In vitro permeability evaluation and colonization of membranes for periodontal regeneration by Porphyromonas gingivalis

Evaluation of the Microbial Profile on the Polydioxanone Membrane and the Collagen Membrane Exposed to Multi-Species Subgingival Biofilm: An In Vitro Study

Dehiscence in surgeries involving membranes often leads to bacterial contamination, hindering the healing process. This study assessed bacterial colonization on various membrane materials. Polydioxanone (PDO) membranes, with thicknesses of 0.5 mm and 1 mm, and a collagen membrane were examined. Packages containing polystyrene pins were crafted using these membranes, attached to 24-well plates, and exposed to oral bacteria from supra and subgingival biofilm. After a week's anaerobic incubation, biofilm formation was evaluated using the DNA-DNA hybridization test. Statistical analysis employed the Kruskal-Wallis test with Dunn's post hoc test. The biofilm on the polystyrene pins covered by the 0.5 mm PDO membrane showed a higher count of certain pathogens. The collagen membrane had a greater total biofilm count on its inner surface compared to both PDO membranes. The external collagen membrane face had a higher total biofilm count than the 0.5 mm PDO membrane. Furthermore, the 1 mm PDO membrane exhibited a greater count of specific pathogens than its 0.5 mm counterpart. In conclusion, the collagen membrane presented more biofilm and pathogens both internally and on its inner surface.

In vitro evaluation of membranes for regenerative procedures against oral bacteria

The current literature on guided bone regeneration (GBR) and guided tissue regeneration (GTR) membrane contamination reports that the physicochemical characteristics of these biomaterials might influence affinity to bacteria, which appears to be a major drawback for the clinical outcome of the regenerative procedures. Thus, this study aimed to evaluate, in vitro, a multispecies biofilm adherence and passage of bacteria through different types of commercially available membranes for GTR/GBR. Four types of membranes were tested (n=12): LC) Lumina Coat®; JS) Jason®; BG) Biogide®; and LP) Lumina PTFE®. Aluminum foil (AL) simulated an impermeable barrier and was used as the control. The membranes were adapted to specific apparatus and challenged with a mixed bacterial culture composed of A. actinomycetemcomitans b, S. mutans, S. mitis, and A. israelii. After 2 h or 7 days, bacterial adhesion and passage of bacteria were evaluated through CFU counting, which was analyzed by two-way ANOVA e post hoc Tukey, at a 5% significance level. Representative areas of two membranes of each group were analyzed through scanning electron microscopy (SEM) to assess the morphology and organization of the biofilm over the membrane fibers. LC and LP presented similar values of adhered bacterial cells (p > 0.05), significantly inferior when compared to the other groups, in both time points (p < 0.05). All the tested groups were permeable to bacterial cells, with no significant difference between the trial period of 2 h and 7 days (p > 0.05). SEM analyses demonstrated that adhered bacteria number increased throughout the time points (2 h < 7 days). Commercially available biological membranes demonstrated intense bacterial adherence and passage of bacteria, which increased throughout the trial period.

Permeability of P. gingivalis or its metabolic products through collagen and dPTFE membranes and their effects on the viability of osteoblast-like cells: an in vitro study

Membrane exposure is a widely reported and relatively common complication in Guided Bone Regeneration (GBR) procedures. The introduction of micro-porous dPTFE barriers, which are impervious to bacterial cells, could reduce the technique sensitivity to membrane exposure, even if there are no studies investigating the potential passage of bacterial metabolites through the barrier. Aim of this study was the in vitro evaluation of the permeability of three different GBR membranes (dPTFE, native and cross-linked collagen membranes) to Porphyromonas gingivalis; in those cases, where bacterial penetration could not be observed, another purpose was the analysis of the viability and differentiation capability of an osteosarcoma (U2OS) cell line in presence of bacteria eluate obtained through membrane percolation. A system leading to the percolation of P. gingivalis broth culture through the experimental membranes was arranged to assess the permeability to bacteria after 24 and 72 h of incubation. The obtained solution was then added to U2OS cell cultures which underwent, after 10 days of incubation, MTT and red alizarin essays. The dPTFE membrane showed resistance to bacterial penetration, while both types of collagen membranes were crossed by P. gingivalis after 24 h. The bacteria eluate filtered through dPTFE membrane didn't show any toxicity on U2OS cells. Results of this study demonstrate that dPTFE membranes can contrast the penetration of both P. gingivalis and its metabolites toxic for osteoblast-like cells. The toxicity analysis was not possible for the collagen membranes, since permeability to bacterial cells was observed within the first period of incubation.

