for implant exerting physiological functions. Nevertheless, biological complications such as insufficient bone volume, poor osseointegration, and postoperative infection can lead to implant failure. Emerging antibacterial-osteogenic multifunctional implant surfaces were designed to make up for these shortcomings both during the stage of forming osseointegration and in the long term of supporting the superstructure. In this mini-review, we summarized the recent antibacterial-osteogenic modifications of the dental implant surface. The effects of these modifications on biological performance like soft tissue integration, bone osteogenesis, and immune response were discussed. In addition, the clinical findings and prospects of emerging antibacterial-osteogenic implant materials were also discussed.
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Affiliation(s)
- Zixuan Wang
- Department of Dental Implantology, Hospital of Stomatology, Jilin University, Changchun, China.,Jilin Provincial Key Laboratory of Oral Biomedical Engineering, Changchun, China
| | - Baosheng Li
- Department of Dental Implantology, Hospital of Stomatology, Jilin University, Changchun, China
| | - Qing Cai
- Department of Dental Implantology, Hospital of Stomatology, Jilin University, Changchun, China
| | - Xiaoyu Li
- Department of Dental Implantology, Hospital of Stomatology, Jilin University, Changchun, China
| | - Zhaoyi Yin
- Department of Dental Implantology, Hospital of Stomatology, Jilin University, Changchun, China
| | - Birong Li
- Department of Dental Implantology, Hospital of Stomatology, Jilin University, Changchun, China
| | - Zhen Li
- Department of Dental Implantology, Hospital of Stomatology, Jilin University, Changchun, China
| | - Weiyan Meng
- Department of Dental Implantology, Hospital of Stomatology, Jilin University, Changchun, China
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15
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Matthes R, Jablonowski L, Pitchika V, Holtfreter B, Eberhard C, Seifert L, Gerling T, Vilardell Scholten L, Schlüter R, Kocher T. Efficiency of biofilm removal by combination of water jet and cold plasma: an in-vitro study. BMC Oral Health 2022; 22:157. [PMID: 35524324 PMCID: PMC9074283 DOI: 10.1186/s12903-022-02195-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 04/25/2022] [Indexed: 11/10/2022] Open
Abstract
Background Peri-implantitis therapy is a major problem in implantology. Because of challenging rough implant surface and implant geometry, microorganisms can hide and survive in implant microstructures and impede debridement. We developed a new water jet (WJ) device and a new cold atmospheric pressure plasma (CAP) device to overcome these problems and investigated aspects of efficacy in vitro and safety with the aim to create the prerequisites for a clinical pilot study with these medical devices. Methods We compared the efficiency of a single treatment with a WJ or curette and cotton swab (CC) without or with adjunctive use of CAP (WJ + CAP, CC + CAP) to remove biofilm in vitro from rough titanium discs. Treatment efficacy was evaluated by measuring turbidity up to 72 h for bacterial re-growth or spreading of osteoblast-like cells (MG-63) after 5 days with scanning electron microscopy. With respect to application safety, the WJ and CAP instruments were examined according to basic regulations for medical devices. Results After 96 h of incubation all WJ and CC treated disks were turbid but 67% of WJ + CAP and 46% CC + CAP treated specimens were still clear. The increase in turbidity after WJ treatment was delayed by about 20 h compared to CC treatment. In combination with CAP the cell coverage significantly increased to 82% (WJ + CAP) or 72% (CC + CAP), compared to single treatment 11% (WJ) or 10% (CC). Conclusion The newly developed water jet device effectively removes biofilm from rough titanium surfaces in vitro and, in combination with the new CAP device, biologically acceptable surfaces allow osteoblasts to grow. WJ in combination with CAP leads to cleaner surfaces than the usage of curette and cotton swabs with or without subsequent plasma treatment. Our next step will be a clinical pilot study with these new devices to assess the clinical healing process. Supplementary Information The online version contains supplementary material available at 10.1186/s12903-022-02195-1.
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Affiliation(s)
- Rutger Matthes
- Department of Restorative Dentistry, Periodontology, Endodontology, Preventive Dentistry and Pedodontics, Dental School, University Medicine Greifswald, Fleischmannstr. 42, 17475, Greifswald, Germany
| | - Lukasz Jablonowski
- Department of Restorative Dentistry, Periodontology, Endodontology, Preventive Dentistry and Pedodontics, Dental School, University Medicine Greifswald, Fleischmannstr. 42, 17475, Greifswald, Germany
| | - Vinay Pitchika
- Department of Restorative Dentistry, Periodontology, Endodontology, Preventive Dentistry and Pedodontics, Dental School, University Medicine Greifswald, Fleischmannstr. 42, 17475, Greifswald, Germany
| | - Birte Holtfreter
- Department of Restorative Dentistry, Periodontology, Endodontology, Preventive Dentistry and Pedodontics, Dental School, University Medicine Greifswald, Fleischmannstr. 42, 17475, Greifswald, Germany
| | | | - Leo Seifert
- Sirona Dental Systems GmbH, Bensheim, Germany
| | - Torsten Gerling
- ZIK Plasmatis, Leibniz-Institute for Plasma Science and Technology e.V. (INP), Greifswald, Germany
| | - Laura Vilardell Scholten
- ZIK Plasmatis, Leibniz-Institute for Plasma Science and Technology e.V. (INP), Greifswald, Germany
| | - Rabea Schlüter
- Imaging Center of the Department of Biology, University of Greifswald, Greifswald, Germany
| | - Thomas Kocher
- Department of Restorative Dentistry, Periodontology, Endodontology, Preventive Dentistry and Pedodontics, Dental School, University Medicine Greifswald, Fleischmannstr. 42, 17475, Greifswald, Germany.
