Surface Modification to Modulate Microbial Biofilms-Applications in Dental Medicine

High-Resolution Large-Area Image Analysis Deciphers the Distribution of Salmonella Cells and ECM Components in Biofilms Formed on Charged PEDOT:PSS Surfaces

Biofilms, comprised of cells embedded in extracellular matrix (ECM), enable bacterial surface colonization and contribute to pathogenesis and biofouling. Yet, antibacterial surfaces are mainly evaluated for their effect on bacterial cells rather than the ECM. Here, a method is presented to separately quantify amounts and distribution of cells and ECM in Salmonella biofilms grown on electroactive poly(3,4-ethylenedioxythiophene):polystyrenesulfonate (PEDOT:PSS). Within a custom-designed biofilm reactor, biofilm forms on PEDOT:PSS surfaces electrically addressed with a bias potential and simultaneous recording of the resulting current. The amount and distribution of cells and ECM in biofilms are analyzed using a fluorescence-based spectroscopic mapping technique and fluorescence confocal microscopy combined with advanced image processing. The study shows that surface charge leads to upregulated ECM production, leaving the cell counts largely unaffected. An altered texture is also observed, with biofilms forming small foci or more continuous structures. Supported by mutants lacking ECM production, ECM is identified as an important target when developing antibacterial strategies. Also, a central role for biofilm distribution is highlighted that likely influences antimicrobial susceptibility in biofilms. This work provides yet a link between conductive polymer materials and bacterial metabolism and reveals for the first time a specific effect of electrochemical addressing on bacterial ECM formation.

Designing biodegradable alternatives to commodity polymers

The development and widespread adoption of commodity polymers changed societal landscapes on a global scale. Without the everyday materials used in packaging, textiles, construction and medicine, our lives would be unrecognisable. Through decades of use, however, the environmental impact of waste plastics has become grimly apparent, leading to sustained pressure from environmentalists, consumers and scientists to deliver replacement materials. The need to reduce the environmental impact of commodity polymers is beyond question, yet the reality of replacing these ubiquitous materials with sustainable alternatives is complex. In this tutorial review, we will explore the concepts of sustainable design and biodegradability, as applied to the design of synthetic polymers intended for use at scale. We will provide an overview of the potential biodegradation pathways available to polymers in different environments, and highlight the importance of considering these pathways when designing new materials. We will identify gaps in our collective understanding of the production, use and fate of biodegradable polymers: from identifying appropriate feedstock materials, to considering changes needed to production and recycling practices, and to improving our understanding of the environmental fate of the materials we produce. We will discuss the current standard methods for the determination of biodegradability, where lengthy experimental timescales often frustrate the development of new materials, and highlight the need to develop better tools and models to assess the degradation rate of polymers in different environments.

Cyclic strain of poly (methyl methacrylate) surfaces triggered the pathogenicity of Candida albicans

