Sebastian Hahnel

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.

Streptococcal adhesion to novel low-shrink silorane-based restorative

OBJECTIVES The aim of the present study was to compare the susceptibility of one novel silorane-based and four widely used conventional methacrylate-based resin composites to adhere oral streptococci and to relate any differences to surface roughness, hydrophobicity and type of matrix. METHODS Specimens of restoratives Filtek Silorane, Filtek Z250, Tetric EvoCeram, Quixfil and Spectrum TPH were prepared (10.0-mm diameter, 2.0-mm height). Surface roughness was assessed by perthometer measurements and hydrophobicity according to water contact angles was determined by computerized image analysis. Bacterial suspensions of Streptococcus oralis, Streptococcus sanguinis, Streptococcus gordonii and Streptococcus mutans were incubated for 2.5 h at 37 degrees C with 15 test specimens for each material and adhesion was quantified with fluorescence dye Alamar Blue/Resazurin and an automated multi-detection reader. Glass served as reference. Statistical analysis was performed using the Mann-Whitney U-test (alpha=0.05). RESULTS Median roughness values of all composites ranged between 0.04 and 0.11 microm, median contact angles between 59.7 degrees and 92.1 degrees. Significantly lowest fluorescence intensities of all test materials were found on Filtek Silorane for three of four streptococcal strains. The fluorescence intensities of the four conventional methacrylate resin composites were significantly higher and comparable among each other. SIGNIFICANCE When compared against four conventional methacrylate composite resins, a general significance to a lower quantity of adhering streptococci was found on the novel silorane-based composite resin, which might result from its increased hydrophobicity. The low adhesion potential of the silorane-based composite may potentially improve the longevity of direct fillings and reduce recurrent caries.

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.

Wear performance of substructure ceramics and veneering porcelains

AIM The aim of this in vitro study was to compare the two-body wear resistance of substructure zirconia and veneering porcelain versus steatite and human enamel antagonists, respectively. MATERIALS AND METHODS Two-body wear tests were performed in a chewing simulator with steatite and enamel antagonists (enamel cusps). A pin-on-block design with a vertical load of 50 N for 1.2 × 10(5) cycles; (f=1.6 Hz; lateral movement: 1mm, mouth opening: 2mm) was used for the wear test. For quantification of the wear resistance, wear tests were performed with standardized steatite spheres. Human enamel was used as a reference. Five zirconia ceramics and four veneering porcelains were investigated. One zirconia ceramic was tested with superficial glaze, which was applied after polishing or sandblasting, respectively. Surface roughness R(a) (SP6, Perthen-Feinprüf, G) and wear depth were determined using a 3D-Profilometer (Laserscan 3D, Willytec, G). SEM (Quanta FEG 400, FEI, USA) pictures were used for evaluating wear performance of both, ceramics and antagonists. RESULTS No wear was found for zirconia substructures. Veneering porcelain provided wear traces between 186.1±33.2 μm and 232.9±66.9 μm (steatite antagonist) and 90.6±3.5 μm and 123.9±50.7 μm (enamel). Wear of the steatite antagonists varied between 0.812±0.256 mm(2) and 1.360±0.321 mm(2) for zirconia and 1.708±0.275 mm(2) and 2.568±0.827 mm(2) for porcelain. Enamel generally showed wear, cracks or even fractures at the ridge, regardless whether opposed by zirconia or porcelain/glaze. Enamel was polished, when opposed to zirconia, or plowed, provoked and grinded, when opposed to porcelain/glaze. CONCLUSION The results of the wear test with steatite or enamel antagonists indicated no measurable wear on zirconia surfaces. Porcelain showed higher wear than zirconia, but comparable or lower wear than an enamel reference. Antagonistic wear against zirconia was found to be lower than wear against porcelain.

Wear performance of dental ceramics after grinding and polishing treatments.

