Abstract
Peri-implant infections from bacterial biofilms on artificial surfaces are a common threat to all medical implants. They are a handicap for the patient and can lead to implant failure or even life-threatening complications. New implant surfaces have to be developed to reduce biofilm formation and to improve the long-term prognosis of medical implants. The aim of this study was (1) to develop a new method to test the antibacterial efficacy of implant surfaces by direct surface contact and (2) to elucidate whether an innovative antimicrobial copolymer coating of 4-vinyl-N-hexylpyridinium bromide and dimethyl(2-methacryloyloxyethyl) phosphonate (VP:DMMEP 30:70) on titanium is able to reduce the attachment of bacteria prevalent in peri-implant infections. With a new in vitro model with semi-coated titanium discs, we were able to show a dramatic reduction in the adhesion of various pathogenic bacteria (Streptococcus sanguinis, Escherichia coli, Staphylococcus aureus, Staphylococcus epidermidis), completely independently of effects caused by soluble materials. In contrast, soft tissue cells (human gingival or dermis fibroblasts) were less affected by the same coating, despite a moderate reduction in initial adhesion of gingival fibroblasts. These data confirm the hypothesis that VP:DMMEP 30:70 is a promising antibacterial copolymer that may be of use in several clinical applications.
Highlights
In almost all medical disciplines, implant systems are of increasing importance as a temporary or permanent replacement of lost organ functions
One disc is coated with the substance and the other is an uncoated disc as control. The limitation of this approach is that—even if there is an antibacterial effect—it remains unclear after microscopy whether this is caused by direct contact or by release of antibacterial substances from the surface coating into the medium
The results indicate that S. mutans was initially barely able to adhere to the coating, but grows it is stressed by the surface
Summary
In almost all medical disciplines, implant systems are of increasing importance as a temporary or permanent replacement of lost organ functions. There have been continuous improvements in implant materials and techniques, as well as tissue integration and compatibility, implant infections still represent a long-term threat to prosthetic treatment in various medical fields, such as orthopedics, dentistry, heart surgery and otolaryngology [1,2]. Implant-associated infections are caused by bacterial biofilms forming on the implant surface. Possible reasons for biofilm formation include intraoperative contamination, systemic spreading and permanent transcutaneous passages. The interaction between implant and tissue—with all its limitations in comparison to a natural interface—supports lasting bacterial adhesion to artificial surfaces, biofilm formation and subsequent infection of peri-implant tissue and, at worst, the loss of the implant or its function. Medical treatment of biofilm-related infections is to this day not effective, since bacteria organized in biofilms exhibit greater resistance to external influences, such as antibiotics and the host’s immune system, than planktonic bacteria [5,6]
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