Bacterial adhesion to antibiotic-loaded guided tissue regeneration membranes - a scanning electron microscopy study

BACKGROUND/PURPOSE

Bacterial contamination of sites undergoing guided tissue regeneration (GTR) therapy may reduce the efficiency of periodontal regeneration. This study compared bacterial adhesion onto various GTR membranes incorporated with antibiotics.

METHODS

Three barrier membranes, including expanded polytetrafluoroethylene (ePTFE) membrane, collagen membrane, and glycolide fiber membrane, were loaded with tetracycline or amoxicillin. The adhesion of Streptococcus mutans and Aggregatibacter actinomycetemcomitans onto the GTR membranes with or without antibiotics was analyzed using the scanning electron microscopy (SEM) analysis.

RESULTS

The SEM analysis showed no apparent alteration in the physical structure of the membranes loaded with antibiotics. Both S. mutans and A. actinomycetemcomitans attached best on the collagen membranes, followed by the ePTFE membranes, and then the glycolide fiber membranes without antibiotics. Moreover, higher numbers of bacteria were observed on the fibril areas than on the laminar areas of the ePTFE membranes. The amounts of attached bacteria on the GTR membranes increased after longer incubation. Incorporation of tetracycline or amoxicillin greatly reduced the adhesion of S. mutans and A. actinomycetemcomitans onto all of the GTR membranes examined.

CONCLUSION

Incorporation of tetracycline or amoxicillin greatly reduced adhesion of S. mutans or A. actinomycetemcomitans on the ePTFE, glycolide fiber, or collagen membranes. This finding indicates that it is valuable and effective to use the antibiotic-loaded GTR membranes for periodontal regeneration therapy.

Ammonium bicarbonate as porogen to make tetracycline-loaded porous bioresorbable membranes for dental guided tissue regeneration: failure due to tetracycline instability

The goal of this work was to manufacture a bioresorbable porous membrane aimed at both promoting osseous regeneration in oral surgery and delivering an antibiotic drug locally. The selected design consisted of a porous poly (D,L-lactic acid) matrix having a closed smooth face on one side to prevent inner migration of conjunctive and epithelial cells, and the rest of the membrane presenting open porosity to allow in-growth of osseous neotissue. The antibiotic drug was tetracycline because of its large antibacterial spectrum and its osteogenetic activity. Solvent casting/particulate leaching and gas foaming/salt leaching methods were selected to create the porosity, and ammonium bicarbonate was selected as thermosensitive water-soluble porogen because other studies reported that sodium chloride was difficult to remove totally. One-side-skinned, porous permeable membranes were successfully obtained. However, deleterious alterations of the drug were observed that were assigned to the basicity of the porogen, thus precluding any practical use in vivo.

Comparison of infrabony defects treated with enamel matrix derivative versus guided tissue regeneration with a nonresorbable membrane

AIM

The purpose of the present multicenter clinical trial was to compare the efficacy of two different procedures in the treatment of infrabony defects: guided tissue regeneration (GTR) with nonresorbable membranes and enamel matrix derivative (EMD).

MATERIAL AND METHODS

Six centers participated in this study. Ninety-eight patients with an interproximal infrabony defect were selected. All patients were treated with an initial phase of scaling and root planing, and at the study's baseline the selected defects presented a value of probing depth (PD) > or =6 mm with an infrabony component > or =4 mm. Forty-nine patients were treated with GTR procedures (using ePTFE membranes (Gore-Tex W.L. Gore and Associates, Flagstaff, AZ, USA)) and forty-nine with EMDs (Emdogain (U Biora AB Malm, Sweden)). The efficacy of each treatment modality was investigated through covariance analysis.