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16
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Zipprich H, Weigl P, Di Gianfilippo R, Steigmann L, Henrich D, Wang HL, Schlee M, Ratka C. Comparison of decontamination efficacy of two electrolyte cleaning methods to diode laser, plasma, and air-abrasive devices. Clin Oral Investig 2022; 26:4549-4558. [PMID: 35322316 DOI: 10.1007/s00784-022-04421-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 02/17/2022] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To compare the in vitro decontamination efficacy of two electrolytic cleaning methods to diode laser, plasma, and air-abrasive devices. MATERIAL AND METHODS Sixty sandblasted large-grit acid-etched (SLA) implants were incubated with 2 ml of human saliva and Tryptic Soy Broth solution under continuous shaking for 14 days. Implants were then randomly assigned to one untreated control group (n = 10) and 5 different decontamination modalities: air-abrasive powder (n = 10), diode laser (n = 10), plasma cleaning (n = 10), and two electrolytic test protocols using either potassium iodide (KI) (n = 10) or sodium formate (CHNaO2) (n = 10) solution. Implants were stained for dead and alive bacteria in two standardized measurement areas, observed at fluorescent microscope, and analyzed for color intensity. RESULTS All disinfecting treatment modalities significantly reduced the stained area compared to the untreated control group for both measurement areas (p < 0.001). Among test interventions, electrolytic KI and CHNaO2 treatments were equally effective, and each one significantly reduced the stained area compared to any other treatment modality (p < 0.001). Efficacy of electrolytic protocols was not affected by the angulation of examined surfaces [surface angulation 0° vs. 60° (staining %): electrolytic cleaning-KI 0.03 ± 0.04 vs. 0.09 ± 0.10; electrolytic cleaning-CHNaO2 0.01 ± 0.01 vs. 0.06 ± 0.08; (p > 0.05)], while air abrasion [surface angulation 0° vs. 60° (staining %): 2.66 ± 0.83 vs. 42.12 ± 3.46 (p < 0.001)] and plasma cleaning [surface angulation 0° vs. 60° (staining %): 33.25 ± 3.01 vs. 39.16 ± 3.15 (p < 0.001)] were. CONCLUSIONS Within the limitations of the present in vitro study, electrolytic decontamination with KI and CHNaO2 was significantly more effective in reducing bacterial stained surface of rough titanium implants than air-abrasive powder, diode laser, and plasma cleaning, regardless of the accessibility of the contaminated implant location. CLINICAL RELEVANCE Complete bacterial elimination (residual bacteria < 1%) was achieved only for the electrolytic cleaning approaches, irrespectively of the favorable or unfavorable access to implant surface.
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Affiliation(s)
| | - Paul Weigl
- Department of Postgraduate Education, Faculty of Oral and Dental Medicine, J. W. Goethe University, 60596, Frankfurt am Main, Germany
| | - Riccardo Di Gianfilippo
- Department of Periodontics and Oral Medicine, The University of Michigan - School of Dentistry, 1011 North university Avenue, Ann Arbor, MI, 48109, USA.
| | - Larissa Steigmann
- Department of Periodontics and Oral Medicine, The University of Michigan - School of Dentistry, 1011 North university Avenue, Ann Arbor, MI, 48109, USA
| | - Dirk Henrich
- Department of Trauma, Hand & Reconstructive Surgery, Goethe University, 60596, Frankfurt am Main, Germany
| | - Hom-Lay Wang
- Department of Periodontics and Oral Medicine, The University of Michigan - School of Dentistry, 1011 North university Avenue, Ann Arbor, MI, 48109, USA
| | - Markus Schlee
- Department of Maxillofacial Surgery, Goethe University, 60596, Frankfurt am Main, Germany
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17
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Efficiency of cold atmospheric plasma, cleaning powders and their combination for biofilm removal on two different titanium implant surfaces. Clin Oral Investig 2022; 26:3179-3187. [PMID: 34988694 PMCID: PMC8898218 DOI: 10.1007/s00784-021-04300-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 11/16/2021] [Indexed: 01/06/2023]
Abstract
Objectives Biofilm removal is the decisive factor for the control of peri-implantitis. Cold atmospheric pressure plasma (CAP) can become an effective aid due to its ability to destroy and to inactivate bacterial biofilm residues. This study evaluated the cleaning efficiency of CAP, and air-polishing with glycine (APG) or erythritol (APE) containing powders alone or in combination with CAP (APG + CAP, APE + CAP) on sandblasted/acid etched, and anodised titanium implant surface. Materials and methods On respective titanium discs, a 7-day ex vivo human biofilm was grown. Afterwards, the samples were treated with CAP, APG, APE, APG + CAP, and APE + CAP. Sterile and untreated biofilm discs were used for verification. Directly after treatment and after 5 days of incubation in medium at 37 °C, samples were prepared for examination by fluorescence microscopy. The relative biofilm fluorescence was measured for quantitative analyses. Results Air-polishing with or without CAP removed biofilms effectively. The combination of air-polishing with CAP showed the best cleaning results compared to single treatments, even on day 5. Immediately after treatment, APE + CAP showed insignificant higher cleansing efficiency than APG + CAP. Conclusions CAP supports mechanical cleansing and disinfection to remove and inactivate microbial biofilm on implant surfaces significantly. Here, the type of the powder was not important. The highest cleansing results were obtained on sandblasted/etched surfaces. Clinical relevance. Microbial residuals impede wound healing and re-osseointegration after peri-implantitis treatment. Air-polishing treatment removes biofilms very effectively, but not completely. In combination with CAP, microbial free surfaces can be achieved. The tested treatment regime offers an advantage during treatment of peri-implantitis.
