Biofilm Formation on Composite Resins for Dental Restorations: An in Situ Study on the Effect of Chlorhexidine Mouthrinses

Study of Streptococcus mutans in Early Biofilms at the Surfaces of Various Dental Composite Resins

BACKGROUND

Biofilm deposit on the composite restoration is a common phenomenon and bacterial growth follows the deposition. The study aims to evaluate Streptococcus mutans (S. mutans) early biofilm formation on the surfaces of various dental composite resins by using the real-time quantitative polymerase chain reaction (qPCR) technique.

MATERIALS AND METHODS

Thirty-two discs, where eight discs were in each group of Filtek Supreme Ultra (FSU; 3M, St. Paul, MN), Clearfil AP-X (APX; Kuraray Noritake Dental Inc., Tokyo, Japan), Beautifil II (BE2; Shofu, Inc., Kyoto, Japan), and Estelite Sigma Quick (ESQ; Tokuyama Dental, Tokyo, Japan), were fabricated and subjected to S. mutans biofilm formation in an oral biofilm reactor for 12 hours. Contact angles (CA) were measured on the freshly fabricated specimen. The attached biofilms underwent fluorescent microscopy (FM). S. mutans from biofilms were analyzed using a qPCR technique. Surface roughness (Sa) measurements were taken before and after biofilm formation. Scanning electron microscopy (SEM), including energy dispersive X-ray spectrometer (EDS) analysis, was also performed for detecting relative elements on biofilms.

RESULTS

The study showed that FSU demonstrated the lowest CA while APX presented the highest values. FM revealed that condensed biofilm clusters were most on FSU. The qPCR results indicated the highest S. mutans DNA copies in the biofilm were on FSU while BE2 was the lowest (p < 0.05). Sa test signified that APX was significantly the lowest among all materials while FSU was the highest (p < 0.05). SEM displayed areas with apparently glucan-free S. mutans more on BE2 compared to APX and ESQ, while FSU had the least. Small white particles detected predominantly on the biofilms of BE2 appeared to be Si, Al, and F extruded from the resin.

CONCLUSION

Differences in early biofilm formation onto various composite resins are dependent on the differences in material compositions and their surface properties. BE2 showed the lowest quantity of biofilm accumulation compared to other resin composites (APX, ESQ, and FSU). This could be attributed to BE2 proprieties as a giomer and fluoride content.

Mesoporous zirconia surfaces with anti-biofilm properties for dental implants

Cytocompatible bioactive surface treatments conferring antibacterial properties to osseointegrated dental implants are highly requested to prevent bacteria-related peri-implantitis. Here we focus on a newly designed family of mesoporous coatings based on zirconia (ZrO₂) microstructure doped with gallium (Ga), exploiting its antibacterial and pro-osseo-integrative properties. The ZrO₂films were obtained via sol-gel synthesis route using Pluronic F127 as templating agent, while Ga doping was gained by introducing gallium nitrate hydrate. Chemical characterization by means of x-ray photoelectron spectroscopy and glow discharge optical emission spectroscopy confirmed the effective incorporation of Ga. Then, coatings morphological and structural analysis were carried out by transmission electron microscopy and selected area electron diffraction unveiling an effective stabilization of both the mesoporous structure and the tetragonal ZrO₂phase. Specimens' cytocompatibility was confirmed towards gingival fibroblast and osteoblasts progenitors cultivated directly onto the coatings showing comparable metabolic activity and morphology in respect to controls cultivated on polystyrene. The presence of Ga significantly reduced the metabolic activity of the adhered oral pathogensPorphyromonas gingivalisandAggregatibacter actinomycetemcomitansin comparison to untreated bulk zirconia (p< 0.05); on the opposite, Ga ions did not significantly reduce the metabolism of the oral commensalStreptococcus salivarius(p> 0.05) thus suggesting for a selective anti-pathogens activity. Finally, the coatings' ability to preserve cells from bacterial infection was proved in a co-culture method where cells and bacteria were cultivated in the same environment: the presence of Ga determined a significant reduction of the bacteria viability while allowing at the same time for cells proliferation. In conclusion, the here developed coatings not only demonstrated to satisfy the requested antibacterial and cytocompatibility properties, but also being promising candidates for the improvement of implantable devices in the field of implant dentistry.

