Ralf Bürgers

In vivo and in vitro biofilm formation on two different titanium implant surfaces.

OBJECTIVES The aim of the present in vitro and human in vivo study was twofold: first, to evaluate the initial biofilm formation on different titanium implant surfaces by means of two highly sensitive fluorescent techniques and, second, to correlate these findings to different surface properties. MATERIALS AND METHODS In vivo biofilm formation was induced on purely machined (Pt) and on sand-blasted and acid-etched titanium (Prom) specimens, which were mounted buccally on individual splints and worn by six study participants for 12 h. In vitro bacterial adhesion was also investigated after incubation with Streptococcus sanguinis suspension (37 degrees C, 2 h). Adherent bacteria were quantified by the following fluorescence techniques: Resazurin staining in combination with an automated fluorescence reader or live/dead cell labeling and fluorescence microscopy. Surface roughness (R(a)) was determined with a perthometer, and surface free energy (SFE) was measured with a goniometer. RESULTS Prom showed a significantly higher median R(a) (0.95 microm) and a significantly lower median SFE (18.3 mJ/m(2)) than Pt (R(a)=0.15 microm; SFE=39.6 mJ/m(2)). The in vitro and in vivo tests showed a significantly higher bacterial adhesion to Prom than to Pt, and the initial biofilm formation on Pt corresponded to the circular surface modifications on the machined substratum. Both observations may be attributed to the predominant influence of surface roughness on bacterial adhesion. No significant differences in the percentage of dead cells among all adhering bacteria were found between Prom (23.7%) and Pt (29.1%). Ectopic solitary epithelial cells from the oral mucosa - strongly adhering to the substratum - were found on each Prom specimen, but not on any of the Pt surfaces. CONCLUSIONS Initial bacterial adhesion to differently textured titanium surfaces is primarily influenced by R(a), whereas the influence of SFE seems to be of only minor importance. Therefore, the micro-structured parts of an implant that are exposed to the oral cavity should be highly polished to prevent plaque accumulation. Both tested fluorometric techniques proved to be highly sensitive and reproducible in the quantification of biofilm formation on titanium implant surfaces.

Effect of six different peri-implantitis disinfection methods on in vivo human oral biofilm

OBJECTIVE The aim of this human in vivo pilot study was to evaluate the efficacy of six antimicrobial agents on the surface decontamination of an oral biofilm attached to titanium implants. DESIGN For in vivo biofilm formation, we fixed titanium specimens to individual removable acrylic upper jaw splints (14 specimens in every splint), which were worn by four volunteers overnight for 12 h. The specimens were then treated with different antimicrobial agents for 1 min (Sodium hypochlorite, Hydrogen peroxide 3%, Chlorhexidingluconate 0.2%, Plax, Listerine, citric acid 40%). Afterwards, we quantified the total bacterial load and the viability of adhering bacteria by live or dead cell labelling in combination with fluorescence microscopy. RESULTS The total bacterial load on the titanium surfaces was significantly higher after incubation in the control solution phosphate-buffered saline (PBS) than after disinfection in sodium hypochlorite, hydrogen peroxide, chlorhexidine, Plax, Listerine, and citric acid. Furthermore, a significantly lower ratio between dead and total adhering bacteria (bactericidal effect) was found after incubation in control PBS, Plax mouth rinse, and citric acid than after incubation in sodium hypochlorite, hydrogen peroxide, chlorhexidine, and Listerine. CONCLUSIONS All tested antiseptics seem to be able to reduce the total amount of microorganisms accumulating on titanium surfaces. Furthermore, sodium hypochlorite, hydrogen peroxide, chlorhexidine, and Listerine showed a significant bactericidal effect against adhering bacteria.

Saliva substitutes for the treatment of radiation-induced xerostomia—a review

GoalThe aim of this review is to summarize the in vitro and in vivo evidence on the performance of contemporary saliva substitutes in the treatment of xerostomia and hyposalivation caused by radiation therapy for head and neck malignancies.MethodsA literature search was conducted during July to September 2008 in PubMed, using the query terms “saliva substitute”, “saliva substitute and xerostomia”, “artificial saliva”, and “artificial saliva and xerostomia”; for clinical studies, only studies in patients suffering from radiation-induced xerostomia have been included in the review.Results and conclusionFifty-two studies met the inclusion criteria and were allotted either to the in vitro topics “viscosity”, “lubrication”, “wetting properties”, “antimicrobial effects”, and “enamel and dentin de- and remineralization”, or to the in vivo topics “clinical acceptance” or “influence on plaque formation and oral mucosa and microflora”. The findings suggest that there are significant differences in the performance of various saliva substitutes concerning the review parameters, yet indicate that further in vitro and in vivo studies on the properties of saliva substitutes are necessary.

The anti-adherence activity and bactericidal effect of microparticulate silver additives in composite resin materials.