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18
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Wagner G, Eggers B, Duddeck D, Kramer FJ, Bourauel C, Jepsen S, Deschner J, Nokhbehsaim M. Influence of cold atmospheric plasma on dental implant materials - an in vitro analysis. Clin Oral Investig 2021; 26:2949-2963. [PMID: 34907458 PMCID: PMC8898257 DOI: 10.1007/s00784-021-04277-w] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 11/01/2021] [Indexed: 12/25/2022]
Abstract
Background and objectives Alterations in the microenvironment of implant surfaces could influence the cellular crosstalk and adhesion patterns of dental implant materials. Cold plasma has been described to have an influence on cells, tissues, and biomaterials. Hence, the mechanisms of osseointegration may be altered by non-thermal plasma treatment depending on different chemical compositions and surface coatings of the biomaterial. The aim of the present study is to investigate the influence of cold atmospheric plasma (CAP) treatment on implant surfaces and its biological and physicochemical side effects. Materials and methods Dental implant discs from titanium and zirconia with different surface modifications were treated with CAP at various durations. Cell behavior and adhesion patterns of human gingival fibroblast (HGF-1) and osteoblast-like cells (MG-63) were examined using scanning electron microscopy and fluorescence microscopy. Surface chemical characterization was analyzed using energy-dispersive X-ray spectroscopy (EDS). Quantitative analysis of cell adhesion, proliferation, and extracellular matrix formation was conducted including real-time PCR. Results CAP did not affect the elemental composition of different dental implant materials. Additionally, markers for cell proliferation, extracellular matrix formation, and cell adhesion were differently regulated depending on the application time of CAP treatment in MG-63 cells and gingival fibroblasts. Conclusions CAP application is beneficial for dental implant materials to allow for faster proliferation and adhesion of cells from the surrounding tissue on both titanium and zirconia implant surfaces with different surface properties. Clinical relevance The healing capacity provided through CAP treatment could enhance osseointegration of dental implants and has the potential to serve as an effective treatment option in periimplantitis therapy.
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Affiliation(s)
- Gunar Wagner
- Department of Periodontology, Operative and Preventive Dentistry, Center of Dento-Maxilo-Facial Medicine, University of Bonn, Welschnonnenstr. 17, 53111, Bonn, Germany.
| | - Benedikt Eggers
- Department of Oral Surgery, Center of Dento-Maxillo-Facial Medicine, University of Bonn, 53111, Bonn, Germany
| | - Dirk Duddeck
- Department of Prosthodontics, Geriatric Dentistry and Craniomandibular Disorders, University Charité Berlin, 14197, Berlin, Germany.,Research Department, CleanImplant Foundation, 10117, Berlin, Germany
| | - Franz-Josef Kramer
- Department of Oral Surgery, Center of Dento-Maxillo-Facial Medicine, University of Bonn, 53111, Bonn, Germany.,Department of Cranio-Maxillofacial Surgery, Center of Dento-Maxillo-Facial Medicine, University of Bonn, 53111, Bonn, Germany
| | - Christoph Bourauel
- Department of Oral Technology, School of Dentistry, University of Bonn, 53111, Bonn, Germany
| | - Søren Jepsen
- Department of Periodontology, Operative and Preventive Dentistry, Center of Dento-Maxilo-Facial Medicine, University of Bonn, Welschnonnenstr. 17, 53111, Bonn, Germany
| | - James Deschner
- Department of Periodontology and Operative Dentistry, University of Mainz, 55131, Mainz, Germany
| | - Marjan Nokhbehsaim
- Section of Experimental Dento-Maxillo-Facial Medicine, Center of Dento-Maxillo-Facial Medicine, University of Bonn, 53111, Bonn, Germany
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19
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Hui WL, Perrotti V, Piattelli A, Ostrikov KK, Fang Z, Quaranta A. Cold atmospheric plasma coupled with air abrasion in liquid medium for the treatment of peri-implantitis model grown with a complex human biofilm: an in vitro study. Clin Oral Investig 2021; 25:6633-6642. [PMID: 33893556 PMCID: PMC8602208 DOI: 10.1007/s00784-021-03949-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 04/13/2021] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Treatment of implants with peri-implantitis is often unsuccessful due to residual microbial biofilm hindering re-osseointegration. The aim of this study was to treat biofilm-grown titanium (Ti) implants with different modalities involving air abrasion (AA) and cold atmospheric plasma (CAP) to compare the effectiveness in surface decontamination and the alteration/preservation of surface topography. MATERIALS AND METHODS Saliva collected from a peri-implantitis patient was used to in vitro develop human biofilm over 35 implants with moderately rough surface. The implants were then mounted onto standardized acrylic blocks simulating peri-implantitis defects and treated with AA (erythritol powder), CAP in a liquid medium, or a combination (COM) of both modalities. The remaining biofilm was measured by crystal violet (CV). Surface features and roughness before and after treatment were assessed by scanning electron microscope (SEM). The data were statistically analyzed using Kruskal-Wallis followed by Tukey's multiple comparison test. RESULTS In the present peri-implantitis model, the human complex biofilm growth was successful as indicated by the statistical significance between the negative and positive controls. All the treatment groups resulted in a remarkable implant surface decontamination, with values very close to the negative control for AA and COM. Indeed, statistically significant differences in the comparison between the positive control vs. all the treatment groups were found. SEM analysis showed no post-treatment alterations on the implant surface in all the groups. CONCLUSIONS Decontamination with AA delivering erythritol with or without CAP in liquid medium demonstrated compelling efficacy in the removal of biofilm from implants. All the tested treatments did not cause qualitative alterations to the Ti surface features. No specific effects of the CAP were observed, although further studies are necessary to assess its potential as monotherapy with different settings or in combination with other decontamination procedures. CLINICAL RELEVANCE CAP is a promising option in the treatment of peri-implantitis because it has potential to improve the elimination of bacterial plaque from implant surfaces, in inaccessible pockets or during open-flap debridement, and should stimulate the process of the re-osseointegration of affected dental implants by not altering surface features and roughness.