Alcohol and light-polymerizing glaze effect on the physical and mechanical properties of a bisacrylate composite resin before and after immersion in chlorhexidine gluconate

STATEMENT OF PROBLEM

The use of 0.12% chlorhexidine gluconate (CHX) may damage bisacrylate composite resin interim restorations, but whether they can be protected with an application of alcohol and/or the use of a glaze is unclear.

PURPOSE

The purpose of this in vitro study was to evaluate the effect of applying a 70% alcohol solution on the physical and mechanical properties of a bisacrylate composite resin, with and without the application of a light-polymerizing glaze subjected to 0.12% CHX twice a day for 7 days.

MATERIAL AND METHODS

Forty specimens of an autopolymerized bisacrylate composite resin were divided into 4 groups (n=10): Group C (without alcohol, without glaze), Group G (without alcohol, with glaze), Group A (with alcohol, without glaze), and Group AG (with alcohol, with glaze). All specimens were submitted to in vitro treatment with 0.12% CHX for 7 days, and tests of color alteration (ΔE₀₀), microhardness, roughness, and surface were performed initially and after treatment. Data were submitted to analysis of variance (ANOVA) and the Tukey HSD test (α=.05).

RESULTS

Group A had the lowest mean value of ΔE₀₀ with a significant statistical difference from Group C. The groups with alcohol presented higher microhardness mean values compared with groups without alcohol in both periods of analysis, except for the groups with glaze in the final period. Group C showed higher mean roughness values in comparison with Group A in both periods. Group AG presented higher mean roughness values than Group G. Surface energy values did not vary significantly among groups, except between Groups C and A in the final period.

CONCLUSIONS

The application of alcohol optimized the properties of the autopolymerized bisacrylate composite resin analyzed, with and without the application of glaze. Overall, the use of CHX changed the microhardness and roughness when the glaze was applied.

New Resin-Based Bulk-Fill Composites: in vitro Evaluation of Micro-Hardness and Depth of Cure as Infection Risk Indexes

The current in vitro study evaluated the Vickers hardness number (VHN) and hardness ratio of four bulk-fill composites (VisCalor bulk; Admira Fusion x-tra; x-tra fil; and GrandioSO x-tra-Voco, Cuxhaven, Germany) to assess the risk of bacterial colonization in comparison with standard composite materials. Thirty samples were prepared for each group. The VHN of both the external (top) and internal surface (bottom) was determined with a micro-hardness tester (200 g load for 15 s), and the hardness ratio was also calculated for each sample. Subsequently, storage in an acidic soft drink (Coca-Cola, Coca-Cola Company, Milano, Italy) was performed; for each group, 10 samples were stored for 1 day, while another 10 were stored for 7 days and the remaining 10 were kept in water as controls. A significant reduction in VHN was shown for all the groups when comparing the external versus internal side (P < 0.05), although the hardness ratio was greater than 0.80, resulting in an adequate polymerization. Regarding the acid storage, all the groups showed a significant decrease of VHN when compared with the controls, both after 1 day (P < 0.05) and after 7 days (P < 0.001). All the products showed adequate depth of cure without further risk of bacterial colonization. However, acid exposure negatively affected micro-hardness values, which might promote subsequent colonization.

A dual PMMA/calcium sulfate carrier of vancomycin is more effective than PMMA-vancomycin at inhibiting Staphylococcus aureus growth in vitro

Both antibiotic-impregnated poly(methyl acrylate, methyl methacrylate) (PMMA) and antibiotic-impregnated calcium sulfate have been successfully used as local antibiotic delivery vehicles for the management of chronic osteomyelitis. Here, we examined the antibiotic elution characteristics and antibacterial properties of a composite drug delivery system consisting of PMMA/calcium sulfate carrying vancomycin (dual carrier-v) against Staphylococcus aureus, with PMMA loaded with vancomycin (PMMA-v) as a control. Vancomycin gradually degraded from dual carrier-v and PMMA-v up to about 8 and 6 weeks, respectively. At different elution time points, the inhibition zones of the dual carrier-v were larger than the inhibition zones of the PMMA-v (P < 0.05). The colony inhibition rate of the dual carrier-v was 95.57%, whereas it was 77.87% for PMMA-v. Scanning electron microscopy was used to demonstrate biofilm formation on the surface of plates treated with vancomycin-unloaded PMMA, whereas there was no biofilm formation on the surface of plates treated with dual carrier-v or PMMA-v. The dual carrier-v was more effective at antibacterial adhesion at each time point after immersion in simulated body fluid as compared with PMMA-v (P < 0.05). In conclusion, our results suggest that the dual carrier-v can release higher concentrations of antibiotics and inhibit bacteria growth more effectively in vitro as compared with PMMA-v. The dual carrier-v thus may have potential as an alternative strategy for osteomyelitis management.