OBJECTIVE Resin composite materials tend to accumulate microorganisms and dental plaque, which in turn may induce secondary caries around adhesive restorations. The aim of the present in vitro study was to evaluate the antibacterial activity of a resin composite material loaded with silver microparticles against Streptococcus mutans. DESIGN Circular specimens (10.0mm in diameter) of a resin composite matrix loaded with two different concentrations of a silver additive (Comp0.3: 0.3%; Comp0.6: 0.6%) and one unloaded reference composite matrix (Comp0: 0%) were made. Surface roughness R(a) was assessed by perthometer measurements and hydrophobicity according to water contact angles was determined by computerized image analysis. The specimens were incubated in a S. mutans suspension (1h, 37 degrees C) and adhering streptococci were quantified by using a biofluorescence assay (Alamar blue/Resazurin). Additionally, the viability of adhering bacteria was assessed by live/dead cell labelling in combination with fluorescence microscopy. RESULTS Statistically significant differences between the median water contact angles of Comp0 (66.3 degrees ), Comp0.3 (76.7 degrees ), and Comp0.6 (89.4 degrees ) were observed (p<0.001). A three- to fourfold higher amount of adhering S. mutans was found on reference Comp0 (12,093relative fluorescence units) than on Comp0.3 (4258rfu) and Comp0.6 (3292) (p<0.001 for both). Significantly higher percentages of dead cells than on Comp0 (0.5%) were found on Comp0.3 (6.1%) and on Comp0.6 (10.1%) (p<0.001 for both). CONCLUSIONS The addition of microparticulate silver to a resin composite material increased the surface hydrophobicity and reduced the number of adhering streptococci. Simultaneously it increased the percentage of dead and inactive cells on the composite surface. Thus, silver additives seem to demonstrate anti-adherence activity as well as a bactericidal effect.

Helicobacter pylori in human oral cavity and stomach

The oral cavity has been suspected as an extra-gastroduodenal reservoir for Helicobacter pylori infection and transmission, but conflicting evidence exists regarding the occurrence of H. pylori in the mouth, independently of stomach colonization. Ninety-four gastric biopsy patients were analysed for the concurrent presence of H. pylori in the mouth and stomach. Samples were collected from different areas within the mouth and H. pylori DNA was amplified by the polymerase chain reaction (PCR) and verified by sequencing. Helicobacter pylori-specific serology was performed, and stomach colonization was determined by culture. In addition, relevant dental and periodontal parameters, as well as general health parameters, were recorded. Helicobacter pylori was found in the stomach of 29 patients and in the oral cavity of 16 patients. In only six patients was the bacterium detected simultaneously in the stomach and mouth. Notably, the 10 patients in whom the bacterium was found solely in the mouth did not have serum antibodies to H. pylori. The occurrence of H. pylori in the mouth was found to be correlated neither to any general or oral health parameters, nor to any particular site of collection. This study shows that H. pylori can occur in the oral cavity independently of stomach colonization.

Adhesion of Candida albicans to various dental implant surfaces and the influence of salivary pellicle proteins

Dental implants may be considered a potential reservoir for (re)infection with oral Candida albicans. Our aim was to evaluate initial fungal adhesion to three differentially textured titanium and one zirconia implant surface, and to correlate these findings to differences in specific surface characteristics (surface roughness (R(a)) and surface free energy (SFE)). Additionally, we investigated the influence of salivary protein films and two pellicle proteins (mucin and albumin). Implant surfaces were characterized by perthometer (R(a)) and goniometer (SFE) measurements. Implant specimens were rinsed with human whole saliva, mucin, albumin, or phosphate buffered saline and incubated in C. albicans suspension for 2.5h. Adherent fungi were quantified by means of a bioluminometric assay. The lowest amount of fungal cells was found on sand-blasted titanium, whereas zirconia implants did not show any reduced potential to adhere C. albicans. The influence of the implant SFE on fungal biofilm formation appears to be more important than the influence of R(a). The protein mucin enhanced C. albicans accumulation. In contrast, albumin is unlikely to be involved in the adhesion process of C. albicans.

Surface characterization of dental ceramics and initial streptococcal adhesion in vitro

OBJECTIVES The aim of this in vitro study was to investigate the surface properties of dental ceramic materials belonging to different ceramic classes, and to correlate the findings to the initial adherence of three oral streptococcal strains. METHODS Rectangular specimens were prepared from different ceramic materials (glass/lithium disilicate glass/glass-infiltrated zirconia/partially sintered zirconia/hipped zirconia ceramic) and polished; surface roughness (Ra) was determined. Glass plates were used as a control. Specimens were incubated with phosphate-buffered saline or an artificial saliva (protein mixture; 2h, 37 degrees C). Surface free energy (gamma(t)) and its polar (gamma(p)) and disperse (gamma(d)) contribution were determined prior to and after artificial saliva exposure. Uncoated and protein-coated specimens were incubated with Streptococcus gordonii DSMZ 6777, Streptococcus oralis DSMZ 20068 or Streptococcus sanguinis DSMZ 20068 suspension for 2.5h at 37 degrees C (n=15 for each treatment and strain). Adherent streptococci were quantified fluorometrically. RESULTS The lithium disilicate glass ceramic showed the highest values for Ra; the lowest values were found for the glass ceramic, the partially sintered zirconia and the hipped zirconia ceramic. Protein coating caused a significant increase in gamma(t) and gamma(p), but not in the control material. The control material showed higher values for streptococcal adhesion than all ceramic materials. After protein coating, only slight and random differences in streptococcal adhesion were found between the various ceramic materials. SIGNIFICANCE Dental ceramic materials show differences in terms of Ra, gamma(t) and initial streptococcal adhesion; however, correlations between surface properties and streptococcal adhesion were poor.