AIM The aim of this in vitro study was to determine the two-body wear resistance of different dental ceramics after grinding and polishing treatments. MATERIAL AND METHODS Standardized specimens were prepared from three zirconia and two veneering ceramics and were subjected to different surface treatments. Zirconia ceramics were polished, ground and repolished, veneering ceramics were ground and repolished. One zirconia ceramic was investigated with a superficial glaze. Human enamel was used for reference. Surface roughness R(a) was determined using a profilometric contact surface measurement device. Two-body wear tests were performed in a chewing simulator with steatite and enamel antagonists, respectively. Specimens were loaded pneumatically in a pin-on-block design for 1.2x10(5) mastication cycles (50 N, 1.2 Hz, lateral movement: 1 mm, mouth opening: 2 mm) under simultaneous thermal cycling (600 cycles, 5/55 °C). Wear depths of specimens were determined using a 3D laser scanning device, wear areas of steatite antagonists were measured by means of light-optical micrographs. Means and standard deviations were calculated, and statistical analysis was performed using one-way analysis of variance (ANOVA) and the Bonferroni multiple comparison test for post hoc analysis (α=0.05). Scanning electron microscopy was applied for evaluating the wear performance of ceramics and antagonists. RESULTS No wear was found for polished, ground and repolished zirconia. Compared to the wear depths of the enamel reference with 274.1±187.4 μm versus steatite and 123.3±131.0 μm versus enamel, relative wear depths of porcelains ranged between 0.54±0.07 and 0.62±0.09 with steatite antagonists and between 0.66±0.26 and 1.04±0.27 with enamel antagonists. Relative wear areas of steatite antagonists (enamel reference: 1.25 mm(2)) varied between 0.84±0.13 and 1.90±0.29 for zirconia and between 1.97±0.38 and 2.47±0.40 for porcelains. Enamel antagonists generally showed wear, cracks or even fractures, but revealed smooth surfaces when opposed to polished/ground/repolished zirconia and ploughed surfaces when opposed to ground/repolished porcelains or glaze. CONCLUSIONS Zirconia ceramics yielded superior wear behavior and lower antagonistic wear compared to porcelains. A trend to higher ceramic and antagonistic wear was shown after grinding treatments.

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.

Efficacy of denture disinfection methods in controlling Candida albicans colonization in vitro

Objective. The aim of this study was to rank 10 denture disinfection methods according to their efficacy in reducing Candida albicans (C. albicans) colonization on soft denture relining material. Material and Methods. Circular specimens (diameter 8 mm) were made of soft denture relining material (Mucopren E, Kettenbach) and thermally aged. Specimens were incubated with C. albicans (strain 1386, DSMZ) followed by 1 of 10 disinfection procedures (6 soaks, 2 microwave irradiation regimes, 1 effervescent commercial cleansing product, and denture left dry overnight). Incubation with phosphate buffered saline (PBS) served as a control. Adhering fungi were quantified using a bioluminometric assay in combination with an automated plate reader for cell quantification. Scanning electron micrographs (SEMs) were made for validation. Results. Low median luminescence intensities indicated the presence of a few viable fungi after the soaking of specimens in sodium hypochlorite (10 relative luminescence units (rlu)), microwave irradiation immersed in water (8 rlu), and application of effervescent cleansing tabs (22 rlu). No statistically significant difference (p>0.05) to control PBS (200 rlu) was found after immersion in hydrogen peroxide (172 rlu), glutaraldehyde (103 rlu), household vinegar (196 rlu), Listerine coolmint (194 rlu), Plax (222 rlu), dry microwave irradiation (221 rlu) and specimens left dry overnight (165 rlu). SEM displayed C. albicans monolayers with different morphologic forms on each surface investigated. Conclusions. Only soaking in sodium hypochlorite (1%; 10 min), microwave irradiation immersed in water (800 W; 6 min), and application of effervescent cleansing tabs (Blend-a-dent tabs; 10 min) proved to be effective against C. albicans colonization on soft denture relining material.

In vitro failure and fracture resistance of veneered and full-contour zirconia restorations.

OBJECTIVES This study evaluated the failure and fracture resistance of zirconia-based fixed partial dentures (FPDs) under the influence of different surface treatments and adjustment procedures. METHODS Seven groups (n=8/group) of three-unit zirconia-based FPDs were fabricated in anatomic design (AD) or anatomically reduced design (ARD) and surfaces were prepared according to clinical relevance: #1: AD - sintered; #2: AD - sintered - glazed; #3: AD - sintered - sandblasted - glazed; #4: AD - sintered - polished - grinded (contact points adjusted); #5: AD - sintered - polished - grinded - repolished; #6: ARD - sintered - veneered; #7: control: analogous to #3 but without thermal cycling (TC) and mechanical loading (ML). FPDs were adhesively bonded to polymethylmethacrylate abutment teeth. TCML (TC: 6000 × 5°/55°; ML: 1.2 × 10(6)× 50 N, 1.6 Hz) was conducted in a chewing simulator with steatite spheres as antagonists. Failures were monitored and fracture resistance was determined after ageing. Data were analysed statistically with Mann-Whitney U-test (Kolmogorov-Smirnov-test; α=0.05). FPDs were subjected to scanning electron microscopy for fractographic failure analysis. RESULTS None of the FPDs failed during TCML, but showed wear at contact points. Median fracture force ranged between 1173.5 N (#4) and 1316.0 N (#3) without significant (p=0.910) differences between the groups or in comparison to the control (p>0.462). CONCLUSIONS Zirconia restorations showed high resistance to failures and fracture under different surface treatment variations. Full-contour polished or glazed zirconia FPDs might be an alternative to common veneered restorations.