Candida albicans is an opportunistic yeast and the primary etiological factor in oral candidiasis and denture stomatitis. The pathogenesis of C. albicans could be triggered by several variables, including environmental, nutritional, and biomaterial surface cues. Specifically, biomaterial interactions are driven by different surface properties, including wettability, stiffness, and roughness. Dental biomaterials experience repetitive (cyclic) stresses from chewing and biomechanical movements. Pathogenic biofilms are formed over these biomaterial surfaces under cyclic strain. This study investigated the effect of the cyclic strain (deformation) of biomaterial surfaces on the virulence of Candida albicans. Candida biofilms were grown over Poly (methyl methacrylate) (PMMA) surfaces subjected to static (no strain) and cyclic strain with different levels (ε˜x=0.1 and 0.2%). To evaluate the biomaterial-biofilm interactions, the biofilm characteristics, yeast-to-hyphae transition, and the expression of virulent genes were measured. Results showed the biofilm biomass and metabolic activity to be significantly higher when Candida adhered to surfaces subjected to cyclic strain compared to static surfaces. Examination of the yeast-to-hyphae transition showed pseudo-hyphae cells (pathogenic) in cyclically strained biomaterial surfaces, whereas static surfaces showed spherical yeast cells (commensal). RNA sequencing was used to determine and compare the transcriptome profiles of cyclically strained and static surfaces. Genes and transcription factors associated with cell adhesion (CSH1, PGA10, and RBT5), biofilm formation (EFG1), and secretion of extracellular matrix (ECM) (CRH1, ADH5, GCA1, and GCA2) were significantly upregulated in the cyclically strained biomaterial surfaces compared to static ones. Genes and transcription factors associated with virulence (UME6 and HGC1) and the secretion of extracellular enzymes (LIP, PLB, and SAP families) were also significantly upregulated in the cyclically strained biomaterial surfaces compared to static. For the first time, this study reveals a biomaterial surface factor triggering the pathogenesis of Candida albicans, which is essential for understanding, controlling, and preventing oral infections. STATEMENT OF SIGNIFICANCE: Fungal infections produced by Candida albicans are a significant contributor to various health conditions. Candida becomes pathogenic when certain environmental conditions change, including temperature, pH, nutrients, and CO2 levels. In addition, surface properties, including wettability, stiffness, and roughness, drive the interactions between Candida and biomaterials. Clinically, Candida adheres to biomaterials that are under repetitive deformation due to body movements. In this work, we revealed that when Candida adhered to biomaterial surfaces subjected to repetitive deformation, the microorganism becomes pathogenic by increasing the formation of biofilms and the expression of virulent factors related to hyphae formation and secretion of enzymes. Findings from this work could aid the development of new strategies for treating fungal infections in medical devices or implanted biomaterials.

Rhamnolipid 89 Biosurfactant Is Effective against Streptococcus oralis Biofilm and Preserves Osteoblast Behavior: Perspectives in Dental Implantology

Biofilm-related peri-implant diseases represent the major complication for osteointegrated dental implants, requiring complex treatments or implant removal. Microbial biosurfactants emerged as new antibiofilm coating agents for implantable devices thanks to their high biocompatibility. This study aimed to assess the efficacy of the rhamnolipid 89 biosurfactant (R89BS) in limiting Streptococcus oralis biofilm formation and dislodging sessile cells from medical grade titanium, but preserving adhesion and proliferation of human osteoblasts. The inhibitory activity of a R89BS coating on S. oralis biofilm formation was assayed by quantifying biofilm biomass and microbial cells on titanium discs incubated up to 72 h. R89BS dispersal activity was addressed by measuring residual biomass of pre-formed biofilms after rhamnolipid treatment up to 24 h. Adhesion and proliferation of human primary osteoblasts on R89BS-coated titanium were evaluated by cell count and adenosine-triphosphate quantification, while cell differentiation was studied by measuring alkaline phosphatase activity and observing mineral deposition. Results showed that R89BS coating inhibited S. oralis biofilm formation by 80% at 72 h and dislodged 63-86% of pre-formed biofilms in 24 h according to concentration. No change in the adhesion of human osteoblasts was observed, whereas proliferation was reduced accompanied by an increase in cell differentiation. R89BS effectively counteracts S. oralis biofilm formation on titanium and preserves overall osteoblasts behavior representing a promising preventive strategy against biofilm-related peri-implant diseases.

Biofilm modifiers: The disparity in paradigm of oral biofilm ecosystem

A biofilm is a population of sessile microorganisms that has a distinct organized structure and characteristics like channels and projections. Good oral hygiene and reduction in the prevalence of periodontal diseases arise from minimal biofilm accumulation in the mouth, however, studies focusing on modifying the ecology of oral biofilms have not yet been consistently effective. The self-produced matrix of extracellular polymeric substances and greater antibiotic resistance make it difficult to target and eliminate biofilm infections, which lead to serious clinical consequences that are often lethal. Therefore, a better understanding is required to target and modify the ecology of biofilms in order to eradicate the infection, not only in instances of oral disorders but also in terms of nosocomial infections. The review focuses on several biofilm ecology modifiers to prevent biofilm infections, as well as the involvement of biofilm in antibiotic resistance, implants or in-dwelling device contamination, dental caries, and other periodontal disorders. It also discusses recent advances in nanotechnology that may lead to novel strategies for preventing and treating infections caused by biofilms as well as a novel outlook to infection control.