Self-adhesive resin cement versus zinc phosphate luting material: A prospective clinical trial begun 2003

OBJECTIVES The literature demonstrates that conventional luting of metal-based restorations using zinc phosphate cements is clinically successful over 20 years. This study compared the clinical outcomes of metal-based fixed partial dentures luted conventionally with zinc phosphate and self-adhesive resin cement. METHODS Forty-nine patients (mean age 54+/-13 years) received 49 metal-based fixed partial dentures randomly luted using zinc phosphate (Richter & Hoffmann, Berlin, Germany) or self-adhesive resin cement (RelyX Unicem Aplicap, 3M ESPE, Germany) at the University Medical Center Regensburg. The core build-up material was highly viscous glass ionomer; the finishing line was in dentin. The study included 42 posterior, 5 anterior crowns and two onlays. Forty-seven restorations were made of precious alloys, 2 of non-precious alloys. The restorations were clinically examined every year. The clinical performance was checked for plaque (0-5; PI, Quigley-Hein), bleeding (0-4; PBI; Mühlemann) and attachment scores. The examination included pulp vitality and percussion tests. STATISTICS Means of scores, standard deviation, cumulative survival and complication rates were calculated using life tables. RESULTS The mean observation time was 3.16+/-0.6 years (min: 2.0; max: 4.5 years). During that time no restoration was lost, no recementation became necessary. One endodontic treatment was performed in the self-adhesive composite group after 2.9 years. At study end bleeding (1.44 RelyX Unicem vs. 1.25 zinc phosphate) and plaque (1.64 RelyX Unicem vs. 1.0 zinc phosphate) scores showed no statistically significant difference. SIGNIFICANCE The self-adhesive resin cement performed clinically as well and can be used as easily as zinc phosphate cement to retain metal-based restorations over a 38-month observation period.

The two main theories on dental bruxism

Bruxism is characterized by non-functional contact of mandibular and maxillary teeth resulting in clenching or grating of teeth. Theories on factors causing bruxism are a matter of controversy in current literature. The dental profession has predominantly viewed peripheral local morphological disorders, such as malocclusion, as the cause of clenching and gnashing. This etiological model is based on the theory that occlusal maladjustment results in reduced masticatory muscle tone. In the absence of occlusal equilibration, motor neuron activity of masticatory muscles is triggered by periodontal receptors. The second theory assumes that central disturbances in the area of the basal ganglia are the main cause of bruxism. An imbalance in the circuit processing of the basal ganglia is supposed to be responsible for muscle hyperactivity during nocturnal dyskinesia such as bruxism. Some authors assume that bruxism constitutes sleep-related parafunctional activity (parasomnia). A recent model, which may explain the potential imbalance of the basal ganglia, is neuroplasticity. Neural plasticity is based on the ability of synapses to change the way they work. Activation of neural plasticity can change the relationship between inhibitory and excitatory neurons. It seems obvious that bruxism is not a symptom specific to just one disease. Many forms (and causes) of bruxism may exist simultaneously, as, for example, peripheral or central forms.

Bacterial adhesion of Streptococcus mutans to esthetic bracket materials

INTRODUCTION The formation of white spot lesions and enamel demineralization might be intensified by enhanced bacterial adhesion and formation of dental plaque on brackets. Our aim in this in-vitro study was to investigate the susceptibility of various plastic bracket materials to the adherence of Streptococcus mutans. METHODS The esthetic bracket raw materials included in this study were polyoxymethylene, polycarbonate, high-density polyethylene, and an experimental polymer (90% polyethylene). Surface roughness was assessed by perthometer. S mutans suspension was incubated with test specimens and examined with fluorescence dye and an automated multi-detection reader. The oxidation-reduction fluorescence dye Alamar Blue/resazurin (0.007536 g per 10 mL distilled water) was used to determine the quantity of bacterial adhesion. RESULTS The median values of fluorescence intensity varied between approximately 600 and 1600. The lowest fluorescence with median values below 700, indicating low bacterial adhesion, was found for polyoxymethylene (median of relative fluorescence intensity, 635). The highest relative fluorescence intensity, with median values of more than 1500, was for high-density polyethylene (1565). No statistical alteration of fluorescence intensity was measured between the polymeric bracket materials. CONCLUSIONS The investigated polymeric bracket materials had no significant differences in the quantities of S mutans adhering to them. Regardless of the polymer, plastic bracket materials have similar bacterial colonization and plaque accumulation properties.