Investigation of Antibacterial and Antiinflammatory Activities of Proanthocyanidins from Pelargonium sidoides DC Root Extract

The study explores antibacterial, antiinflammatory and cytoprotective capacity of Pelargonium sidoides DC root extract (PSRE) and proanthocyanidin fraction from PSRE (PACN) under conditions characteristic for periodontal disease. Following previous finding that PACN exerts stronger suppression of Porphyromonas gingivalis compared to the effect on commensal Streptococcus salivarius, the current work continues antibacterial investigation on Staphylococcus aureus, Staphylococcus epidermidis, Aggregatibacter actinomycetemcomitans and Escherichia coli. PSRE and PACN are also studied for their ability to prevent gingival fibroblast cell death in the presence of bacteria or bacterial lipopolysaccharide (LPS), to block LPS- or LPS + IFNγ-induced release of inflammatory mediators, gene expression and surface antigen presentation. Both PSRE and PACN were more efficient in suppressing Staphylococcus and Aggregatibacter compared to Escherichia, prevented A. actinomycetemcomitans- and LPS-induced death of fibroblasts, decreased LPS-induced release of interleukin-8 and prostaglandin E2 from fibroblasts and IL-6 from leukocytes, blocked expression of IL-1β, iNOS, and surface presentation of CD80 and CD86 in LPS + IFNγ-treated macrophages, and IL-1β and COX-2 expression in LPS-treated leukocytes. None of the investigated substances affected either the level of secretion or expression of TNFα. In conclusion, PSRE, and especially PACN, possess strong antibacterial, antiinflammatory and gingival tissue protecting properties under periodontitis-mimicking conditions and are suggestable candidates for treatment of the disease.

In situ substrate-formed biofilms using IDODS mimic supragingival tooth-formed biofilms

This study aimed to compare the bacterial viability and diversity of a substrate-formed biofilm (SF-biofilm) in situ to a supragingival tooth-formed biofilm (TF-biofilm) in the same group of individuals. The impact of the device/disc position and toothbrushing during the formation of SF-biofilm was also assessed. Two tests were run. In test 1, 15 volunteers wore two hemi-splints carrying six discs of human enamel, glass, and hydroxyapatite for 2 days, and were instructed to not perform any oral hygiene measure. Biofilm samples were collected from the substrates and the contralateral tooth and were analysed using CLSM. In five volunteers, half of the biofilm present on the discs and their contralateral teeth were scraped and analysed using 16S  pyrosequencing. In test 2, the microscopic analysis was repeated only on the SF-biofilm samples, and the volunteers were allowed to brush their teeth. Multivariate analyses revealed that the donors had a significant effect on the composition of the biofilm, confirming its subject-dependent character. The bacterial composition of the SF-biofilm was similar to the TF-biofilm, with significant differential abundance detected in very few taxa of low abundance. The toothbrushing during the formation of SF-biofilm was the only factor that conditioned the thickness or bacterial viability.

Biofilm Removal and Bacterial Re-Colonization Inhibition of a Novel Erythritol/Chlorhexidine Air-Polishing Powder on Titanium Disks

Air-polishing with low abrasiveness powders is fast arising as a valid and mini-invasive instrument for the management of biofilm colonizing dental implants. In general, the reported advantage is the efficient removal of plaque with respect to the titanium integrity. In the present study, we evaluated the in situ plaque removal and the preventive efficacy in forestalling further infection of an innovative erythritol/chlorhexidine air-polishing powder and compared it with sodium bicarbonate. Accordingly, two peri-implantitis-linked biofilm formers, strains Staphylococcus aureus and Aggregatibacter actinomycetemcomitans, were selected and used to infect titanium disks before and after the air-polishing treatment to test its ability in biofilm removal and re-colonization inhibition, respectively. Biofilm cell numbers and viability were assayed by colony-forming unit (CFU) count and metabolic-colorimetric (2,3-Bis-(2-Methoxy-4-Nitro-5-Sulfophenyl)-2H-Tetrazolium-5-Carboxanilide) (XTT) assay. Results demonstrated that air-polishing performed with either sodium bicarbonate or erythritol/chlorhexidine was effective in reducing bacteria biofilm viability and number on pre-infected specimens, thus showing a similar ability in counteracting existing infection in situ; on the other hand, when air-polished pre-treated disks were infected, only erythritol/chlorhexidine powder showed higher post-treatment biofilm re-growth inhibition. Finally, surface analysis via mechanical profilometry failed to show an increase in titanium roughness, regardless of the powder selected, thus excluding any possible surface damage due to the use of either sodium bicarbonate or erythritol/chlorhexidine.

