Modification of in situ Biofilm Formation on Titanium by a Hydroxyapatite Nanoparticle-Based Solution

Graveyard effects of antimicrobial nanostructured titanium over prolonged exposure to drug resistant bacteria and fungi

Innovations in nanostructured surfaces have found a practical place in the medical area with use in implant materials for post-operative infection prevention. These textured surfaces should be dual purpose: (1) bactericidal on contact and (2) resistant to biofilm formation over prolonged periods. Here, hydrothermally etched titanium surfaces were tested against two highly antimicrobial resistant microbial species, methicillin-resistant Staphylococcus aureus and Candida albicans. Two surface types - unmodified titanium and nanostructured titanium - were incubated in a suspension of each microbial strain for 1 day and 7 days. Surface topography and cross-sectional information of the microbial cells adhered to the surfaces, along with biomass volume and live/dead rate, showed that while nanostructured titanium was able to kill microbes after 1 day of exposure, after 7 days, the rate of death becomes negligible when compared to the unmodified titanium. This suggests that as biofilms mature on a nanostructured surface, the cells that have lysed conceal the nanostructures and prime the surface for planktonic cells to adhere, decreasing the possibility of structure-induced lysis. Synchrotron macro-attenuated total reflection Fourier transform infrared (macro ATR-FTIR) micro-spectroscopy was used to elucidate the biochemical changes occurring following exposure to differing surface texture and incubation duration, providing further understanding into the effects of surface morphology on the biochemical molecules (lipids, proteins and polysaccharides) in an evolving and growing microbial colony.

Clinical evidence of caries prevention by hydroxyapatite: An updated systematic review and meta-analysis

OBJECTIVES

A systematic review and meta-analysis were undertaken to update our 3-year-old meta-analysis to include RCTs, in vivo, and in situ clinical evidence that showed hydroxyapatite in oral care products can reduce dental caries.

DATA

Using the PICO guide, published clinical trials were searched where subjects (P) of all ages, with primary, mixed or permanent dentitions, using toothpastes, mouthwashes or gels containing hydroxyapatite as an active ingredient (I) were compared to subjects who used placebo or no intervention, or fluoride-containing positive controls (C), and the outcomes (O) were direct measurement of reduced dental caries or suitable proxy for reduced caries risk.

SOURCES

PubMed, Scopus, EMBASE, and Web of Science databases were searched using search terms from previous searches.

STUDY SELECTION

All authors collectively agreed which studies to include after applying the exclusion/inclusion criteria. Eighteen studies were retrieved and analyzed. The studies were graded according to a National Institutes of Health grading system. Three authors decided on the final list of publications suitable for meta-analysis, and the meta-analysis was carried out using the public domain R statistical program.

RESULTS

After applying more specific inclusion criteria and assessment, out of 18 retrieved studies, 5 clinical trials and 8 in situ trials were included in the meta-analysis.

CONCLUSIONS

The evidence for the effectiveness of fluoride-free, hydroxyapatite-containing oral care products in reducing dental caries, both from RCTs and in situ clinical trials, has expanded. More studies now show that hydroxyapatite is effective as an anti-caries active ingredient in the absence of fluoride.

CLINICAL SIGNIFICANCE

As a sole active ingredient, considered safe if swallowed, hydroxyapatite is an ideal substitute for fluoride in toothpaste and mouthwash tailored for young children, and new data as presented in this review, demonstrated that hydroxyapatite-based oral care products can be used by people of all ages.

Reduced Cell Adhesion on LightPLAS-Coated Implant Surfaces in a Three-Dimensional Bioreactor System

Most implants used in trauma surgery are made of steel and remain inside the body only temporarily. The strong tissue interaction of such implants sometimes creates problems with their explantation. Modified implant surfaces, which decrease tissue attachment, might allow an easier removal and therefore a better outcome. Such a modification must retain the implant function, and needs to be biocompatible and cost-effective. Here, we used a novel VUV-light (Vacuum-Ultraviolett)-based coating technology (LightPLAS) to generate coated stainless-steel plates. The tested LightPLAS coating only had an average thickness of around 335 nm, making it unlikely to interfere with implant function. The coated plates showed good biocompatibility according to ISO 10993-5 and ISO 10993-12, and reduced cell adhesion after four different time points in a 2D cell culture system with osteoblast-like MG-63 cells. Furthermore, we could show decreased cell adhesion in our 3D cell culture system, which mimics the fluid flow above the implant materials as commonly present in the in vivo environment. This new method of surface coating could offer extended options to design implant surfaces for trauma surgery to reduce cell adhesion and implant ingrowth. This may allow for a faster removal time, resulting in shorter overall operation times, thereby reducing costs and complication rates and increasing patient wellbeing.