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Affiliation(s)
- Wang Lai Hui
- Smile Specialists Suite, Newcastle, NSW, Australia
- Formerly, School of Dentistry and Oral Health, Griffith University, Gold Coast, Queensland, Australia
| | - Vittoria Perrotti
- Department of Medical, Oral and Biotechnological Sciences (DSMOB), University of Chieti-Pescara, Via dei vestini, 31, 66100, Chieti, Italy.
| | - Adriano Piattelli
- Department of Medical, Oral and Biotechnological Sciences (DSMOB), University of Chieti-Pescara, Via dei vestini, 31, 66100, Chieti, Italy
| | - Kostya Ken Ostrikov
- School of Chemistry and Physics, Queensland University of Technology, Brisbane, Queensland, 4000, Australia
| | - Zhi Fang
- College of Electrical Engineering and Control Science, Nanjing Tech University, Nanjing, 210009, China
| | - Alessandro Quaranta
- Smile Specialists Suite, Newcastle, NSW, Australia
- Formerly, School of Dentistry and Oral Health, Griffith University, Gold Coast, Queensland, Australia
- Sydney Dental Hospital, Sydney, NSW, Australia
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20
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Hentenaar DFM, De Waal YCM, Stewart RE, Van Winkelhoff AJ, Meijer HJA, Raghoebar GM. Erythritol air polishing in the surgical treatment of peri-implantitis: A randomized controlled trial. Clin Oral Implants Res 2021; 33:184-196. [PMID: 34808006 PMCID: PMC9299917 DOI: 10.1111/clr.13881] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 11/03/2021] [Accepted: 11/16/2021] [Indexed: 01/14/2023]
Abstract
Objectives To compare erythritol air polishing with implant surface cleansing using saline during the surgical treatment of peri‐implantitis. Material and Methods During a resective surgical intervention, implant surfaces were randomly treated with either air polishing (test group n = 26 patients/53 implants) or saline‐soaked cotton gauzes (control group n = 31 patients/ 40 implants). Primary outcome was change in mean bleeding on probing (BoP) from baseline to 12 months follow‐up. Secondary outcomes were changes in mean suppuration on probing (SoP), plaque score (Plq), probing pocket depth (PPD), marginal bone loss (MBL), periodontal full‐mouth scores (PFMS), and levels of 8 classical periodontal pathogens. Clinical and radiographical parameters were analyzed using multilevel regression analyses. Microbiological outcomes were analyzed using the Mann–Whitney U test. Results No differences between the test and control group were found for BoP over 12 months of follow‐up, nor for the secondary parameters Plq, PPD, and MBL. Between both groups, a significant difference was found for the levels of SoP (p = 0.035). No significant effect on microbiological levels was found. A total number of 6 implants were lost in the test group and 10 in the control group. At 1‐year follow‐up, a successful treatment outcome (PPD<5 mm, max 1 out of 6 sites BoP, no suppuration and no progressive bone loss >0.5 mm) was achieved for a total of 18 implants (19.2%). Conclusions Erythritol air polishing as implant surface cleansing method was not more effective than saline during resective surgical treatment of peri‐implantitis in terms of clinical, radiographical, and microbiological parameters. Both therapies resulted in low treatment success. Trial registry: https://www.trialregister.nl/ Identifier: NL8621.
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Affiliation(s)
- Diederik F M Hentenaar
- Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Yvonne C M De Waal
- Center for Dentistry and Oral Hygiene, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Roy E Stewart
- Department of Health Sciences, Community and Occupational Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Arie Jan Van Winkelhoff
- Center for Dentistry and Oral Hygiene, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Henny J A Meijer
- Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Center for Dentistry and Oral Hygiene, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Gerry M Raghoebar
- Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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21
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Garner SJ, Dalby MJ, Nobbs AH, Barbour ME. A novel chlorhexidine-hexametaphosphate coating for titanium with antibiofilm efficacy and stem cell cytocompatibility. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2021; 32:139. [PMID: 34800182 PMCID: PMC8605967 DOI: 10.1007/s10856-021-06616-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 10/03/2021] [Indexed: 06/13/2023]
Abstract
Dental implants are an increasingly popular way to replace missing teeth. Whilst implant survival rates are high, a small number fail soon after placement, with various factors, including bacterial contamination, capable of disrupting osseointegration. This work describes the development of chlorhexidine-hexametaphosphate coatings for titanium that hydrolyse to release the antiseptic agent chlorhexidine. The aim was to develop a coating for titanium that released sufficient chlorhexidine to prevent biofilm formation, whilst simultaneously maintaining cytocompatibility with cells involved in osseointegration. The coatings were characterised with respect to physical properties, after which antibiofilm efficacy was investigated using a multispecies biofilm model, and cytocompatibility determined using human mesenchymal stem cells. The coatings exhibited similar physicochemical properties to some implant surfaces in clinical use, and significantly reduced formation of multispecies biofilm biomass up to 72 h. One coating had superior cytocompatibility, with mesenchymal stem cells able to perform normal functions and commence osteoblastic differentiation, although at a slower rate than those grown on uncoated titanium. With further refinement, these coatings may have application in the prevention of bacterial contamination of dental implants at the time of surgery. This could aid a reduction in rates of early implant failure.
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Affiliation(s)
- Sarah J Garner
- Bristol Dental School, University of Bristol, Lower Maudlin Street, Bristol, BS1 2LY, UK
| | - Mathew J Dalby
- Centre for Cell Engineering, Institute of Molecular Cell and Systems Biology, University of Glasgow, Joseph Black Building, University Avenue, Glasgow, G12 8QQ, UK
| | - Angela H Nobbs
- Bristol Dental School, University of Bristol, Lower Maudlin Street, Bristol, BS1 2LY, UK.
| | - Michele E Barbour
- Bristol Dental School, University of Bristol, Lower Maudlin Street, Bristol, BS1 2LY, UK.
