Simonetta D'Ercole

Bacterial Leakage in Implants With Different Implant–Abutment Connections: An In Vitro Study

BACKGROUND Two-piece implants present gaps and cavities between the implant and the abutment, and these hollow spaces can act as a trap for bacteria. The aim of the present in vitro study was to evaluate the migration of two different microbial species from the inside to the outside of the implant-abutment assembly in three different connection types. METHODS A total of 30 implants (10 implants per group) were used. The implants presented a screwed trilobed connection (group 1), a cemented connection (group 2), and an internal conical connection (group 3). The inner parts of five implants, per group, were inoculated with Pseudomonas aeruginosa suspension and the remaining five implants, per group, with Aggregatibacter actinomycetemcomitans. The penetration of bacteria into the surrounding solution was determined by the observation of turbidity of the broth. RESULTS In group 1, bacterial contamination was found in six of 10 implants. In group 2, no contaminated samples were found. In group 3, bacterial contamination was found in one implant of 10. Statistically significant differences were detected between group 1 versus group 3 (P <0.05) and between group 1 versus group 2 (P <0.01), whereas no significant differences were found when comparing group 2 versus group 3 (P >0.05). CONCLUSION The present study confirms previous results about the hermeticity of the cement-retained implant-abutment assembly, the very low permeability to bacteria of the conical implant-abutment connection, and the high prevalence of bacterial penetration of screw-retained implant-abutment assemblies.

Clinical, microbiologic, and biochemical effects of subgingival administration of a xanthan-based chlorhexidine gel in the treatment of periodontitis: a randomized multicenter trial.

BACKGROUND The use of locally delivered antibacterials containing chlorhexidine (CHX) was proposed to improve the effectiveness of non-surgical periodontal treatment. The present multicenter randomized study investigated the effects of a xanthan-based chlorhexidine (Xan-CHX) gel used as an adjunct to scaling and root planing (SRP) in the treatment of chronic periodontitis. METHODS Ninety-eight systemically healthy subjects with moderate to advanced periodontitis were recruited in four centers (59 females and 39 males; aged 24 to 58 years). For each subject, two experimental sites located in two symmetric quadrants were chosen with probing depths (PD) >or=5 mm and positive for bleeding on probing (BOP). These two sites were randomized at the split-mouth level with one receiving a single SRP treatment and the other receiving a single SRP + Xan-CHX gel treatment. Supragingival plaque, modified gingival index, PD, clinical attachment level (CAL), and BOP were evaluated at baseline (prior to any treatment) and after 3 and 6 months. At the same times, subgingival microbiologic samples and gingival crevicular fluid (GCF) were collected for the analysis of total bacterial counts (TBCs), including the identification of eight putative periodontopathogens, and alkaline phosphatase (ALP) activity, respectively. RESULTS The Xan-CHX treatment group showed greater improvements compared to the SRP group for PD and CAL at 3 and 6 months (P <0.001). The differences in PD reduction between the treatments were 0.87 and 0.83 mm at 3 and 6 months, respectively (P <0.001); for CAL, these were 0.94 and 0.90 mm, respectively (P <0.001). Similar behavior was seen when the subgroup of pockets >or=7 mm was considered. The percentage of sites positive for BOP was similar between the treatments at each time point. For the comparisons between the treatment groups, no differences were seen in the TBCs and GCF ALP activity at baseline and 6 months; in contrast, slightly, but significantly, lower scores were recorded for the Xan-CHX treatment group at 3 months (P = 0.018 and P = 0.045, respectively). Moreover, greater reductions in the percentages of sites positive for the eight putative periodontopathic bacteria were generally seen for the Xan-CHX treatment group compared to SRP alone. CONCLUSIONS The adjunctive use of Xan-CHX gel promoted greater PD reductions and CAL gains compared to SRP alone. These results were concomitant with better microbiologic and biochemical outcomes when Xan-CHX gel use was added to SRP, particularly up to 3 months after treatment.

Diagnosis in periodontology: a further aid through microbiological tests.

Most of the current knowledge of the complex microbiology of oral biofilms, which initiates and maintains periodontal lesions, has been facilitated by the introduction of molecular techniques. Several studies exalt the high sensitivity and specificity of molecular tests in the detection and quantification of periodontal pathogens. Although they have large a diffusion, the old method of bacterial culture remains nowadays the gold standard when determining the utility of a new microbial test. Moreover, cultures have the important advantage of allowing an antibiotic sensitivity test and this is much more important during the treatment of patients with aggressive periodontitis.

Implants with internal hexagon and conical implant-abutment connections: an in vitro study of the bacterial contamination.