Hydroxyapatite as Remineralization Agent for Children's Dental Care

Children are prone to develop dental caries. This is supported by epidemiological data confirming early childhood caries (ECC) as a highly prevalent disease affecting more than every second child worldwide. ECC is known to result from an imbalance between re- and demineralization where demineralization dominates due to frequent acid production by cariogenic bacteria present in oral biofilms. The application of oral care formulations containing remineralizing agents helps to prevent dental caries. As young children are sensitive and usually swallow (intended or unintended) a majority of toothpaste or other oral care products during daily dental care, all ingredients, especially the actives, should be non-toxic. Biomimetic hydroxyapatite [HAP; Ca5(PO4)3(OH)] is known to have favorable remineralizing properties combined with an excellent biocompatibility, i.e., it is safe if accidently swallowed. Several clinical trials as well as in situ and in vitro studies have shown that HAP remineralizes enamel and dentin. Remineralization occurs due to deposition of HAP particles on tooth surfaces forming mineral-mineral bridges with enamel crystals, but also indirectly through calcium and phosphate ions release as well as HAP's buffering properties in acidic environments (i.e., in plaque). HAP induces a homogenous remineralization throughout the subsurface enamel lesions. This review summarizes the current evidence showing HAP as an effective remineralizing agent in oral care products for children. Additional studies showing also further beneficial effects of HAP such as the reduction of biofilm formation and the relief of hypersensitivity in children with molar incisor hypomineralization (MIH). It can be concluded that HAP is an effective and safe remineralizing agent for child dental care.

Titanium Nanobowl-Based Nest-Like Nanofiber Structure Prepared at Room Temperature and Pressure Promotes Osseointegration of Beagle Implants

Nest-like nanofiber structures have potential applications in surface modifications of titanium implants. In this study, nest-like nanofiber structures were prepared on a titanium surface at room temperature and pressure by using the nanobowl template-assisted method combined with alkali etching. The characterization and biocompatibility of this material were analyzed by cellular adhesion, death, CCK-8, ALP, and RT-PCR assays in vitro, and osseointegration was evaluated by micro-CT and fluorescent labeling in vivo. The results showed that this nest-like nanofiber structure has a firmer and asperate surface than nanotubes, which leads to better cellular adhesion, proliferation, and differentiation capacity. In a beagle alveolar bone implant model, the nest-like nanofiber structure showed a better osseointegration capacity. In conclusion, this nest-like nanofiber structure has potential applications in dental implantology.

Biomimetic hydroxyapatite and caries prevention: a systematic review and meta-analysis

Dental caries is still one of the most prevalent diseases worldwide. Research has shown that fluoride has a role in caries prevention. For many reasons there are concerns about young children using fluoride-containing oral care products. Consequently, there is a need to identify effective fluoride-free products. A large body of literature now exists on the use of biomimetic hydroxyapatite (HAP) as an active ingredient in oral care products to combat caries.

AIM

To conduct a systematic review of the clinical evidence of the effects of HAP-based fluoride-free oral care products in caries reduction and conduct a meta-analysis of available randomized clinical trials (RCTs).

METHODS

Using the PICO question "In individuals of all ages (P), do fluoride-free oral care products containing HAP as the anti-caries agent (I), compared to products with fluoride or without caries control products (C), reduce the risk of dental caries (O)?" Ovid MEDLINE (PubMed), Scopus, EMBASE, and Web of Science databases were searched using the following keywords: apatite, hydroxyapatite, caries, dental decay, dentin(e), enamel, toothpaste, dentifrice, mouthwash, gels, biofilm, (dental) plaque, ero(de, ded, sion), (de, re)mineral(ise, ized, ised, ization, isation). Reviews, tooth whitening, tooth sensitivity, and in vitro studies were excluded. PRISMA was used for the search and GRADE was used to assess quality. Clinical trials were subjected to the Cochrane Risk of Bias assessment followed by meta-analysis.

RESULTS

291 studies were retrieved; 22 were suitable for systematic review, 5 were clinical caries trials and 4 were RCTs. A meta-analysis of 3 RCTs was possible showing HAP provided 17% protection against caries. The other 17 trials had simpler proxy outcomes for anticaries effects. Some trials showed non-inferior performance of HAP products compared to those with fluoride.

CONCLUSION

There is good evidence that hydroxyapatite in oral care products in the absence of fluoride effectively reduces caries.

Hydroxyapatite-Based Solution as Adjunct Treatment for Biofilm Management: An In Situ Study

Synthetic hydroxyapatite-based solution is a bioinspired material that may present anti-adhesive properties, restraining the dental biofilm formation without causing adverse effects. This in situ study aims to evaluate the effects of three different hydroxyapatite (HAP) watery solutions as a mouthwash against biofilm adhesion on different dental material surfaces under oral conditions. Hence, four volunteers carried maxillary splints containing enamel, titanium, ceramics, and polymethyl-methacrylate resin (PMMA) samples. Three HAP watery solutions (5%) were prepared with HAP particles presenting different shapes and sizes (HAP I, HAP II, HAP III). During 24 h, the volunteers rinsed two times with one of the following selected tested solution: HAP I, HAP II, HAP III, water, or chlorhexidine 0.2% (CHX). The first rinse was performed 3 min after pellicle formation; the second rinse occurred after a 12 h interval. The surface analysis was performed by scanning electron microscopy (SEM), fluorescence microscopy (FM), and transmission electron microscopy (TEM). Statistical and microscopic analysis showed that most samples treated with any HAP solution revealed reduced biofilm coverage presenting comparable results to CHX treated samples, however without altering the microorganisms' viability. In conclusion, the results of this investigation showed that a pure hydroxyapatite-based mouthrinse could be a promising bioinspired adjunct solution for biofilm management.

