The Role of Biofilms and Material Surface Characteristics in Microbial Adhesion to Maxillary Obturator Materials: A Literature Review

Impact of Biofilms on Surface Properties of Polymethyl Methacrylate (PMMA) Resins

Poly(methyl methacrylate) (PMMA) resins are widely used in medical and dental applications. Their susceptibility to bacterial biofilm formation poses significant challenges related to material degradation and infection risk. This study investigated the effects of Pseudomonas aeruginosa (P. aeruginosa) and Staphylococcus aureus (S. aureus) biofilms on PMMA resin surface properties over a 45-day period at 35°C. The study examined various parameters including biofilm adhesion, morphology, surface roughness, hydrophobicity, solid fraction, and zeta potential. PMMA resin specimens were inoculated with bacteria and incubated for 45 days. Biofilm adhesion was visually assessed, while surface characterization was conducted using scanning electron microscopy (SEM), atomic force microscopy (AFM), roughness analysis, contact angle measurements, solid fraction determination, and zeta potential analysis. The P. aeruginosa and S. aureus isolates were selected based on their biofilm-positive characteristics, which were further confirmed using Congo red and biofilm formation assays through crystal violet staining and spectrophotometric analysis. The results demonstrated robust biofilm adhesion on PMMA surfaces. SEM and AFM imaging revealed textured surfaces with elevated structures and depressions within the biofilm matrix. Biofilm-exposed resins exhibited significantly increased roughness (Ra = 164.5 nm, Rq = 169.5 nm) and hydrophobicity (mean angle = 85.5°-90.5°) compared to control samples (Ra = 38-50 nm, angle = 55°). Solid fraction measurements indicated a denser biofilm matrix on exposed resins (0.908) compared to controls (0.65). Additionally, zeta potential values were more negative for biofilm-exposed resins (mean = -84.2 mV) than controls (-45.0 mV). These findings underscore the substantial alterations in PMMA resin surface properties induced by bacterial biofilms, emphasizing the critical need for strategies to prevent biofilm formation and mitigate associated risks in healthcare settings. Future research should focus on developing anti-biofilm coatings or treatments to preserve the integrity and functionality of PMMA materials.

Mixed species biofilm: Structure, challenge and its intricate involvement in hospital associated infections

Hospital associated infections or healthcare associated infections (HAIs) are a major threat to healthcare and medical management, mostly because of their recalcitrant nature. The primary cause of these HAIs is bacterial associations, especially the interspecies interactions. In interspecies interactions, more than one species co-exists in a common platform of extracellular polymeric substances (EPS), establishing a strong interspecies crosstalk and thereby lead to the formation of mixed species biofilms. In this process, the internal microenvironment and the surrounding EPS matrix of the biofilms ensure the protection of the microorganisms and allow them to survive under antagonistic conditions. The communications between the biofilm members as well as the interactions between the bacterial cells and the matrix polymers, also aid in the rigidity of the biofilm structure and allow the microorganisms to evade both the host immune response and a wide range of anti-microbials. Therefore, to design a treatment protocol for HAIs is difficult and it has become a growing point of concern. This review therefore first aims to discuss the role of microenvironment, molecular structure, cell-cell communication, and metabolism of mixed species biofilms in manifestation of HAIs. In addition, we discuss the electrochemical properties of mixed-species biofilms and their mechanism in developing drug resistance. Then we focus on the most dreaded bacterial HAI including oral and gut multi-species infections, catheter-associated urinary tract infections, surgical site infections, and ventilator-associated pneumonia. Further, we highlight the challenges to eradication of the mixed species biofilms and the current and prospective future strategies for the treatment of mixed species-associated HAI. Together, the review presents a comprehensive understanding of mixed species biofilm-mediated infections in clinical scenario, and summarizes the current challenge and prospect of therapeutic strategies against HAI.

Understanding the intricacies of microbial biofilm formation and its endurance in chronic infections: a key to advancing biofilm-targeted therapeutic strategies

Bacterial biofilms can adhere to various surfaces in the environment with human beings being no exception. Enclosed in a self-secreted matrix which contains extracellular polymeric substances, biofilms are intricate communities of bacteria that play a significant role across various sectors and raise concerns for public health, medicine and industries. These complex structures allow free-floating planktonic cells to adopt multicellular mode of growth which leads to persistent infections. This is of great concern as biofilms can withstand external attacks which include antibiotics and immune responses. A more comprehensive and innovative approach to therapy is needed in view of the increasing issue of bacterial resistance brought on by the overuse of conventional antimicrobial medications. Thus, to oppose the challenges posed by biofilm-related infections, innovative therapeutic strategies are being explored which include targeting extracellular polymeric substances, quorum sensing, and persister cells. Biofilm-responsive nanoparticles show promising results by improving drug delivery and reducing the side effects. This review comprehensively examines the factors influencing biofilm formation, host immune defence mechanisms, infections caused by biofilms, diagnostic approaches, and biofilm-targeted therapies.