Prevention of microbial leakage at the implant-abutment junction is a major challenge for the construction of 2-stage implants in order to minimize inflammatory reactions and to maximize bone stability at the implant neck. The aim of the present in vitro study was an evaluation of the leakage observed over a period of 28 days in Cone Morse taper internal connections and in screwed-abutments connections. In the present study 10 specimens of Cone Morse (Group 1) and 10 of internal hexagon (Group 2) implants were used. The inner parts of 5 implants per group were inoculated with Pseudomonas aeruginosa (PS) suspension and 5 implants per group with Aggregatibacter actinomycetemcomitans (AA). The possible penetration of bacterial suspension into the surrounding solution was determined by the observation of turbidity of the broth. In Group 1, bacterial contamination was found in 3 out of 5 implant-abutment assemblies seeded with the PS and in 2 samples out of 5 in the assemblies seeded with AA, with a total of leaked assemblies in this group of 5 out of 10. In Group 2, bacterial contamination was found in 4 out of 5 implant-abutment assemblies seeded with the PS, and in 4 out of 5 samples seeded with AA, with a total of leaked assemblies of 8 out of 10. The present data confirm the reported high permeability to bacterial leakage of screw-retained abutment connections, and the lower infiltration rates-although not significantly-of Cone Morse taper internal connections.

Microbiological and biochemical effectiveness of an antiseptic gel on the bacterial contamination of the inner space of dental implants: a 3-month human longitudinal study.

Microbial penetration inside the implants internal cavity produces a bacterial reservoir that is associated with an area of inflamed connective tissue facing the fixture-abutment junction. The aim of this clinical trial is to evaluate the effectiveness of a 1% chlorhexidine gel on the internal bacterial contamination of implants with screw-retained abutments and on the level of AST secreted in peri-implant crevicular fluid. Twenty-five patients (aged 29 to 58 years) each received one implant. Three months after the end of the restorative treatment, and immediately after a clinical and radiographic examination and the abutment removal, microbiological samples were obtained from the internal part of each fixture and biochemical samples were collected by peri-implant sulci. The patients were then divided into two groups: the control (CG; n=10) and test (TG; n=15) groups. The CG had the abutment screwed into place and the crown cemented without any further intervention. In contrast, before the abutment placement and screw tightening, the TG had the internal part of the fixture filled with a 1% chlorhexidine gel. Three months later, the same clinical, microbiological and biochemical procedures were repeated in both groups. Total bacterial count, specific pathogens and AST activity were detected. The clinical parameters remained stable throughout the study. From baseline to the 3-month examination, the total bacterial counts underwent a significant reduction only in the TG. In contrast, the AST activity showed a significant increase in the CG. The administration of a 1% chlorhexidine gel appears to be an effective method for the reduction of bacterial colonization of the implant cavity and for safeguarding the health status of peri-implant tissue over a 3-month administration period.

In vitro inactivation of Enterococcus faecalis with a led device.

Non-coherent light-emitting diodes (LEDs) are effective in a large variety of clinical indications; however, the bactericidal activity of LEDs is unclear, although the effectiveness of such lights is well known. Currently, no studies have examined the effects of NIR-LED on bacteria. The aims of this study were to verify the antibacterial activity of 880-nm LED irradiation on a bacterial suspension of Enterococcus faecalis and to compare it with the actions of sodium hypochlorite (NaOCl) and the concurrent use of both treatments. Before we proceeded with the main experiment, we first performed preliminary tests to evaluate the influence of such parameters as the distance of irradiation, the energy density, the irradiation time and the presence of photosensitizers on the antimicrobial effects of LEDs. After treatment, the colony forming units per milliliter (CFU/mL) was recorded and the data were submitted to ANOVA and Bonferroni post hoc tests at a level of significance of 5%. The results showed that LED irradiation, at the parameters used, is able to significantly decrease E. faecalis viability in vitro. The total inhibition of E. faecalis was obtained throughout concurrent treatment of LED and NaOCl (1%) for 5min. The same antimicrobial activity was confirmed in all of the experiments (p<0.05), but no statistically significant differences were found by varying such parameters as the distance of irradiation (from 0.5mm to 10mm), energy density (from 2.37 to 8.15mJ/s), irradiation time (from 5min to 20min) or by adding toluidine blue O (TBO).

In vitro antimicrobial activity of LED irradiation on Pseudomonas aeruginosa

Pseudomonas aeruginosa is an opportunistic pathogen responsible of many deaths due to nosocomial pneumonia each year. It is particularly resistant to many different classes of antibiotics and disinfectants. For all these reasons, there is the necessity to find novel approaches of treatment. The aim of this study was to evaluate the effect of 880nm light emitting diodes (LED) irradiation on P. aeruginosa, in vitro. Different LED irradiation parameters (time, energy output and the addition of methylene blue and chlorhexidine) have been tested in order to evaluate the effects on this bacterium. After treatment, the colony forming units per milliliter (CFU mL-1) were recorded and the data were submitted to ANOVA and Bonferroni post hoc tests at a level of significance of 5%. A statistical significant reduction of bacterial count has been registered after 5min of LED irradiation. The antibacterial effect was directly proportional to irradiation time and the output energy. The pre-treatment with methylene blue, seems to be not effective against P. aeruginosa, independently from irradiation parameters. On the contrary, the contemporary action of LED and chlorhexidine has shown a great reduction of bacterial count that was statistical significant respect chlorhexidine and LED alone. The effect of LED irradiation was visible also after 24h, when a lower bacterial count characterized all irradiated samples respect controls.