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22
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Dhaliwal JS, Abd Rahman NA, Ming LC, Dhaliwal SKS, Knights J, Albuquerque Junior RF. Microbial Biofilm Decontamination on Dental Implant Surfaces: A Mini Review. Front Cell Infect Microbiol 2021; 11:736186. [PMID: 34692562 PMCID: PMC8531646 DOI: 10.3389/fcimb.2021.736186] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Accepted: 09/09/2021] [Indexed: 11/25/2022] Open
Abstract
Introduction After insertion into the bone, implants osseointegrate, which is required for their long-term success. However, inflammation and infection around the implants may lead to implant failure leading to peri-implantitis and loss of supporting bone, which may eventually lead to failure of implant. Surface chemistry of the implant and lack of cleanliness on the part of the patient are related to peri-implantitis. The only way to get rid of this infection is decontamination of dental implants. Objective This systematic review intended to study decontamination of microbial biofilm methods on titanium implant surfaces used in dentistry. Methods The electronic databases Springer Link, Science Direct, and PubMed were explored from their inception until December 2020 to identify relevant studies. Studies included had to evaluate the efficiency of new strategies either to prevent formation of biofilm or to treat matured biofilm on dental implant surfaces. Results and Discussion In this systematic review, 17 different groups of decontamination methods were summarized from 116 studies. The decontamination methods included coating materials, mechanical cleaning, laser treatment, photodynamic therapy, air polishing, anodizing treatment, radiation, sonication, thermal treatment, ultrasound treatment, chemical treatment, electrochemical treatment, antimicrobial drugs, argon treatment, and probiotics. Conclusion The findings suggest that most of the decontamination methods were effective in preventing the formation of biofilm and in decontaminating established biofilm on dental implants. This narrative review provides a summary of methods for future research in the development of new dental implants and decontamination techniques.
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Affiliation(s)
- Jagjit Singh Dhaliwal
- Pengiran Anak Puteri Rashidah Sa'adatul Bolkiah Institute of Health Sciences, Universiti Brunei, Darussalam, Gadong, Brunei
| | - Nurul Adhwa Abd Rahman
- Pengiran Anak Puteri Rashidah Sa'adatul Bolkiah Institute of Health Sciences, Universiti Brunei, Darussalam, Gadong, Brunei
| | - Long Chiau Ming
- Pengiran Anak Puteri Rashidah Sa'adatul Bolkiah Institute of Health Sciences, Universiti Brunei, Darussalam, Gadong, Brunei
| | - Sachinjeet Kaur Sodhi Dhaliwal
- Pengiran Anak Puteri Rashidah Sa'adatul Bolkiah Institute of Health Sciences, Universiti Brunei, Darussalam, Gadong, Brunei
| | - Joe Knights
- Pengiran Anak Puteri Rashidah Sa'adatul Bolkiah Institute of Health Sciences, Universiti Brunei, Darussalam, Gadong, Brunei
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23
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Evert K, Kocher T, Schindler A, Müller M, Müller K, Pink C, Holtfreter B, Schmidt A, Dombrowski F, Schubert A, von Woedtke T, Rupf S, Calvisi DF, Bekeschus S, Jablonowski L. Repeated exposure of the oral mucosa over 12 months with cold plasma is not carcinogenic in mice. Sci Rep 2021; 11:20672. [PMID: 34667240 PMCID: PMC8526716 DOI: 10.1038/s41598-021-99924-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Accepted: 09/28/2021] [Indexed: 01/20/2023] Open
Abstract
Peri-implantitis may result in the loss of dental implants. Cold atmospheric pressure plasma (CAP) was suggested to promote re-osseointegration, decrease antimicrobial burden, and support wound healing. However, the long-term risk assessment of CAP treatment in the oral cavity has not been addressed. Treatment with two different CAP devices was compared against UV radiation, carcinogen administration, and untreated conditions over 12 months. Histological analysis of 406 animals revealed that repeated CAP exposure did not foster non-invasive lesions or squamous cell carcinoma (SCCs). Carcinogen administration promoted non-invasive lesions and SCCs. Molecular analysis by a qPCR screening of 144 transcripts revealed distinct inflammatory profiles associated with each treatment regimen. Interestingly, CAP treatment of carcinogen-challenged mucosa did not promote but instead left unchanged or reduced the proportion of non-invasive lesions and SCC formation. In conclusion, repeated CAP exposure of murine oral mucosa was well tolerated, and carcinogenic effects did not occur, motivating CAP applications in patients for dental and implant treatments in the future.
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Affiliation(s)
- K Evert
- Institute of Pathology, University of Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany.