RESULTS

The patients were reevaluated at one year postop. Probing attachment level (PAL) gain and PD reduction were analyzed. In the Emdogain group the PAL before surgery (PAL 0) and the PD before surgery (PD 0) were respectively 9.9+/-1.4 and 8.5+/-1.6 mm. The PAL gain and the PD reduction at 1 year postsurgery were respectively 4.1+/-1.8 and 5.3+/-1.9 mm. The group of patients treated with membranes showed that PAL 0 and PD 0 were respectively 8.9+/-1.9 and 8.1+/-1.9. The PAL gain was 4.3+/-1.9 mm and the PD reduction was 5.6+/-1.5 mm. The mean PAL gain expressed by percentage (PAL gain/PAL 0) for the group treated with EMD was 41%, while it was 48% for the group treated with GTR. Results from our analysis suggest that there is no statistically significant difference between GTR and EMD treatments in terms of PAL gain, PD reduction and recession variation. Applying the regression model to a group of patients with a PAL 0 > or =8 mm, we observed a better clinical outcome in terms of PAL gain (difference of 0.3 mm) in patients treated with the GTR procedure compared to those treated with EMD. Covariance analysis showed a strong correlation in both groups of patients between PAL gain and full mouth bleeding score, and between PAL gain and defect morphology and depth.

Guided tissue regeneration using a polylactic acid barrier

OBJECTIVES

The purpose of this study was to determine the relative impact of various predictors responsible for the variability in treatment outcome after guided tissue regeneration (GTR) in intraosseous periodontal defects.

PATIENTS AND METHODS

30 patients with chronic periodontitis and at least one intraosseous periodontal lesion (> or =4 mm) were enrolled. Following full-mouth scaling, GTR using polylactic acid membranes was performed at one site in each patient. Main periodontal pathogens, defect morphology, membrane exposure and smoking habit were assessed as predictor variables. Alveolar bone level change served as the primary outcome variable in a multiple regression analysis.

RESULTS

After 12 months, the 29 patients completing the study showed alveolar bone changes ranging from 4 mm bone gain to 1 mm bone loss (mean: 1.6+/-0.4 mm gain). Active smoking (beta-weight:-0.49, P=0.003) and persistence of subgingival infection with P. gingivalis (P.g.) (beta-weight:-0.25, P=0.11) were associated with poor treatment outcome. Deep initial intraosseous defects (beta-weight: 0.32, P=0.045) were associated with favorable treatment outcome, and membrane exposure had no impact on bone gain.

CONCLUSION

Active smoking was the strongest predictor variable negatively affecting alveolar bone gain following GTR in the treatment of periodontal defects. It was followed by a positive influence of a deeper intraosseous defect and by a negative effect by persistent subgingival infection of P. gingivalis. The relative impact of these factors may be useful in assessing the prognosis of GTR in intraosseous periodontal defects.

Guided tissue regeneration using a polylactic acid barrier. Part I: Environmental effects on bacterial colonization

OBJECTIVES

The purpose of this study was to assess the dynamics of bacterial colonization in intra-osseous defects following guided tissue regeneration (GTR) therapy using a resorbable barrier.

PATIENTS AND METHODS

In each of 30 patients, one intra-osseous defect was treated with GTR using a polylactic acid membrane (Guidor). Plaque samples were taken from the defect site, other teeth and mucous membranes following initial therapy (baseline), and at 3, 6 and 12 months after periodontal surgery. Additionally, samples were taken from the defect sites at 1, 2 and 4 weeks. Actinobacillus actinomycetemcomitans (A.a.), Porphyromonas gingivalis (P.g.), and Bacteroides forsythus (B.f.) were detected by polymerase chain reaction (PCR). Supportive periodontal therapy was performed at 3-month intervals.