Cariogenic Biofilms: Development, Properties, and Biomimetic Preventive Agents

Oral biofilms will build up within minutes after cleaning of the dental hard tissues. While the application of remineralizing agents is a well-known approach to prevent dental caries, modern oral care products offer also additional active agents to maintain oral health. Human saliva contains many different organic and inorganic compounds that help to buffer organic acids produced by cariogenic microorganisms. However, most oral care products only contain remineralizing agents. To improve the benefit of those products, further active ingredients are needed. Books, review articles, and original research papers were included in this narrative review. Putting all these data together, we give an overview of oral biofilms and active compounds used in modern oral care products to interact with them. The special focus is on inorganic compounds and their interaction with oral biofilms. While organic compounds have several limitations (e.g., cell toxicity), inorganic compounds based on calcium and/or phosphate (e.g., sodium bicarbonate, hydroxyapatite, calcium carbonate) offer several advantages when used in oral care products. Calcium release can inhibit demineralization, and the release of hydroxide and phosphate ions might help in the buffering of acids. Therefore, the focus of this review is to summarize the scientific background of further active ingredients that can be used for oral care formulations.

Cannabidiol Induces Autophagy to Protects Neural Cells From Mitochondrial Dysfunction by Upregulating SIRT1 to Inhibits NF-κB and NOTCH Pathways

The protective effect of Cannabidiol on Parkinson’s disease (PD) has been found in recent study. However, the specific mechanism of the protective effect of Cannabidiol on PD nerve damage require further exploration. This study aims to investigate effect of Cannabidiol on MMP-induced Neural Cells (SH-SY5Y) mitochondrial dysfunction. MMP⁺ and Cannabidiol were used to treat SH-SY5Y cells, the cells viability was measured by MTT assay. The expression of Tyrosine hydroxylase (TH) in cells was measured by western blotting and Immunofluorescence staining. The relationship among Cannabidiol, Silent mating type information regulation 2 homolog-1 (SIRT1) and NOTCH signaling, NF-κB signaling was examined by western blotting. The effect of Cannabidiol on MMP⁺-induced mitochondrial dysfunction of SH-SY5Y cells was measured by western blotting. Cannabidiol alleviated loss of TH expression and cytotoxicity in the MPP⁺-induced SH-SY5Y cells. Further mechanistic investigation showed that Cannabidiol induced SH-SY5Y cells autophagy to protects cells from mitochondrial dysfunction by upregulating SIRT1 to Inhibits NF-κB and NOTCH Pathways. Taken together, Cannabidiol acts as a protector in PD.

Evaluation of Anti-Biofilm Activity of Mouthrinses Containing Tannic Acid or Chitosan on Dentin In Situ

In contrast to enamel, dentin surfaces have been rarely used as substrates for studies evaluating the effects of experimental rinsing solutions on oral biofilm formation. The aim of the present in situ study was to investigate the effects of tannic acid and chitosan on 48-h biofilm formation on dentin surfaces. Biofilm was formed intraorally on dentin specimens, while six subjects rinsed with experimental solutions containing tannic acid, chitosan and water as negative or chlorhexidine as positive control. After 48 h of biofilm formation, specimens were evaluated for biofilm coverage and for viability of bacteria by fluorescence and scanning electron microscopy. In addition, saliva samples were collected after rinsing and analyzed by fluorescence (five subjects) and transmission electron microscopy (two subjects) in order to investigate the antibacterial effect on bacteria in a planktonic state and to visualize effects of the rinsing agents on salivary proteins. After rinsing with water, dentin specimens were covered by a multiple-layered biofilm with predominantly vital bacteria. In contrast, chlorhexidine led to dentin surfaces covered only by few and avital bacteria. By rinsing with tannic acid both strong anti-adherent and antibacterial effects were observed, but the effects declined in a time-dependent manner. Transmission electron micrographs of salivary samples indicated that aggregation of proteins and bacteria might explain the antiadhesion effects of tannic acid. Chitosan showed antibacterial effects on bacteria in saliva, while biofilm viability was only slightly reduced and no effects on bacterial adherence on dentin were observed, despite proteins being aggregated in saliva after rinsing with chitosan. Tannic acid is a promising anti-biofilm agent even on dentin surfaces, while rinsing with chitosan could not sufficiently prevent biofilm formation on dentin.