Investigation of a novel sterilization method for biofilms formed on titanium surfaces

Effectiveness of mechanical and chemical decontamination methods for the treatment of dental implant surfaces affected by peri-implantitis: A systematic review and meta-analysis

OBJECTIVE

To assess which decontamination method(s) used for the debridement of titanium surfaces (disks and dental implants) contaminated with bacterial, most efficiently eliminate bacterial biofilms.

MATERIAL AND METHODS

A systematic search was conducted in four electronic databases between January 1, 2010 and October 31, 2022. The search strategy followed the PICOS format and included only in vitro studies completed on either dental implant or titanium disk samples. The assessed outcome variable consisted of the most effective method(s)-chemical or mechanical- removing bacterial biofilm from titanium surfaces. A meta-analysis was conducted, and data was summarized through single- and multi-level random effects model (p < .05).

RESULTS

The initial search resulted in 5260 articles after the removal of duplicates. After assessment by title, abstract, and full-text review, a total of 13 articles met the inclusion criteria for this review. Different decontamination methods were assessed, including both mechanical and chemical, with the most common method across studies being chlorhexidine (CHX). Significant heterogeneity was noted across the included studies. The meta-analyses only identified a significant difference in biofilm reduction when CHX treatment was compared against PBS. The remaining comparisons did not identify significant differences between the various decontamination methods.

CONCLUSIONS

The present results do not demonstrate that one method of decontamination is superior in eliminating bacterial biofilm from titanium disk and implant surfaces.

Peroxynitric acid inhibits amyloid β aggregation

Peroxynitric acid (PNA), a reactive oxygen nitrogen species, has attracted attention in life science because of its unique properties such as high bacteriacidal activity. Since the bactericidal activity of PNA could be related to its reaction with amino acid residues, we speculate that PNA can be used for protein modifications. In this study, PNA was applied to inhibit aggregation of amyloid β1-42 (Aβ42), which is thought to cause Alzheimer's disease (AD). We demonstrated for the first time that PNA could inhibit the aggregation and cytotoxicity of Aβ42. Since PNA could inhibit aggregation of other amyloidogenic proteins such as amylin and insulin, our study shed a light on a novel strategy for the prevention of various diseases caused by amyloids.

Kinetics of Bacterial Inactivation by Peroxynitric Acid in the Presence of Organic Contaminants

Low-temperature atmospheric-pressure plasma has been studied for disinfection purposes. When plasma is exposed to water, reactive oxygen and nitrogen species are generated and preserved in the water fraction (plasma-treated water [PTW]), which consequently exhibits bactericidal activity. At low temperatures, one of the bactericidal components of PTW is peroxynitric acid (PNA). Importantly, PNA can also be synthesized by chemical reaction, without exposure to plasma. In this study, we evaluated the bactericidal properties of PNA based on reaction kinetics in comparison with other disinfectants. The analysis, based on dose-dependent effects, showed that PNA exhibited about 1 and 10 times the bactericidal activity of hypochlorous acid (HOCl) and peracetic acid, respectively. In addition, we evaluated the influence of organic contaminants on the bactericidal effects of PNA and HOCl. The bactericidal potential of both disinfectants was reduced by bovine serum albumin (BSA); however, PNA showed about 30-times-higher resistance against BSA inhibition than HOCl. Analysis of the dose-dependent effects of PNA revealed that the inhibition of bactericidal effect was caused by its consumption. Further experiments using model substrates containing particular amino acid residues (Met, Cys, Lys, and Leu) suggested that the bacterial inactivation by PNA is less affected by BSA due to the low reactivity and narrow reactivity spectrum of PNA for amino acid residues. Overall, our results suggest that PNA has a great disinfection potential, especially in the presence of organic contaminants (e.g., on the surface of the human body and on medical instruments contaminated with biological fluids).IMPORTANCE A good disinfectant for the human body should have various properties, such as strong bactericidal activity, harmlessness to living tissues, and resistance against biological fluids (or other organic contaminants). Peroxynitric acid (PNA) showed a bactericidal effect that was several tens up to several hundred times higher per unit of molarity than that of sodium hypochlorite and peracetic acid, which are used as general disinfectants for medical equipment. Moreover, the high resistance of PNA to organic load was confirmed, indicating that PNA will inactivate bacteria effectively even on contaminated surfaces, such as used medical devices or the human body surface. Therefore, we propose that PNA can be used as a strong disinfectant for the human body.

Kinetics Analysis of the Reactions between Peroxynitric Acid and Amino Acids

Plasma disinfection using low-temperature atmospheric pressure plasma is widely studied in many applications, and the use of plasma-treated water (PTW) for disinfection is being developed by many researchers. Exposing plasma to water supplies and preserves reactive oxygen and nitrogen species (RONS) in the water, and this PTW exhibits bactericidal activity. In our previous study, it was revealed that peroxynitric acid (O₂NOOH, PNA) was the dominant bactericidal component in PTW. PNA can be easily synthesized without plasma treatment, and the physicochemical properties of PNA have been well-analyzed. As the application of PNA in fields related to medicine and biology has not been reported, a basic study on the behavior of PNA is required. In this study, the bactericidal activity of PNA and its reactivities with 20 naturally occurring amino acids were evaluated to understand its reaction mechanism with biomolecules. Interestingly, PNA exhibited 10^-6 times lower reactivities with amino acids when compared with hypochlorous acid and other RONS, although its bactericidal activity was 310 times higher than that of sodium hypochlorite. In addition, the reactivity of PNA with methionine was over 100 times higher than that with other amino acids, indicating that the reactions of PNA with amino acids are highly specific. No other oxidants have been reported to react selectively with only methionine. As methionine is involved in specific activities in cells, the unique reaction profile of PNA was examined in the context of biological systems.

High microbicidal effect of peroxynitric acid on biofilm-infected dentin in a root carious tooth model and verification of tissue safety

OBJECTIVES

Root-caries, which frequently occurs in elderly people, is more difficult to treat than caries in a tooth crown, especially in filling restorations. To overcome this difficulty, it is essential to find a strategy for sufficiently sterilizing the infected dentin; however, techniques for sterilizing carious pathogens inside the biofilm, called dental plaque, have not yet been established. Recently, dental applications of plasma sterilization technology have attracted attention. The mechanism of plasma sterilization became clear, and revealed that peroxynitric acid (PNA) is an effective sterilization substance. Highly concentrated PNA solutions can be chemically synthesized in large quantities without using plasma technology. We thought that the application of PNA solution could be a novel treatment for root caries, and examined the microbicidal effect and safety of PNA.

METHODS

A sterilization experiment was performed using an extracted tooth model infected with Streptococcus mutans. Subsequently, a biofilm of S. mutans and Candida albicans was formed on a plate or a dentin slice, and sterilization experiments were performed in comparison with chlorhexidine. Furthermore, a toxicity test of PNA was performed using an epithelial tissue model.

RESULTS

In the infection model, sterilization was achieved with a 22 mM PNA solution in only 10 s. In the biofilm model, a 22 mM PNA solution showed a higher microbicidal effect than 2.0% chlorhexidine. In the toxicity test, 2.0% chlorhexidine was toxic, but a 220 mM PNA solution showed no toxicity.

CONCLUSIONS

PNA is an unprecedented disinfectant that has high microbicidal activity on biofilm and is safe for tissues.