RESULTS

In the 29 patients completing the study, the assessed microflora was detected in 3 (A.a.), 13 (P.g.) and 14 (B.f.) defect sites at baseline, in 2 (A.a.), 2 (P.g.) and 2 (B.f.) following surgical debridement, and in 6 (A.a.), 10 (P.g.) and 22 (B.f.) at 12 months. Defect site colonization following GTR therapy was significantly correlated with presurgical colonization at other assessed teeth (A.a. and P.g.: tau = 0.45 and 0.66, respectively; P < 0.001), or on mucous membranes (B.f.: tau = 0.44, P < 0.001).

CONCLUSION

The colonization of periodontal pathogens at sites treated by GTR may correlate with the intra-oral presence of these pathogens before surgery. If colonization of GTR sites by periodontal pathogens is to be prevented, intra-oral suppression/eradication of these pathogens may be required before surgery.

Permeability of Streptococcus mutans and Actinobacillus actinomycetemcomitans Through guided tissue regeneration membranes and their effects on attachment of periodontal ligament cells

BACKGROUND

Microbial colonization on barrier materials used in guided tissue regeneration (GTR) may adversely affect treatment outcomes. The purposes of this study were: 1) to compare the invasion of Streptococcus mutans and Actinobacillus actinomycetemcomitans through 3 GTR membranes, composed of expanded polytetrafluoroethylene (ePTFE; non-resorbable), a glycolide fiber composite, and type I collagen (both bioabsorbable), and 2) to explore the effects of bacteria on the attachment of periodontal ligament (PDL) fibroblasts onto these membranes.

METHODS

Bacterial permeability was analyzed using a tube capped with a GTR membrane as a septum and filled with media. The tube was then placed in a bigger tube inoculated with S. mutans or A. actinomycetemcomitans. The passage of bacteria through the membranes into the inner tube was monitored. For cellular attachment experiments, primary human PDL cells were placed onto the GTR membranes with or without bacteria. Attached cells were analyzed by scanning electron microscopy (SEM) analysis.

RESULTS

The ePTFE membrane had the best barrier effects followed by the collagen membrane and then the glycolide fiber composite membrane. Moreover, S. mutans passed through these membranes faster than A. actinomycetemcomitans. The attachment of PDL cells on the 3 membranes was also varied. The ePTFE membrane was the worst substrate for PDL fibroblast attachment. Moreover, both bacteria influenced the cellular attachment on the GTR membranes.

CONCLUSIONS

Differences in the behavior of 3 GTR membranes penetrated by S. mutans and A. actinomycetemcomitans were demonstrated. The results suggest that attachment of PDL cells was affected on bacterial-contaminated GTR membranes, which may alter healing following membrane exposure.

Physicochemical, mechanical, and biological properties of commercial membranes for GTR

Barrier membranes for guided tissue regeneration (GTR) to treat bone defects have to satisfy criteria of biocompatibility, cell-occlusiveness, spacemaking, tissue integration, and clinical manageability. In this study, the morphological and mechanical properties of two commercial biodegradable membranes (Resolut LT and Biofix) as a function of the incubation time have been compared. Moreover, their permeability to both fluids and epithelial cells as well as the bacteria adhesion have been evaluated. The membranes are asymmetric and composed of a dense polymeric layer coupled with nonwoven (Resolut LT) or woven (Biofix) fibers. Both of the membranes, when incubated in complete culture medium, completely lose the structural and mechanical properties within 30 days. Moreover the results of solute permeability show that Resolut LT and Biofix membranes cannot be considered selective membranes to the solute crossing. On the contrary, they act as a barrier to the passage of the gingivial cells and to S. mutans bacteria.

The effect of chlorhexidine mouthrinses on early bacterial colonization of guided tissue regeneration membranes. An in vivo study

BACKGROUND

Different membrane materials accumulate varying amounts of bacteria when exposed in the oral cavity, due to their textural and structural surface characteristics. The aim of the study was to evaluate the effect of chlorhexidine mouthrinses on the in vivo early bacterial colonization of 3 different guided tissue regeneration membrane materials.