Dental caries and bacterial load in saliva and dental biofilm of type 1 diabetics on continuous subcutaneous insulin infusion

Objectives

Since most of the studies evaluates diabetics on multiple daily injections therapy and continuous subcutaneous insulin infusion may help gain better metabolic control and prevent complications, the objective of this study was to evaluate the prevalence of dental caries, the unstimulated salivary flow rate and the total bacteria load, Streptococcus spp. levels and Lactobacillus spp. levels in saliva and supragingival dental biofilm of type 1 diabetics on insulin pump.

Material and Methods

Sixty patients with type 1 diabetes on insulin pump and 60 nondiabetic individuals were included. The dental caries evaluation was performed using ICDAS and the oral hygiene was assessed according to Greene and Vermillion Simplified Oral Hygiene Index. Unstimulated saliva and supragingival dental biofilm were collected. Total bacteria, Streptococcus spp. and Lactobacillus spp. was quantified by qPCR.

Results

Patients with type 1 diabetes had a higher prevalence of dental caries and filled and missing teeth when compared with the control group. These patients were associated with more risk factors for the development of dental caries, namely a lower unstimulated salivary flow rate and a higher bacterial load in saliva and dental biofilm.

Conclusion

Some risk factors related to dental caries were associated with type 1 diabetics. An early diagnosis combined with the evaluation of the risk profile of the diabetic patient is imperative, allowing the dental caries to be analyzed through a perspective of prevention and the patient to be integrated into an individualized oral health program.

Alginate membranes loaded with hyaluronic acid and silver nanoparticles to foster tissue healing and to control bacterial contamination of non-healing wounds

Chronic non-healing wounds are a clinically important problem in terms of number of patients and costs. Wound dressings such as hydrogels, hydrocolloids, polyurethane films and foams are commonly used to manage these wounds since they tend to maintain a moist environment which is shown to accelerate re-epithelialization. The use of antibacterial compounds is important in the management of wound infections. A novel wound-dressing material based on a blended matrix of the polysaccharides alginate, hyaluronic acid and Chitlac-silver nanoparticles is here proposed and its application for wound healing is examined. The manufacturing approach to obtain membranes is based on gelling, foaming and freeze-casting of alginate, hyaluronic acid and Chitlac-silver nanoparticles mixtures using calcium ions as the cross-linking agent. Comprehensive evaluations of the morphology, swelling kinetics, permeability, mechanical characteristics, cytotoxicity, capability to inhibit metalloproteinases and of antibacterial property were conducted. Biological in vitro studies demonstrated that hyaluronic acid released by the membrane is able to stimulate the wound healing meanwhile the metal silver exploits an efficient antibacterial activity against both planktonic bacteria and biofilms. Overall, the experimental data evidence that the studied material could be used as antibacterial wound dressing for wound healing promotion.

Cytotoxicity and the effect of cationic peptide fragments against cariogenic bacteria under planktonic and biofilm conditions

This study evaluated the cytotoxicity and effect of fragments derived from three oral cationic peptides (CP): LL-37, D6-17 and D1-23 against cariogenic bacteria under planktonic and biofilm conditions. For cytotoxicity analysis, two epithelial cell lines were used. The minimum inhibitory concentration and the minimal bactericidal concentration were determined for the CP fragments and the control (chlorhexidine-CHX) against cariogenic bacteria. The fractional inhibitory concentration was obtained for the combinations of CP fragments on Streptococcus mutans. Biofilm assays were conducted with the best antimicrobial CP fragment against S. mutans. The results indicated that D6-17 was not cytotoxic. D1-23, LL-37 and CHX were not cytotoxic in low concentrations. D1-23 presented the best bactericidal activity against S. mutans, S. mitis and S. salivarius. Combinations of CP fragments did not show a synergic effect. D1-23 presented a higher activity against S. mutans biofilm than CHX. It was concluded that D1-23 showed a substantial effect against cariogenic bacteria and low cytotoxicity.