Microbial Analysis of Obturators During Maxillofacial Prosthodontic Treatment Over an 8-Year Period

The aim of the study was to investigate the microbial colonization (by Candida species, anaerobic and facultative anaerobic bacteria) of maxillary obturators used for the restoration of maxillary defects, including during radiotherapy.

Retrospective cohort study.

Fifteen patients requiring a maxillary obturator prosthesis had swabs of their obturators and adjacent tissues taken at different stages of their treatment over a period of 8 years.

Identification of microbial species from the swabs was carried out using randomly amplified polymorphic DNA polymerase chain reaction (RAPD PCR) analysis, checkerboard DNA-DNA hybridization, CHROMagar Candida chromogenic agar, and DNA sequencing.

Candida species were detected in all patients and all patients developed mucositis and candidiasis during radiotherapy which was associated with an increase in colonization of surfaces with Candida spp., particularly C albicans. Microbial colonization increased during radiotherapy and as an obturator aged, and decreased following a reline, delivery of a new prosthesis, or antifungal treatment during radiotherapy.

Microbial colonization of maxillary obturators was related to the stage of treatment, age of the obturator material, radiotherapy and antifungal medications, and antifungal treatment may be recommended if C albicans colonization of palatal tissues is greater than 105 colony-forming units per cm2 following the first week of radiotherapy.

Cerium oxide nanozymes confer a cytoprotective and bio-friendly surface micro-environment to methacrylate based oro-facial prostheses

Poly-(methyl methacrylate) (PMMA) is the preferred biomaterial for orofacial prostheses used for the rehabilitation of naso-palatal defects. However, conventional PMMA has limitations determined by the complexity of the local microbiota and the friability of oral mucosa adjacent to these defects. Our purpose was to develop a new type of PMMA, i-PMMA, with good biocompatibility and better biological effects such as higher resistance to microbial adhesion of multiple species and enhanced antioxidant effect. The addition of cerium oxide nanoparticles to PMMA using a mesoporous nano-silica carrier and polybetaine conditioning, resulted in an increased release of cerium ions and enzyme mimetic activity, without tangible loss of mechanical properties. Ex vivo experiments confirmed these observations. In stressed human gingival fibroblasts, i-PMMA reduced the levels of reactive oxygen species and increased the expression of homeostasis-related proteins (PPARg, ATG5, LCI/III). Furthermore, i-PMMA increased the levels of expression of superoxide dismutase and mitogen-activated protein kinases (ERK and Akt), and cellular migration. Lastly, we demonstrated the biosafety of i-PMMA using two in vivo models: skin sensitization assay and oral mucosa irritation test, respectively. Therefore, i-PMMA offers a cytoprotective interface that prevents microbial adhesion and attenuates oxidative stress, thus supporting physiological recovery of the oral mucosa.

Extended Post-Curing Light Exposure and Sandblasting Effects on Surface Hydrophobicity of 3D-Printed Denture Base Resin

This in vitro study evaluated the surface hydrophobicity of 3D-printed denture base resin exposed to either an extended post-curing light exposure time or a sandblasting procedure. MATERIALS AND METHODS: Disk-shaped samples (diameter × height: 10 mm × 3 mm) were 3D-printed with stereolithography SLA technology using the denture-base resin. Samples were divided into three groups: control, extended UV-post-curing, and sandblasted. The surface roughness parameters for each group were calculated, and the surface hydrophobicity was evaluated by measuring the drop contact angle. Analysis was done using the T-test; significance was when p < 0.05. RESULTS: The comparison of surface roughness parameters showed significant differences between the control group and the sandblasted group (Sa: p = 0.001, Sz: p < 0.001, Str: p < 0.001, Spc: p = 0.044) as well as between the extended-cure group and the sandblasted group (Sa: p = 0.006, Sz: p < 0.001, Str: p < 0.001, Spc: p = 0.036) except for the Sdr measures. The surface hydrophobicity was also statistically lower in the sandblasted group compared to both the control and extended curing groups (p < 0.001). CONCLUSION: The sandblasting procedure created a less hydrophobic surface of the 3D-printed denture base resin, and the altered surface roughness could be a contributor to this observation.

