Kotsakis Georgios A, Lan Caixia, Barbosa Joao, Lill Krista, Chen Ruoqiong, Rudney Joel, Aparicio Conrado
Department of Periodontics, University of Washington, Seattle, WA.
Department of Restorative Sciences, University of Minnesota, Minneapolis, MN.
J Periodontol. 2016 Jul;87(7):809-19. doi: 10.1902/jop.2016.150684. Epub 2016 Feb 28.
Chemotherapeutic agents (ChAs) are considered an integral part of current treatment protocols for the decontamination of titanium implants with peri-implantitis, based on their antimicrobial effect. Despite the proven antimicrobial effect of ChAs on titanium-bound biofilms, previous studies have elucidated an unexpected disassociation between bacterial reduction and biologically acceptable treatment outcomes. In this study, the authors hypothesize that ChAs residues alter titanium physicochemistry and thus compromise cellular response to decontaminated surfaces.
Grit-blasted acid-etched titanium disks were contaminated with multispecies microcosm biofilms grown from in vivo peri-implant plaque samples. To simulate implant decontamination, the contaminated disks were burnished with 0.12% chlorhexidine, 20% citric acid, 24% EDTA/1.5% NaOCl, or sterile saline and assessed surface physicochemical properties. Sterile untreated surfaces were the controls. The biologic effects of decontamination were assessed via cell proliferation and differentiation assays.
Bacterial counts after decontamination confirmed that the ChAs were antimicrobial. X-ray photoelectron spectroscopy invariably detected elemental contaminants associated with each ChA molecule or salt that significantly altered wettability compared with controls. Notably, all surfaces with ChA residues showed some cytotoxic effect compared with controls (P <0.05). Increased cell counts were consistently found in the saline-treated group compared with chlorhexidine (P = 0.03). Interestingly, no association was found between antimicrobial effect and cell counts (P >0.05).
ChA-specific residues left on the titanium surfaces altered titanium physical properties and adversely affected the osteoblastic response irrespective of their observed antimicrobial effect. Chlorhexidine may compromise the biocompatibility of titanium surfaces, and its use is not recommended to detoxify implants. Sterile saline, citric acid, and NaOCl-EDTA may be proposed for use in the treatment of peri-implantitis. Contrary to previous studies that recommended the selection of ChAs for the decontamination of titanium implants according to their antimicrobial effects, the present study demonstrated that the restoration of the biocompatibility of contaminated titanium surfaces is also contingent on the preservation of titanium material properties.
基于化疗药物（ChAs）的抗菌作用，其被视为当前种植体周围炎钛种植体去污治疗方案的一个组成部分。尽管已证实ChAs对钛结合生物膜具有抗菌作用，但先前的研究已阐明细菌减少与生物学上可接受的治疗结果之间存在意外的脱节。在本研究中，作者假设ChAs残留物会改变钛的物理化学性质，从而损害细胞对去污表面的反应。
用从体内种植体周围菌斑样本中生长的多物种微观生物膜污染喷砂酸蚀钛盘。为模拟种植体去污，用0.12%氯己定、20%柠檬酸、24%乙二胺四乙酸/1.5%次氯酸钠或无菌盐水对污染的钛盘进行打磨，并评估表面物理化学性质。未处理的无菌表面作为对照。通过细胞增殖和分化试验评估去污的生物学效应。
去污后的细菌计数证实ChAs具有抗菌作用。X射线光电子能谱始终检测到与每个ChA分子或盐相关的元素污染物，与对照相比，这些污染物显著改变了润湿性。值得注意的是，与对照相比，所有带有ChA残留物的表面均表现出一定的细胞毒性作用（P<0.05）。与氯己定相比，盐水处理组的细胞计数持续增加（P = 0.03）。有趣的是，未发现抗菌作用与细胞计数之间存在关联（P>0.05）。
留在钛表面的ChA特异性残留物改变了钛的物理性质，并对成骨细胞反应产生不利影响，无论其观察到的抗菌作用如何。氯己定可能会损害钛表面的生物相容性，不建议使用其对种植体进行解毒。可建议使用无菌盐水、柠檬酸和次氯酸钠-乙二胺四乙酸来治疗种植体周围炎。与先前根据抗菌作用推荐选择ChAs对钛种植体进行去污的研究相反，本研究表明，污染钛表面生物相容性的恢复还取决于钛材料性能的保持。