Devices for In situ Development of Non-disturbed Oral Biofilm. A Systematic Review

Objective: The aim of this review was to assess the types of devices used for in situ development of oral biofilm analyzed microbiologically.

Materials and Methods: A systematic search of the literature was conducted to identify all in situ studies of oral biofilm which used an oral device; the Ovid MEDLINE and EMBASE databases complemented with manual search were used. Specific devices used to microbiologically analyze oral biofilm in adults were included. After reading of the selected full texts, devices were identified and classified according to the oral cavity zone and manufacturing material. The “ideal” characteristics were analyzed in every group.

Results: The search provided 787 abstracts, of which 111 papers were included. The devices used in these studies were classified as palatal, lingual or buccal. The last group was sub-classified in six groups based on the material of the device. Considering the analyzed characteristics, the thermoplastic devices and the Intraoral Device of Overlaid Disk-holding Splints (IDODS) presented more advantages than limitations.

Conclusions: Buccal devices were the most commonly used for the study of in situ biofilm. The majority of buccal devices seemed to slightly affect the volunteer's comfort, the IDODS being the closest to the “ideal” model.

Clinical Relevance: New devices for in situ oral biofilm microbiological studies should take into account the possible effect of their design on the volunteer's comfort and biofilm formation.

Data in support of Gallium (Ga(3+)) antibacterial activities to counteract E. coli and S. epidermidis biofilm formation onto pro-osteointegrative titanium surfaces

This paper contains original data supporting the antibacterial activities of Gallium (Ga³⁺)-doped pro-osteointegrative titanium alloys, obtained via Anodic Spark Deposition (ASD), as described in “The effect of silver or gallium doped titanium against the multidrug resistant Acinetobacter baumannii” (Cochis et al. 2016) [1].

In this article we included an indirect cytocompatibility evaluation towards Saos2 human osteoblasts and extended the microbial evaluation of the Ga³⁺ enriched titanium surfaces against the biofilm former Escherichia coli and Staphylococcus epidermidis strains. Cell viability was assayed by the Alamar Blue test, while bacterial viability was evaluated by the metabolic colorimetric 3-[4,5-dimethylthiazol-2-yl]-2,5 diphenyl tetrazolium bromide (MTT) assay. Finally biofilm morphology was analyzed by Scanning Electron Microscopy (SEM). Data regarding Ga³⁺ activity were compared to Silver.

The effect of silver or gallium doped titanium against the multidrug resistant Acinetobacter baumannii

Implant-related infection of biomaterials is one of the main causes of arthroplasty and osteosynthesis failure. Bacteria, such as the rapidly-emerging Multi Drug Resistant (MDR) pathogen Acinetobacter Baumannii, initiate the infection by adhering to biomaterials and forming a biofilm. Since the implant surface plays a crucial role in early bacterial adhesion phases, titanium was electrochemically modified by an Anodic Spark Deposition (ASD) treatment, developed previously and thought to provide osseo-integrative properties. In this study, the treatment was modified to insert gallium or silver onto the titanium surface, to provide antibacterial properties. The material was characterized morphologically, chemically, and mechanically; biological properties were investigated by direct cytocompatibility assay, Alkaline Phosphatase (ALP) activity, Scanning Electron Microscopy (SEM), and Immunofluorescent (IF) analysis; antibacterial activity was determined by counting Colony Forming Units, and viability assay. The various ASD-treated surfaces showed similar morphology, micrometric pore size, and uniform pore distribution. Of the treatments studied, gallium-doped specimens showed the best ALP synthesis and antibacterial properties. This study demonstrates the possibility of successfully doping the surface of titanium with gallium or silver, using the ASD technique; this approach can provide antibacterial properties and maintain high osseo-integrative potential.

A silver complex of hyaluronan-lipoate (SHLS12): Synthesis, characterization and biological properties

In this study we present a novel silver complex of hyaluronan-lipoate (SHLS12) in a gel-state form. NMR analysis, conductometry and elemental analysis demonstrated stable non-covalent interactions between silver ions and the polysaccharide-lipoate backbone, whereas rheological investigations confirmed its gel-like physical-chemical behavior. Biological studies showed the ability of SHLS12 to exert a straightforward activity against different bacterial strains grown in sessile/planktonic state. The biocompatibility was also proved toward two eukaryotic cell lines. By considering both its ability to preserve antibacterial properties when exposed to the serum protein BSA and its low susceptibility to be degraded by hyaluronidase enzyme, this novel complex may be considered as a promising biomaterial for future in vivo applications.

