Abstract
Background Peri-implant mucositis and peri-implantitis are the main biological complications associated with dental implants. Since most authors agree that bacteria play a major etiological role, the main aims of this study were to determine if a formulation of erythritol and chlorhexidine applied with an air polishing system inhibits biofilm regrowth over dental implants and to compare the decontamination capacity of this therapy with that of mechanical removal by saline and gauze.Material and Methods A multispecies biofilm (P. gingivalis, A. actinomycetemcomitans, F. nucleatum, A. naeslundii, V. parvula and S. oralis) was grown for 14 days on 52 dental implants in an artificial mouth. These implants were divided into three groups according to the applied treatment: 14 negative control (CON), 19 erythritol-chlorhexidine (ERY) and 19 gauze with saline (GAU) samples. Twelve dental implants from the ERY and GAU groups and 8 implants from the CON group were re-incubated for 7 additional days after treatment. The bacterial count was performed by quantitative polymerase chain reaction (qPCR) using propidium monoazide (PMA). A descriptive and bivariate analysis of the data was performed.Results The erythritol and chlorhexidine formulation significantly inhibited biofilm regrowth in comparison with the mechanical treatment (GAU), since a significant decrease in all the species was observed in the ERY group (except for Aggregatibacter actinomycetemcomitans). The antibiofilm and antibacterial capacity of the two active treatment groups (ERY and GAU) was similar for a 14 days multispecies in vitro biofilm, except for the lower count of A. naeslundii in the GAU group.Conclusions The use of erythritol powder with chlorhexidine applied with an air polishing system reduces biofilm regrowth over dental implants when compared with mechanical removal by saline and gauze. This effect might be beneficial for patients included in peri-implant maintenance programs. Key words:Dental implants, biofilms, peri-implantitis, erythritol, chlorhexidine.
Highlights
Dental implants have become the gold standard when aiming at reconstruction of missing teeth
The use of erythritol powder with chlorhexidine applied with an air polishing system reduces biofilm regrowth over dental implants when compared with mechanical removal by saline and gauze
Due to the results found in the ERY group, 2 negative control implants and 2 implants treated with erythritol were examined under a scanning electron microscope (Merlin FESEM®, Carl Zeiss, Oberkochen, Germany) at 30,000x in order to detect surface alterations after treatment. - Statistical analysis A descriptive analysis of the data was performed with the Statistical Package for Social Sciences software (SPSS v22.0; IBM Corp, Armonk, New York)
Summary
Dental implants have become the gold standard when aiming at reconstruction of missing teeth. Biofilms are surface-adhered microbial communities embedded in a self-produced matrix [5]. These organized communities represent a significant health risk due to their resistance to host-defense mechanisms and their decreased susceptibility to conventional antimicrobials. Biofilm-mediated resistance has been attributed to impaired penetration of antimicrobials through the matrix, increased expression of drug-resistance genes, and reduced metabolic activity of cells residing in the biofilm. Because of their involvement in bacterial infections in humans, biofilms have been the subject of intensive research for many years [5]
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