| | - T Kocher
- Department of Restorative Dentistry, Periodontology, Endodontology, and Preventive and Pediatric Dentistry, University Medicine Greifswald, Greifswald, Germany
| | - A Schindler
- Leibniz Institute of Surface Modification (IOM Leipzig), Leipzig, Germany.,Consultants PILOTO, Ion Beam & Plasma Surface Technologies, Grimma, Germany
| | - M Müller
- Institute of Pathology, University of Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - K Müller
- Center for Clinical Studies, University Hospital Regensburg, Regensburg, Germany
| | - C Pink
- Department of Restorative Dentistry, Periodontology, Endodontology, and Preventive and Pediatric Dentistry, University Medicine Greifswald, Greifswald, Germany
| | - B Holtfreter
- Department of Restorative Dentistry, Periodontology, Endodontology, and Preventive and Pediatric Dentistry, University Medicine Greifswald, Greifswald, Germany
| | - A Schmidt
- ZIK Plasmatis, Leibniz Institute for Plasma Science and Technology (INP), Greifswald, Germany
| | - F Dombrowski
- Institute of Pathology, University Medicine Greifswald, Greifswald, Germany
| | - A Schubert
- Department of Immunology, Fraunhofer Institute for Cell Therapy and Immunology (IZI), Leipzig, Germany
| | - T von Woedtke
- ZIK Plasmatis, Leibniz Institute for Plasma Science and Technology (INP), Greifswald, Germany.,Department of Hygiene and Environmental Medicine, University Medicine Greifswald, Greifswald, Germany
| | - S Rupf
- Clinic of Operative Dentistry, Saarland University, Homburg, Germany
| | - D F Calvisi
- Institute of Pathology, University of Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - S Bekeschus
- ZIK Plasmatis, Leibniz Institute for Plasma Science and Technology (INP), Greifswald, Germany
| | - L Jablonowski
- Department of Restorative Dentistry, Periodontology, Endodontology, and Preventive and Pediatric Dentistry, University Medicine Greifswald, Greifswald, Germany
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24
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Hentenaar DFM, De Waal YCM, Stewart RE, Van Winkelhoff AJ, Meijer HJA, Raghoebar GM. Erythritol airpolishing in the non-surgical treatment of peri-implantitis: A randomized controlled trial. Clin Oral Implants Res 2021; 32:840-852. [PMID: 33844373 PMCID: PMC8360148 DOI: 10.1111/clr.13757] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 02/13/2021] [Accepted: 03/31/2021] [Indexed: 12/14/2022]
Abstract
Objectives To compare erythritol air polishing with piezoelectric ultrasonic scaling in the non‐surgical treatment of peri‐implantitis. Material and methods Eighty patients (n = 139 implants) with peri‐implantitis (probing pocket depth (PPD) ≥5 mm, marginal bone loss (MBL) ≥2 mm as compared to bone level at implant placement, bleeding, and/or suppuration on probing (BoP/SoP)) were randomly allocated to air polishing or ultrasonic treatment. The primary outcome was mean BoP (%) at 3 months after therapy (T3). Secondary outcomes were mean SoP (%), plaque score (Plq) (%), PPD (mm), MBL (mm), full mouth periodontal scores (FMPS) (%), levels of 8 classical periodontal pathogens, and treatment pain/discomfort (Visual Analog Scale, VAS). Patients who were considered successful at T3 were additionally assessed at 6, 9, and 12 months. Differences between both groups were analyzed using multilevel statistics. Results Three months after therapy, no significant difference in mean BoP (%) between the air polishing and ultrasonic therapy was found (crude analysis β (95% CI) −0.037 (−0.147; 0.073), p = .380). Neither secondary outcomes SoP (%), Plq (%), PPD (mm), MBL (mm), FMPS (%), and periodontal pathogens showed significant differences. Treatment pain/discomfort was low in both groups (VAS score airpolishing group 2.1 (±1.9), ultrasonic 2.6 (±1.9); p = .222). All successfully treated patients at T3 (18.4%) were still considered successful at 12‐month follow‐up. Conclusions Erythritol air polishing seems as effective as piezoelectric ultrasonic scaling in the non‐surgical treatment of peri‐implantitis, in terms of clinical, radiographical, and microbiological parameters. However, neither of the proposed therapies effectively resolved peri‐implantitis. Hence, the majority of patients required further surgical treatment.
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Affiliation(s)
- Diederik F M Hentenaar
- Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Yvonne C M De Waal
- Center for Dentistry and Oral Hygiene, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Roy E Stewart
- Department of Health Sciences, Community and Occupational Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Arie Jan Van Winkelhoff
- Center for Dentistry and Oral Hygiene, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Henny J A Meijer
- Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Center for Dentistry and Oral Hygiene, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Gerry M Raghoebar
- Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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25
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Matthes R, Jablonowski L, Holtfreter B, Pink C, Kocher T. Enzymatic biofilm destabilisation to support mechanical cleansing of inserted dental implant surfaces: an in-vitro pilot study. Odontology 2021; 109:780-791. [PMID: 33740161 PMCID: PMC8387265 DOI: 10.1007/s10266-021-00599-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 02/27/2021] [Indexed: 12/14/2022]
Abstract
Peri-implantitis is caused by microbial contamination and biofilm formation on the implant surface. To achieve re-osseointegration, the microbes must be completely removed from the surface. Adjunctive to mechanical cleaning, chemical treatment with enzymes or other substances could optimise the treatment outcome. Therefore, we investigated the efficacy of different enzymes, a surfactant, and a chelator in destabilising dental polymicrobial biofilm. The biofilm destabilising effect of the glycosidases α-amylase, dextranase, DispersinB®, and lysozyme, as well as the proteinase subtilisin A, and the nuclease Benzonase®, the chelator EDTA, and the surfactant cocamidopropyl betaine were investigated on biofilms, inoculated with plaque on rough titanium discs. The test and the control solutions were incubated for 15 min at 36 °C on biofilms, and loosened biofilm mass was removed by shear stress with a shaker. Fluorescence-stained biofilms were microscopically analysed. Acceptable cell tolerability concentrations of test substances were determined by the MTT (tetrazolium dye) assay on the MG-63 cell line. A statistically significant biofilm destabilising effect of 10% was shown with lysozyme (2500 µg/ml).
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Affiliation(s)
- Rutger Matthes
- Department of Restorative Dentistry, Periodontology, Endodontology, Preventive and Pediatric Dentistry, Dental School, University Medicine, Greifswald Rotgerberstr. 8, 17475, Greifswald, Germany.