Advances in Material Modification with Smart Functional Polymers for Combating Biofilms in Biomedical Applications

Biofilms as living microorganism communities are found anywhere, and for the healthcare sector, these constitute a threat and allied mechanism for health-associated or nosocomial infections. This review states the basis of biofilms and their formation. It focuses on their relevance for the biomedical sector, generalities, and the major advances in modified or new synthesized materials to prevent or control biofilm formation in biomedicine. Biofilm is conceptualized as an aggregate of cells highly communicated in an extracellular matrix, which the formation obeys to molecular and genetic basis. The biofilm offers protection to microorganisms from unfavorable environmental conditions. The most frequent genera of microorganisms forming biofilms and reported in infections are Staphylococcus spp., Escherichia spp., and Candida spp. in implants, heart valves, catheters, medical devices, and prostheses. During the last decade, biofilms have been most commonly related to health-associated infections and deaths in Europe, the United States, and Mexico. Smart, functional polymers are materials capable of responding to diverse stimuli. These represent a strategy to fight against biofilms through the modification or synthesis of new materials. Polypropylene and poly-N-isopropyl acrylamide were used enough in the literature analysis performed. Even smart polymers serve as delivery systems for other substances, such as antibiotics, for biofilm control.

Bioactive Glass-Enhanced Resins: A New Denture Base Material

BACKGROUND

The creation of the denture base material with bioactive properties that releases ions and produces hydroxyapatite.

METHODS

Acrylic resins were modified by the addition of 20% of four types of bioactive glasses by mixing with powders. Samples were subjected to flexural strength (1, 60 days), sorption and solubility (7 days), and ion release at pH 4 and pH 7 for 42 days. Hydroxyapatite layer formation was measured using infrared.

RESULTS

Biomin F glass-containing samples release fluoride ions for a period of 42 days (pH = 4; Ca = 0.62 ± 0.09; P = 30.47 ± 4.35; Si = 22.9 ± 3.44; F = 3.1 ± 0.47 [mg/L]). The Biomin C (contained in the acrylic resin releases (pH = 4; Ca = 41.23 ± 6.19; P = 26.43 ± 3.96; Si = 33.63 ± 5.04 [mg/L]) ions for the same period of time. All samples have a flexural strength greater than 65 MPa after 60 days.

CONCLUSION

The addition of partially silanized bioactive glasses allows for obtaining a material that releases ions over a longer period of time.

CLINICAL SIGNIFICANCE

This type of material could be used as a denture base material, helping to preserve oral health by preventing the demineralization of the residual dentition through the release of appropriate ions that serve as substrates for hydroxyapatite formation.

Biofilm Formation on the Surfaces of CAD/CAM Dental Polymers

Dental polymers are now available as monolithic materials which can be readily used in computer-aided design and computer-aided manufacturing (CAD/CAM) systems. Despite possessing numerous advantages over conventionally produced polymers, the polymers produced by either of these systems fail to exhibit immunity to surface microbial adhesion when introduced into the oral environment, leading to the development of oral diseases. The aim of this study was to analyze the biofilm formation of six microorganisms from the oral cavity and its correlation to the surface characteristics of CAD/CAM dental polymers. A total of ninety specimens were divided into three groups: resin-based composite, polymethyl methacrylate, and polyether ether ketone. The experimental procedure included surface roughness and water contact angle measurements, colony forming unit counting, and scanning electron microscopy analysis of biofilm formed on the surface of the tested materials. The data were analyzed using the Kruskal-Wallis test, with a Dunn's post hoc analysis, and one way analysis of variance, with a Tukey's post hoc test; the correlation between the measurements was tested using Spearman's correlation coefficient, and descriptive statistics were used to present the data. Despite using the same manufacturing procedure, as well as the identical manufacturer's finishing and polishing protocols, CAD/CAM dental polymers revealed significant differences in surface roughness and water contact angle, and the increased values of both parameters led to an increase in biofilm formation on the surface of the materials. The CAD/CAM resin-based composite showed the lowest number of adhered microorganisms compared to CAD/CAM polymethyl methacrylate and CAD/CAM polyether ether ketone.

