Bacterial Adhesion on Dental Fixed

Prosthetic Materials. Interaction with

Physicochemical Surface Properties

Course Name: An Overview on Biomaterials

Course Code: 09702

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 Introduction

• Dental plaque⁄biofilm formation on teeth and

restorative materials plays an important role
in the pathogenesis of oral diseases.

• So, it attracted the attention to study biofilms

formation, composition, microbiology and
their interaction with physicochemical surface
properties of dental fixed prosthetic materials.

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Our Presentation Will Be Composed of Four
: Parts

Part I: Oral Biofilms

Part II: Dental Fixed Prosthetic Materials
Interaction with Physicochemical Surface :
Properties
Part III: Investigation of Oral Biofilms
Part VI: Control of Oral Biofilms
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 Part I: Oral Biofilms

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 History and Definition

,In 1976
,In 17th century Bowen W.H. defined dental
Anton Von Leeuwenhoek, plaque clinically as a
the inventor of the structured, resilient, yellow-
microscope, saw greyish substrate that adheres
microbial aggregates on tenaciously to the intraoral
scrapings of plaque from hard surfaces, including
removable and fixed
.his teeth .restorations

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 ,In 1989
,In 1978 Wilderer and Charakis
defined dental biofilm as a
Bill Costerton relatively undefinable
coined the term microbial community
associated with a tooth
.’‘Biofilm surface or any other hard
.non-shedding material

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 ,In 2002
Donlan and Costerton offered the most salient description of a
biofilm. They stated that biofilm is “a microbially derived sessile
community characterized by cells that are irreversibly attached
to a substratum or interface or to each other, embedded in a
matrix of extracellular polymeric substances that they have
produced, and exhibit an altered phenotype with respect to
”.growth rate and gene transcription

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 Composition of Oral Biofilms

microbial population 15-20%

matrix containing 80-85%

,extracellular polysaccharides
proteins, mineral salts
.and cellular material

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 Bacterial
Microbial 15-20%
Bacterial Biofilm

Population
Non-bacterial

Organic Material
Matrix 80-85%
Inorganic Material

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 Classification of Oral Biofilms

:On Basis of Location *

.Supragingival; Present coronal to the gingival margin
.Subgingival; Present apical to the gingival margin

* On Basis of Pathogenicity:
.Cariogenic; Generally acidogenic and gram+ve
.Periopathogenic; Mostly basophilic and gram-ve

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 Formation of A biofilm

• Biofilm formation in the oral cavity is a

gradated process consisting of four stages:

• 1- Acquired pellicle formation

• 2- Primary colonization
• 3- Coaggregation
• 4- Mature biofilm establishment

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 Microbiology of Biofilms

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 Properties of Biofilms

• When bacteria grow in the form of a biofilm, they work

together as a bacterial community, which gives them
the following properties:

• 1- Physiological heterogeneity
• 2- Increased phenotypic resistance
• 3- Quorum sensing (interbacterial communication)
• 4- Adaptive capacity
• 5- Resistance to antimicrobial agents

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 Biofilms and Infectious Diseases

Oral diseases Systemic diseases

Dental caries Otitis media

Musculoskeletal infections
Gingivitis
Osteomyelitis
Periodontitis
Native valve endocarditis
Peri-implantitis
Cystic fibrosis pneumonia

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 Part II: Dental Fixed Prosthetic Materials

Interaction with Physicochemical :

Surface Properties

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 Types of Fixed Prostheses

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 Materials Used for Fixed Prostheses

Metals Composites

Ceramics Polymers

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 Interaction of Biofilm with Dental Fixed
Prosthetic Materials
Components in materials will be biodegraded by the -
dental plaque, which will probably compromise the
marginal integrity and induce the development and
progression of secondary caries, periodontitis, and peri-
. implantitis

Also with time the material surface will become more -

rough which provides more surface area for bacterial
. adhesion and colonization

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 Factors Influencing the Adhesion and
Pathogenesis of Biofilms
:

A. Local Factors B. Systemic Factors

Physical Characteristics of -1 The Response of the Host -1

Dental Materials Immune System

Chemical Characteristics of -2
Other Factors -2
Dental Materials

Tooth 3- Abutment
Luting Agent -4

Oral Environment -5

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 Physical Characteristics of Dental -1
Materials
Surface Roughness )i(
• Surface roughness significantly affect bacterial
adhesion to fixed prosthetic materials.
• The irregularities of the material surface
promote bacterial adhesion and biofilm
deposition whereas the ultrasmooth surface
does not favor bacterial adhesion and biofilm
deposition.