A Literature Review on Biofilm Formation on Silicone and Poymethyl Methacrylate Used for Maxillofacial Prostheses

Silicone elastomers are considered the most suitable maxillofacial materials for extraoral prostheses to date due to their superior physicochemical properties. The aim of this review was to describe the characteristics of biofilm formation on silicone and polymethyl methacrylate used for maxillofacial prostheses and review different strategies of biofilm management for silicone maxillofacial prosthesis. A structured literature search was conducted using the following databases - PubMed, Google Scholar, ScienceDirect, LILACS, IndeMED, OVID, EMBASE, NIH Clinical Trials - for reports related to the biofilms. English language articles were only included in the study. Biofilms induced various systemic infections if they are not treated at an early stage. Biofilms are formed due to various reasons like fungal, bacterial and mixed infections of the patient and also due to prosthetic appliances. The manual or mechanical pressure physically removes the biofilm and most biofilm molecules from surfaces. Treatment must be given with utmost caution and concern irrespective of the presence or absence of biofilm. With regards to the materials used for fabricating maxillofacial substitutes, it has been defined that both acrylic resin and silicone may harbour microorganisms, however, the larger porosities in silicone make it vulnerable to microbial adhesion. The major limitations of these materials are that they have numerous porosities on their surface and, along with the modification of the anatomy of the facial tissues as a result of the lesion, may compromise the natural balance of the microbial flora, favouring microbial colonization and formation of biofilms.

Functional biomedical materials derived from proteins in the acquired salivary pellicle

In the oral environment, the acquired salivary pellicle (ASP) on the tooth surface comprises proteins, glycoproteins, carbohydrates, and lipids. The ASP can specifically and rapidly adsorb on the enamel surface to provide effective lubrication, protection, hydration, and remineralisation, as well as be recognised by various bacteria to form a microbial biofilm (plaque). The involved proteins, particularly various phosphoproteins such as statherins, histatins, and proline-rich proteins, are vital to their specific functions. This review first describes the relationship between the biological functions of these proteins and their structures. Subsequently, recent advances in functional biomedical materials derived from these proteins are reviewed in terms of dental/bone therapeutic materials, antibacterial materials, tissue engineering materials, and coatings for medical devices. Finally, perspectives and challenges regarding the rational design and biomedical applications of ASP-derived materials are discussed.

Evaluation of Antimicrobial and Antibiofilm Activities of Copper Oxide Nanoparticles within Soft Denture Liners against Oral Pathogens

OBJECTIVES

Soft denture liners provide a favorable environment for adhesion and colonization of microorganisms. This in vitro study aimed to examine the efficacy of different concentrations of copper oxide nanoparticles (CuO NPs) incorporation into soft denture liner on the biofilm formation of the microbial species.

METHODS

Field Emission Scanning Electron Microscopy (FESEM) images from NPs were recorded. Antifungal susceptibility testing of CuO NPs against five standard strains of Candida albicans (CBS 10261, 1905, 1912, 1949, 2730), Streptococcus mutans (ATCC35668), Streptococcus sobrinus (ATCC27607), and Streptococcus salivarius (ATCC9222) was performed by the broth microdilution method with the Clinical and Laboratory Standards Institute reference method. The biofilm inhibition percentages of CuO NPs on the soft denture liners were determined by XTT assay.

RESULTS

The characterization of CuO NPs by scanning electron microscope (SEM) analyses confirmed the synthesis of NPs with appropriate structure and size with a mean diameter of 18.3 ± 9.1 nm. The CuO NPs successfully inhibited the growth of the tested standard strains of C. albicans and Streptococcus spp. at concentrations ranging from 64 to 128 µg mL-1. Indeed, incorporation of CuO NPs at a concentration of 500 µg mL-1 into the soft denture liners exhibited a significant activity (75%) in inhibition of C. albicans. biofilm formation in a dose-dependent manner. The biofilm formation of C. albicans in the presence of CuO NPs was lower than Streptococcus spp. in comparison with the control group (p < 0.05).

CONCLUSION

Incorporation of CuO NPs significantly decreased the colonization and plaque formation of the oral pathogens, especially C. albicans accumulation. These NPs may be useful as a promising agent for the antimicrobial management of soft denture liner materials.