The Biological Activity of Fragmented Computer-Aided Design/Manufacturing Dental Materials before and after Exposure to Acidic Environment

Three ceramic and composite computer-aided design/computer-aided manufacturing (CAD/CAM) materials from different manufacturers (Cerasmart (CS)-nanoceramic resin; Straumann Nice (SN)-glass ceramic and Tetric CAD (TC)-composite resin) were tested to investigate the biocompatibility and sustainability on human fibroblasts and keratinocytes cells. Each type of CAD/CAM blocks restorative materials with fine and rough surfaces was exposed to an acidic environment for one month. After that, various powders were obtained by milling. In parallel, powders were also prepared from each restorative material, which were not exposed to the acidic environment. The cytotoxic effects were investigated by means of MTT and LDH assays, as well as nitric oxide production on two human normal cell lines, namely, fibroblasts (BJ) and keratinocytes (HaCaT). In addition, the degree of adhesion of fibroblast cells to each CAD/CAM material was evaluated by scanning electron microscopy (SEM). The results showed that the two samples that were exposed to an acidic environment (CS and SN) induced a reduction of mitochondrial activity and plasma membrane damage as regards the fibroblast cells. A similar effect was observed in TC_fine-exposed material, which seemed to induce necrosis at the tested concentration of 1 mg/mL. No oxidative stress was observed in fibroblasts and keratinocytes treated with the CAD/CAM materials. Regarding the adhesion degree, it was found that the fibroblasts adhere to all the occlusal veneers tested, with the mention that the CS and SN materials have a weaker adhesion with fewer cytoplasmic extensions than TC material. With all of this considered, the CAD/CAM restorative materials tested are biocompatible and represent support for the attachment and dispersion of cells.

Biocompatibility and Surface Roughness of Different Sustainable Dental Composite Blocks: Comprehensive In Vitro Study

The study purposed to investigate the biocompatibility and sustainability of two computer-aided design/computer-aided manufacturing (CAD/CAM) resin-based composites compared to a resin-modified ceramic in terms of surface roughness, biofilm formation, cytotoxicity, genotoxicity, and cellular changes observed under transmission electron microscopy (TEM). Three CAD/CAM blocks were used, two resin-based composites [Brilliant Crios (BC) and Cerasmart, (CS) and one hybrid ceramic (Vita Enamic (EN)]. Each block was sectioned into 10 × 12 × 2 mm specimens, followed by finishing and polishing. Each specimen was evaluated for surface roughness using 3D optical profilometry and scanned by scanning electron microscopy. Biofilm formation and its relation to surface roughness have been investigated for all tested materials. A Hep-2 cell line was used to investigate the viability through MTT assay. The cytotoxicity of the materials was measured at 24, 48, and 168 h. The activity of P53, caspase 3, and cytochrome C was evaluated to detect the genotoxicity of different groups, followed by TEM tracking of the cellular changes. Statistical analysis was implemented by utilizing a one-way analysis of variance test. The significance was set at P ≤ 0.05. With regard to the surface roughness, no statistically significant differences were shown between groups. BC possessed the highest biofilm formation value, followed by EN and CS, with no significance between them. No correlation between surface roughness of tested materials and biofilm formation was shown. Considering viability, the highest values were recorded for EN, whereas BC showed the lowest values. P53-fold changes in EN were significantly the lowest, indicating less genotoxicity. Within the current study's limitations, BC showed the highest biofilm formation. However, no significant surface roughness difference or correlation with biofilm formation was observed in tested materials. EN showed the lowest cytotoxicity and the highest viability. EN revealed the best compatibility performance among tested materials. On the contrary, the BC exhibited fewer preferences.