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• A higher surface roughness increased biofilm
formation and maturation, independent of the
material.
• This may happen since a rough surface has a
greater surface area and the depressions in the
roughened surfaces provide a more favorable
sites for colonization and increased difficulty in
complete removal of the biofilm by mechanical
brushing.
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To reduce possible surface roughness effects, -
all substrata should be polished until a stylus
.surface roughness of < 0.1 μm is obtained

Quirynen et al. (1996), demonstrated the -

existence of a threshold roughness (roughness
of 0.2 μm) below which no further impact on
.the bacterial adhesion should be expected

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(ii) Surface Hardness
• Surface hardness means resistance to in
service scratching which develop a rough
surface for bacterial adhesion and
colonization.
• Metals and ceramics in constraint to
composites showed higher surface hardness
with more resistance to in service scratching.

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(iii) Surface Free Energy
• SFE is related to the wettability of the material
surface.
• Surfaces with a low surface free energy usually
display lower adherence to biofilms than similar
surfaces with higher surface energy.
• Most dental materials, with the exception of
ceramics, have a higher surface free energy than
enamel and have thus a greater risk of biofilm
accumulation.
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The SFE of a solid substrate could be examined
.by the static measurement of the contact angle

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If the water contact angle is < 90°, the solid -
.surface is considered hydrophilic with high SFE

If the water contact angle is > 90°, the solid -

.surface is considered hydrophobic with low SFE

Surface roughness plays a more important role

.than surface free energy

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Zeta Potential )Vi(
• Zeta Potential is an electrokinetic potential.

• Electrostatic interactions has been reported

during the adsorption of oral cavity bacteria to
the surfaces of dental materials, and this
phenomenon critically depends on zeta
potential.

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• Most of the oral bacteria have a negatively
charged surface. The larger the negative zeta
potential of a material, the higher the quantity
of bacterial adhesion.

• Scarano et al. (2004), attributed the low

bacterial adhesion on zirconium to the
electrical conductivity of the material.

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 Chemical Characteristics of Dental -2
Materials

The different dental biomaterials used for fixed

prosthetic restorations have different surface
; and bulk chemical composition

.which affect bacterial adhesion and colonization

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Resin-Based Composite )i(
• Although the composite resin has been widely
used in recent years for fabrication of direct
and indirect dental restorations, it has more
biofilm accumulation, more frequent
replacement, and shorter longevity.

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Biofilm formation is influenced by the surface
:chemical composition of the material including

Filler size, shape, and distribution -

Matrix composition -
And the proportions of resin matrix and filler -
.particles on the surface of RBC
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Up to now, there is still a high secondary caries -
rate, probably because of relatively few
commercially antibacterial resins materials
applied in clinic. In spite of, more and more
experimental antibacterial components and
.materials that have been produced in the lab

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 Metals and Alloys )ii(
The alloys for full-cast and porcelain-fused-to-
metal restorations, can be divided into three
: kinds

High-noble alloys (Au–Pt, Au–Pd, Au–Cu–Ag–Pd)

Noble alloys (Au–Cu–Ag–Pd, Pd–Cu, Pd–Ag)
.Base-metal alloys (Ni–Cr, Co–Cr, Ti)

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Oral microbial metabolites, such as acids, -
sulfides, and ammonia, can induce the microbial
.corrosion of metallic materials

Dental alloys corrode and release metal ions in -

the oral environment which may compromise
material biocompatibility and mechanical
properties, and lead to esthetic loss of dental
.restorations, and influence health
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(iii) Ceramic

• Due to compositional and microstructural

differences, bacterial colonization was thought
to differ from one ceramic material to another.

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(vi) Polymers

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Poly-ether-ether-ketone (PEEK) is a newly -
introduced polymer material that could be used in
.fixed prosthodontics to fabricate crowns, bridges

It shows high mechanical properties, -

.biocompatibility, resistance to hydrolysis and wear

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With regard to the influence of PEEK surface -
chemical composition on adhesion and
colonization of oral biofilms, a study conducted
by Etxeberria et al. (2013), showed less bacterial
adhesion on PEEK dental implant surfaces than
.titanium, zirconium, and Co-Cr alloys

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 Abutment -3

• Different sites in the oral cavity are

characterized by specific groups of bacteria:

• Higher levels of streptococcus species were

found in the sulcus fluid of the abutments
compared with residual teeth.
• Also microbial diversity of supra- and
subgingival biofilms on abutment teeth.
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Surface and geometry influences bacterial and -
.yeast colonization