METHODS

Rectangular-shaped strips cut from 3 periodontal membranes (expanded polytetrafluoroethylene, polyglactin 910, and polylactic acid) were glued to removable devices adapted to the 2 upper quadrants in 8 dental students. In each student 1 quadrant was randomly selected as test side while the other served as control side. The experiment was divided in 2 phases: in the first phase plaque accumulation was followed for 4 hours while the second accumulation was followed for 24 hours. During the 4-hour experiment, students rinsed the test device twice (immediately following device application and after 2 hours) with 0. 12% chlorhexidine solution. The control device was rinsed with saline. In the second phase, students rinsed the test device with chlorhexidine and the control devices with saline 3 times (after device application and at 8 and 16 hours). Both the 4-hour and the 24-hour specimens were processed for scanning electron microscopy analysis. Fifty-four fields (at 200x magnification) were randomly selected and analyzed on each strip. Magnification was increased to determine the presence and morphotype of bacteria. The presence or absence of bacteria was assessed in a binomial fashion: the field was bacteria-positive when bacteria constituted the deposits covering the membrane surface. The microscopic field was negative (bacteria-negative) when no bacteria were observed. Bacteria-positive fields showing rods and filaments as prevalent morphotypes were recorded as rod-positive fields.

RESULTS

The results of data analysis suggest that bacterial contamination of membrane materials is significantly reduced by treatment with chlorhexidine. They also suggest that other variables affect plaque accumulation as well; i.e., the time allowed (4 versus 24 hours) and the different membrane materials. The interaction between these 2 variables is also highly significant, thereby indicating a different rate of plaque accumulation on different materials, irrespective of the treatment with chlorhexidine.

CONCLUSIONS

It was concluded that chlorhexidine mouthrinses may be effective in reducing and delaying the early bacterial accumulation on membrane materials although they are not able to fully prevent it. Membrane surface characteristics seem to be a more critical factor than the use of chlorhexidine, in influencing bacterial adhesion and colonization of barrier materials.

Tetracycline-coated polytetrafluoroethylene barrier membranes in the treatment of intraosseous periodontal lesions

BACKGROUND

Periodontal pathogens are detrimental to periodontal healing in barrier membrane-assisted periodontal therapy. Tetracycline-coating of barrier membranes may reduce levels of infecting pathogens. This study evaluated the clinical and microbiological effects of tetracycline-coated expanded polytetrafluoroethylene (T-ePTFE) barrier membranes in the treatment of 2- to 3-wall intraosseous periodontal lesions around mandibular molars.

METHODS

Eleven patients received non-coated barrier membranes (ePTFE) and 11 patients received T-ePTFE barrier membranes. Tetracycline coating was performed by placing ePTFE membranes first in a 5% tridodecylmethylammonium chloride solution and then in a basic 3% tetracycline solution. Microbiological examination included conventional culture and DNA probe analyses. Barrier membranes were removed 6 weeks after insertion.

RESULTS

At baseline, the periodontal lesion depth averaged 8.0 mm in the ePTFE treated group and 7.4 mm in the T-ePTFE group. At 1 year post-treatment, the mean gain of probing attachment was 1.9 mm in the ePTFE group and 3.3 mm in the T-ePTFE group (P = 0.02). At 3 minutes after membrane placement, suspected periodontal pathogens were detected in several ePTFE membranes but only in one T-ePTFE membrane. At 6 weeks, all membranes showed periodontal pathogens, including Porphyromonas gingivalis, Fusobacterium species, Peptostreptococcus micros, Bacteroides forsythus, and motile rods.

CONCLUSIONS

This study suggests that the use of tetracycline-coated ePTFE barrier membranes can result in additional gain of clinical periodontal attachment, most likely due to the antimicrobial properties of tetracycline during initial healing.