Essential Oil from Berries of Lebanese Juniperus excelsa M. Bieb Displays Similar Antibacterial Activity to Chlorhexidine but Higher Cytocompatibility with Human Oral Primary Cells

Chlorhexidine (CHX), one of the most effective drugs administered for periodontal treatment, presents collateral effects including toxicity when used for prolonged periods; here, we have evaluated the bactericidal potency and the cytocompatibility of Juniperus excelsa M. Bieb essential oil (EO) in comparison with 0.05% CHX. The EO was extracted from berries by hydrodistillation and components identified by gas chromatography and mass spectrometry. Bacterial inhibition halo analysis, quantitative cell viability 2,3-bis(2-methoxy-4-nitro-5-sulphophenyl)-5-[(phenyl amino) carbonyl]-2H-tetrazolium hydroxide assay (XTT), and colony forming unit (CFU) count were evaluated against the two biofilm formers Aggregatibacter actinomycetemcomitans and Streptococcus mutans. Finally, cytocompatibility was assessed with human primary gingival fibroblasts (HGF) and mucosal keratinocytes (HK). The resulting EO was mainly composed of monoterpene hydrocarbons and oxygenated monoterpenes. An inhibition halo test demonstrated that both bacteria were sensitive to the EO; XTT analysis and CFU counts confirmed that 10-fold-diluted EO determined a statistically significant (p < 0.05) reduction in bacteria count and viability towards both biofilm and planktonic forms in a comparable manner to those obtained with CHX. Moreover, EO displayed higher cytocompatibility than CHX (p < 0.05). In conclusion, EO exhibited bactericidal activity similar to CHX, but a superior cytocompatibility, making it a promising antiseptic alternative to CHX.

Silver-containing antimicrobial membrane based on chitosan-TPP hydrogel for the treatment of wounds

Treatment of non-healing wounds represents hitherto a severe dilemma because of their failure to heal caused by repeated tissue insults, bacteria contamination and altered physiological condition. This leads to face huge costs for the healthcare worldwide. To this end, the development of innovative biomaterials capable of preventing bacterial infection, of draining exudates and of favoring wound healing is very challenging. In this study, we exploit a novel technique based on the slow diffusion of tripolyphosphate for the preparation of macroscopic chitosan hydrogels to obtain soft pliable membranes which include antimicrobial silver nanoparticles (AgNPs) stabilized by a lactose-modified chitosan (Chitlac). UV-Vis and TEM analyses demonstrated the time stability and the uniform distribution of AgNPs in the gelling mixture, while swelling studies indicated the hydrophilic behavior of membrane. A thorough investigation on bactericidal properties of the material pointed out the synergistic activity of chitosan and AgNPs to reduce the growth of S. aureus, E. coli, S. epidermidis, P. aeruginosa strains and to break apart mature biofilms. Finally, biocompatibility assays on keratinocytes and fibroblasts did not prove any harmful effects on the viability of cells. This novel technique enables the production of bioactive membranes with great potential for the treatment of non-healing wounds.

Biofilm formation on titanium implants counteracted by grafting gallium and silver ions

Biofilm-associated infections remain the leading cause of implant failure. Thanks to its established biocompatibility and biomechanical properties, titanium has become one of the most widely used materials for bone implants. Engineered surface modifications of titanium able to thwart biofilm formation while endowing a safe anchorage to eukaryotic cells are being progressively developed. Here surfaces of disks of commercial grade 2 titanium for bone implant were grafted with gallium and silver ions by anodic spark deposition. Scanning electron microscopy of the surface morphology and energy dispersive X-ray spectroscopy were used for characterization. Gallium-grafted titanium was evaluated in comparison with silver-grafted titanium for both in vivo and in vitro antibiofilm properties and for in vitro compatibility with human primary gingival fibroblasts. Surface-modified materials showed: (i) homogeneous porous morphology, with pores of micrometric size; (ii) absence of cytotoxic effects; (iii) ability to support in vitro the adhesion and spreading of gingival fibroblasts; and (iv) antibiofilm properties. Although both silver and gallium exhibited in vitro strong antibacterial properties, in vivo gallium was significantly more effective than silver in reducing number and viability of biofilm bacteria colonies. Gallium-based treatments represent promising titanium antibiofilm coatings to develop new bone implantable devices for oral, maxillofacial, and orthopedic applications.