Plaque retentive sites exist in fixed prostheses -

especially under the connectors and pontics.
Thus, a gap can boost the biofilm formation.
which increase the risk of invading bacteria
causing inflammation of gingival and periodontal
.tissues
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 Luting Agent -4

Excess cement (luting agent) in the sulcus may -

favor biofilm formation, and result in
inflammation of gingival tissues, which may
facilitate the development of periodontal
.inflammation and loss

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Resin cements have weak mechanical -
properties and are easily hydrolyzed by salivary
esterases that could be enhanced by cariogenic
. bacteria

The degraded dental resin usually have a weaker

mechanical strength and easier to debond at the
resin-tooth interface leaving a gap for more
. bacterial biofilms
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 Oral Environment -5

Saliva: - Oral salivary flow applies continuous

shear forces, and supplies proteins to bacteria,
.accelerating bacteria growth and metabolism
Moreover, saliva coating changes the -
physicochemical surface property of the
material and adds specific receptors for
microbial adhesion, then, influences bacteria
. adhesion

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PH: The pH range of 6 to 7 in saliva is
considered to be normal and any deviation from
.this range favors the plaque biofilm formation

Several studies have illustrated the significance -

.of the saliva as a buffer in maintaining the pH

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• Nutrients: nutrients including proteins,
carbohydrates, and amino acids in saliva
nourish the bacteria in dental plaque.
• Temperature: The normal temperature of the
oral cavity ranges from 36 to 37ͦ C. A slightest
change in temperature can result in the
relocation of the dominant species.

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Chemical reactions of the oral cavity: The -
redox reactions that are carried out by the
aerobic bacteria maintain the oxygen at a stable
level which in turn favors the bacterial biofilms
. to survive

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 B. Systemic Factors

• The response of the host immune system to

the bacterial challenge can significantly affect
the clinical outcome.
• It can result in either resolution of the
inflammation, or tissue destruction, since
immune response to bacteria and/or their by-
products can induce contradictory events by
playing both protective and destructive roles.

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Other factors such as diabetes, smoking and -
previous periodontitis history also affect the
occurrence of periodontal diseases that may
lead to bone resorption and eventually loss of
.the supporting tooth⁄ teeth

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 Part III: Methods of Investigation of Bacterial
Adhesion and Biofilm Formation

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• Importance of the study of biofilms: the
isolated bacteria (planktonic bacteria) behave
differently and have different properties than
bacteria that are organized in biofilms.

• These different properties give them increased

resistance to antiseptics and greater
pathogenicity.

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So, it is necessary to study the behavior of -
bacteria in biofilms to therefore prevent the oral
diseases they may cause. Most methods depend
on in vitro biofilm development for easier
. examination

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 Culture Plate

The mature treated biofilm is plated on the culture -

.media appropriate for its growth

Depending on the metabolic -

,characteristics of the species
different culture media are
.used

Then, the microbial population that has grown is -

.assessed (quantitatively and qualitatively)
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 Molecular Techniques

PCR (polymerase chain reaction)

.These are DNA extraction techniques
PCR: Qualitative. Detects DNA through gel -
electrophoresis signalling
PCR-RT (real time PCR): quantifies the product of this -
amplification as it is synthesised with fluorochromes
.PCR-RT-PMA (PCR-RT with propidium monoazide) -
When PMA is added, DNA from live and dead bacteria
.can be distinguished to thereby assess antiseptic efficacy

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 Microscopic Techniques

Scanning Electron Microscopy (SEM) -1

Confocal Laser Scanning Microscopy (CLSM) -2
Atomic Force Microscopy (AFM) -3

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 Part VI: Control of Oral Biofilms

Prevention

Removal Killing

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 :Prevention
Development of new materials with )i(
.antimicrobial properties
Improvement of physical and chemical )ii(
.properties of available materials
Proper design of restorative and prosthetic )iii(
materials; accurate design and adequate
.marginal fit
.Sound application techniques )iv(
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 :Killing
Using antibiotics )i(
Dentifrices and mouth washes containing )ii(
antimicrobial agents

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 Removal:
(i) Mechanical plaque control using tooth
brushes (both manual and electrical) and
interdental cleaning aids (dental floss,
interdental brushes).
(ii) Professional oral prophylaxis; calculus-
associated biofilms can effectively be removed
by scaling and root planning and tissue-
associated biofilms by gingival curettage.
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 Thank You

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