| | - Lukasz Jablonowski
- Department of Restorative Dentistry, Periodontology, Endodontology, Preventive and Pediatric Dentistry, Dental School, University Medicine, Greifswald Rotgerberstr. 8, 17475, Greifswald, Germany
| | - Birte Holtfreter
- Department of Restorative Dentistry, Periodontology, Endodontology, Preventive and Pediatric Dentistry, Dental School, University Medicine, Greifswald Rotgerberstr. 8, 17475, Greifswald, Germany
| | - Christiane Pink
- Department of Restorative Dentistry, Periodontology, Endodontology, Preventive and Pediatric Dentistry, Dental School, University Medicine, Greifswald Rotgerberstr. 8, 17475, Greifswald, Germany
| | - Thomas Kocher
- Department of Restorative Dentistry, Periodontology, Endodontology, Preventive and Pediatric Dentistry, Dental School, University Medicine, Greifswald Rotgerberstr. 8, 17475, Greifswald, Germany
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26
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Jungbauer G, Moser D, Müller S, Pfister W, Sculean A, Eick S. The Antimicrobial Effect of Cold Atmospheric Plasma against Dental Pathogens-A Systematic Review of In-Vitro Studies. Antibiotics (Basel) 2021; 10:211. [PMID: 33672690 PMCID: PMC7924351 DOI: 10.3390/antibiotics10020211] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 02/16/2021] [Accepted: 02/18/2021] [Indexed: 12/14/2022] Open
Abstract
Interest in the application of cold atmospheric plasma (CAP) in the medical field has been increasing. Indications in dentistry are surface modifications and antimicrobial interventions. The antimicrobial effect of CAP is mainly attributed to the generation of reactive oxygen and reactive nitrogen species. The aim of this article is to systematically review the available evidence from in-vitro studies on the antimicrobial effect of CAP on dental pathogens. A database search was performed (PubMed, Embase, Scopus). Data concerning the device parameters, experimental set-ups and microbial cultivation were extracted. The quality of the studies was evaluated using a newly designed assessment tool. 55 studies were included (quality score 31-92%). The reduction factors varied strongly among the publications although clusters could be identified between groups of set pathogen, working gases, and treatment time intervals. A time-dependent increase of the antimicrobial effect was observed throughout the studies. CAP may be a promising alternative for antimicrobial treatment in a clinically feasible application time. The introduced standardized protocol is able to compare the outcome and quality of in-vitro studies. Further studies, including multi-species biofilm models, are needed to specify the application parameters of CAP before CAP should be tested in randomized clinical trials.
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Affiliation(s)
- Gert Jungbauer
- Department of Periodontology, School of Dental Medicine, University of Bern, 3010 Bern, Switzerland; (D.M.); (A.S.); (S.E.)
| | - Dominick Moser
- Department of Periodontology, School of Dental Medicine, University of Bern, 3010 Bern, Switzerland; (D.M.); (A.S.); (S.E.)
| | - Steffen Müller
- Department of Cranio-Maxillofacial Surgery, Hospital of the University of Regensburg, 93053 Regensburg, Germany;
| | - Wolfgang Pfister
- Department of Hospital Hygiene, Sophien- und Hufeland-Klinikum Weimar, 99425 Weimar, Germany;
| | - Anton Sculean
- Department of Periodontology, School of Dental Medicine, University of Bern, 3010 Bern, Switzerland; (D.M.); (A.S.); (S.E.)
| | - Sigrun Eick
- Department of Periodontology, School of Dental Medicine, University of Bern, 3010 Bern, Switzerland; (D.M.); (A.S.); (S.E.)
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27
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Ao XG, Chen WC. [Research progress on the osseointegration of titanium implants promoted by cold atmospheric plasma]. HUA XI KOU QIANG YI XUE ZA ZHI = HUAXI KOUQIANG YIXUE ZAZHI = WEST CHINA JOURNAL OF STOMATOLOGY 2020; 38:566-570. [PMID: 33085243 DOI: 10.7518/hxkq.2020.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The application of cold atmospheric plasma to titanium surface modification has recently become a research focus in the area of material modification. Previous studies found that cold atmospheric plasma can affect the colonization of bacteria and biological behaviors of osteoblasts by changing the surface characteristics of titanium in vitro. In vivo studies reveal that cold atmospheric plasma can promote the process of osseointegration of titanium implants. This review focuses on research on the effects of the surface modification of titanium implants with cold atmospheric plasma on osseointegration.
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Affiliation(s)
- Xiao-Gang Ao
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Dept. of Prosthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Wen-Chuan Chen
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Dept. of Prosthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
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28
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The Emerging Role of Cold Atmospheric Plasma in Implantology: A Review of the Literature. NANOMATERIALS 2020; 10:nano10081505. [PMID: 32751895 PMCID: PMC7466481 DOI: 10.3390/nano10081505] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 07/24/2020] [Accepted: 07/28/2020] [Indexed: 12/12/2022]
Abstract
In recent years, cold atmospheric plasma (CAP) technologies have received increasing attention in the field of biomedical applications. The aim of this article is to review the currently available literature to provide an overview of the scientific principles of CAP application, its features, functions, and its applications in systemic and oral diseases, with a specific focus on its potential in implantology. In this narrative review, PubMed, Medline, and Scopus databases were searched using key words like “cold atmospheric plasma”, “argon plasma”, “helium plasma”, “air plasma”, “dental implants”, “implantology”, “peri-implantitis”, “decontamination”. In vitro studies demonstrated CAP’s potential to enhance surface colonization and osteoblast activity and to accelerate mineralization, as well as to determine a clean surface with cell growth comparable to the sterile control on both titanium and zirconia surfaces. The effect of CAP on biofilm removal was revealed in comparative studies to the currently available decontamination modalities (laser, air abrasion, and chlorhexidine). The combination of mechanical treatments and CAP resulted in synergistic antimicrobial effects and surface improvement, indicating that it may play a central role in surface “rejuvenation” and offer a novel approach for the treatment of peri-implantitis. It is noteworthy that the CAP conditioning of implant surfaces leads to an improvement in osseointegration in in vivo animal studies. To the best of our knowledge, this is the first review of the literature providing a summary of the current state of the art of this emerging field in implantology and it could represent a point of reference for basic researchers and clinicians interested in approaching and testing new technologies.