New insights into the inhibitory roles and mechanisms of D-amino acids in bacterial biofilms in medicine, industry, and agriculture

Biofilms are complex aggregates of microbes that are tightly protected by an extracellular matrix (ECM) and may attach to a surface or adhere together. A higher persistence of bacteria on biofilms makes them resistant not only to harsh conditions but also to various antibiotics which led to the emergence of problems in different applications. Recently, it has been discovered that many bacteria produce and release various D-amino acids (D-AAs) to inhibit biofilm formation, which made a great deal of interest in research into the control of bacterial biofilms in diverse fields, such as human health, industrial settings, and medical devices. D-AAs have various mechanisms to inhibit bacterial biofilms such as: (i) interfering with protein synthesis (ii) Inhibition of extracellular polymeric materials (EPS) productions (protein, eDNA, and polysaccharide) (iii) Inhibition of quorum sensing (autoinducers), and (iv) interfere with peptidoglycan synthesis, these various modes of action, enables these small molecules to inhibit both Gram-negative and Gram-positive bacterial biofilms. Since most biofilms are multi-species, D-AAs in combination with other antimicrobial agents are good choices to combat a variety of bacterial biofilms without displaying toxicity on human cells. This review article addressed the role of D-AAs in controlling several bacterial biofilms and described the possible or definite mechanisms involved in this process.

Evolution of the Geometric Structure of X39Cr13 Steel upon Thermochemical Treatment Specific to Medical-Grade Steels

This paper presents the results of the multi-aspect surface characterization of X39Cr13 steel samples subjected to technological processes specific to medical instrumentation, such as heat and thermochemical treatment, as well as sterilization, which are implemented in corrosion resistance measurements. The application of numerical methods of fractal analysis to averaged profiles obtained from SEM images resulted in double-log plots of structure function, from which the determination of the fractal parameters of interest was possible. The discussion was focused on the fractal dimension D, which governs relative height variations upon scaling in length, and corner frequency fc, which separates the scaling behavior of different-order structures (particles and their aggregates). The obtained results show that the heat treatment leaves behind a granular structure of steel (D2 = 2.43; fc2 = 1.97 nm), whereas corrosion tests reveal the appearance of pits (D1 = 2.17; fc1 = 0.303 nm; D2 = 2.59; fc2 = 4.76 nm). In turn, the ion nitriding improves the resistance of steel X39Cr13 to local corrosion. The fractal analysis also shows that the structure of the nitrided layer differs insignificantly from that of the untreated material, seen only as a shortening of the radius of the self-similarity area by a factor of two (fc2 = 1 nm).

Review of Professionally Applied Fluorides for Preventing Dental Caries in Children and Adolescents

This review aims to evaluate the effectiveness of professional topical fluoride application on the prevention of dental caries in primary and permanent dentition. A web search was conducted for English papers published from 2000 to 2020, using various digital resources (Pubmed, Google Scholar, Cochrane Library, and ResearchGate). The keywords were “professionally applied fluoride”, “fluoride gel”, “fluoride varnish”, “fluoride foam”, “fluoride mouthrinses”, and “non-cavitated caries lesions”. Inclusion criteria: (a) participants: children and adolescents, treated in a dental care setting; (b) intervention: professionally applied fluorides (gel, varnish, foam, mouthrinse); (c) comparator: no professional treatment or other preventive treatments; (d) outcomes: clinical effectiveness (e.g., caries reduction, tooth remineralization); (e) study design: randomized controlled trials, systematic reviews, meta-analyses; (f) publication period: 1 January 2000–31 December 2021. Clinical studies about home-use fluoride products, discussion papers, in-vitro studies, case reports, non-English articles, and studies with unclear methodology were excluded. Topical fluoride applications are indicated for patients with active smooth surface caries and for patients in high caries risk groups. Both APF gel and fluoride varnish are effective and can be recommended for caries prevention in primary and permanent teeth. For children under the age of 6, only 2.26% fluoride varnish is recommended.