Early bacterial accumulation on guided tissue regeneration membrane materials. An in vivo study

The aim of the study was to compare the in vivo early bacterial plaque colonization of 3 different guided tissue regeneration (GTR) membrane materials using a morphological (scanning electron microscope) method. Rectangular-shaped strips were cut from 3 periodontal membranes (expanded polytetrafluoroethylene, polyglactin 910, and polylactic acid) and glued to the buccal aspect of removable acrylic devices, which were applied to the molar-premolar region of the upper quadrants in 8 dental students. Each device held 3 strips: one ePTFE, one polyglactin 910, and one polylactic acid. The surface roughness of each membrane material was measured by means of a laser profilometer. During a 24-hour period, the students had to refrain from any oral hygiene procedures and did not use chlorhexidine mouthrinses. In each subject, one device was removed after 4 hours and the other after 24 hours. After removal, the devices were placed in a 2.5% gluteraldehyde solution to fix the membranes, which were then processed for SEM analysis. Fifty-four microscopic fields (at 200x magnification) were randomly selected and analyzed in each strip. Magnification was increased to determine the presence of bacterial morphotypes. The presence or absence of bacteria was assessed in a binomial fashion. In such a system, the field was bacteria-positive when bacteria constituted the deposits covering the surface of the membrane. The microscopic field was considered bacteria-negative when no bacteria were present. Bacteria-positive fields showing rods and filaments as prevalent bacterial morphotypes were recorded as rod-positive fields. A different pattern of plaque accumulation was demonstrated on different membrane materials. The 4-hour results indicated a statistically significant difference (P = 0.008, ANOVA) in the proportion of bacteria-positive fields among the 3 membranes; a greater amount of bacteria was demonstrated on the ePTFE membrane compared to the other 2 membranes. At 24 hours, the difference in the proportion of bacteria-positive fields was statistically significant (P = 0.002, ANOVA); a lesser amount of bacterial plaque was present on the polylactic acid membrane compared to the ePTFE and polyglactin 910 membranes. No difference in the proportion of rod/bacteria-positive fields was demonstrated among the 3 membranes at either 4 or 24 hours. It was concluded that quantitative differences in early plaque accumulation on various membranes seem to be related to the textural and structural characteristics of the surface, which is not adequately represented by the surface Ra value measured with a profilometric instrument.

Integrated connective tissue in bioabsorbable barrier material and periodontal regeneration

The objective of this study was to evaluate the relationship between integrated connective tissue (ICT), that is, the presence of connective tissue into the membrane structure, and the clinical outcome of membrane-supported periodontal surgery. Twenty-six systemically healthy subjects affected by chronic adult periodontitis were enrolled in the study. One tooth site per patient, associated with an angular bony defect and an attachment loss of > 7 mm, was selected to be treated by means of a guided tissue regeneration procedure using a bioabsorbable membrane. Barrier material was surgically removed after 4 weeks for SEM analysis. For each treated site, the difference in clinical attachment loss, probing depth, and gingival recession between the baseline examination and follow-up 6 months after the second surgery was calculated. Gain of attachment was statistically (P < 0.001) greater in sites with no membrane exposure when compared to sites with exposed barrier material (5.5 +/- 1.0 vs. 4.0 +/- 0.6), while further gingival recession was greater (3.0 +/- 0.9 vs. 2.1 +/- 0.5) in sites with clinically exposed membranes. The results of SEM analysis revealed that when connective tissue structures were observed on membrane surfaces, no bacteria could be detected; conversely, areas heavily colonized by bacteria did not show the presence of connective tissue. Regression analysis indicated that integrated connective tissue on the external layer of the barrier material was positively correlated with the amount of attachment gain and negatively with the amount of gingival recession. Bacterial colonization of the membrane was negatively correlated with attachment gain and positively with gingival recession. It was concluded that connective tissue integration is an important biological phenomenon in preventing membrane exposure and bacterial plaque colonization and thus in enhancing the clinical outcome following guided tissue regeneration surgery.