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Jiao Y, Tay FR, Niu LN, Chen JH. Advancing antimicrobial strategies for managing oral biofilm infections. Int J Oral Sci 2019; 11:28. [PMID: 31570700 PMCID: PMC6802668 DOI: 10.1038/s41368-019-0062-1] [Citation(s) in RCA: 106] [Impact Index Per Article: 21.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 08/02/2019] [Accepted: 08/04/2019] [Indexed: 02/06/2023] Open
Abstract
Effective control of oral biofilm infectious diseases represents a major global challenge. Microorganisms in biofilms exhibit increased drug tolerance compared with planktonic cells. The present review covers innovative antimicrobial strategies for controlling oral biofilm-related infections published predominantly over the past 5 years. Antimicrobial dental materials based on antimicrobial agent release, contact-killing and multi-functional strategies have been designed and synthesized for the prevention of initial bacterial attachment and subsequent biofilm formation on the tooth and material surface. Among the therapeutic approaches for managing biofilms in clinical practice, antimicrobial photodynamic therapy has emerged as an alternative to antimicrobial regimes and mechanical removal of biofilms, and cold atmospheric plasma shows significant advantages over conventional antimicrobial approaches. Nevertheless, more preclinical studies and appropriately designed and well-structured multi-center clinical trials are critically needed to obtain reliable comparative data. The acquired information will be helpful in identifying the most effective antibacterial solutions and the most optimal circumstances to utilize these strategies.
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Affiliation(s)
- Yang Jiao
- Department of Stomatology, the 7th Medical Center of PLA General Hospital, Beijing, PR China
| | - Franklin R Tay
- Department of Endodontics, the Dental College of Georgia, Augusta University, Augusta, GA, USA
| | - Li-Na Niu
- State Key Laboratory of Military Stomatology & National Clinical Research Center for Oral Diseases & Shaanxi Key Laboratory of Oral Diseases, Department of Prosthodontics, School of Stomatology, the Fourth Military Medical University, Xi'an, PR China.
| | - Ji-Hua Chen
- State Key Laboratory of Military Stomatology & National Clinical Research Center for Oral Diseases & Shaanxi Key Laboratory of Oral Diseases, Department of Prosthodontics, School of Stomatology, the Fourth Military Medical University, Xi'an, PR China.
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Moharrami M, Perrotti V, Iaculli F, Love RM, Quaranta A. Effects of air abrasive decontamination on titanium surfaces: A systematic review of in vitro studies. Clin Implant Dent Relat Res 2019; 21:398-421. [PMID: 30838790 DOI: 10.1111/cid.12747] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Revised: 02/05/2019] [Accepted: 02/11/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND Air abrasion (AA) is one of the decontamination methods that have demonstrated promising results in treating peri-implant diseases. PURPOSE This systematic review aimed at evaluating the in vitro effect of AA on surface change, cleaning efficacy, and biocompatibility of titanium surfaces and at comparing it with other decontamination methods. MATERIALS AND METHODS A comprehensive search was conducted up to April 2018 using PubMed, Scopus, and Google Scholar databases to identify studies on the decontamination effect of AA. All types of titanium surfaces, abrasive powders, contaminated surfaces, and measuring methods were included. RESULTS Overall, 1502 articles were identified. After screening the titles and abstracts, and carefully reading the full-texts, 48 articles published between 1989 and 2018 were selected. AA was considered almost safe, particularly for the nonmodified surfaces. Nevertheless, harder powders such as sodium bicarbonate tended to damage the surface more than glycine. AA resulted in surface change similar to plastic curettes and Er: YAG lasers. Regarding the cleaning efficacy, there was no significant difference between glycine and sodium bicarbonate, but different mixtures of calcium phosphate, hydroxyapatite, and erythritol were superior to glycine. AA was superior or equal to all other decontamination methods in cleaning. Regarding biocompatibility, AA was more successful in preserving biocompatibility for noncontaminated surfaces compared with contaminated surfaces and when used with erythritol and osteoinductive powders. CONCLUSIONS AA can efficiently remove contamination without serious damage to the surface. The main drawback of the AA method seems to be its limitation in restoring the biocompatibility of the surface.
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Affiliation(s)
| | - Vittoria Perrotti
- Department of Medical, Oral and Biotechnological Sciences, University of Chieti-Pescara, Chieti, Italy
| | - Flavia Iaculli
- Department of Medical, Oral and Biotechnological Sciences, University of Chieti-Pescara, Chieti, Italy
| | - Robert M Love
- School of Dentistry and Oral Health, Griffith University, Gold Coast, Queensland, Australia
| | - Alessandro Quaranta
- School of Dentistry and Oral Health, Griffith University, Gold Coast, Queensland, Australia
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31
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Surface conditioning with cold argon plasma and its effect on the osseointegration of dental implants in miniature pigs. J Craniomaxillofac Surg 2019; 47:484-490. [DOI: 10.1016/j.jcms.2018.12.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 11/05/2018] [Accepted: 12/18/2018] [Indexed: 12/27/2022] Open
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Carreiro AF, Delben JA, Guedes S, Silveira EJ, Janal MN, Vergani CE, Pushalkar S, Duarte S. Low‐temperature plasma on peri‐implant–related biofilm and gingival tissue. J Periodontol 2018; 90:507-515. [DOI: 10.1002/jper.18-0366] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 10/18/2018] [Accepted: 10/22/2018] [Indexed: 12/23/2022]
Affiliation(s)
- Adriana F.P. Carreiro
- Department of DentistryFederal University of Rio Grande do Norte Natal Rio Grande do Norte Brazil
| | - Juliana A. Delben
- Department of DentistryState University of West of Parana Londrina Paraná Brazil
| | - Sarah Guedes
- Post‐Graduate Program in DentistryFederal University of Ceará Fortaleza Ceará Brazil
| | - Ericka J.D. Silveira
- Department of DentistryFederal University of Rio Grande do Norte Natal Rio Grande do Norte Brazil
| | - Malvin N. Janal
- Department of Epidemiology and Health PromotionCollege of DentistryNew York University New York NY USA
| | - Carlos Eduardo Vergani
- Department of Dental Materials and ProsthodonticsAraraquara Dental SchoolUNESP Araraquara São Paulo Brazil
| | - Smruti Pushalkar
- Department of Basic Sciences and Craniofacial BiologyNew York University College of Dentistry New York NY USA
| | - Simone Duarte
- Department of CariologyOperative Dentistry and Dental Public HealthIndiana University School of Dentistry Indianapolis IN USA
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