Biofilm Models for the Evaluation of Dental Treatment.

When analyzing the activity of antimicrobial agents, it should be considered that microorganisms mainly occur in biofilms. Data obtained for planktonic bacteria cannot be transferred non-critically to biofilms. Biofilm models should consider both the relevant microorganisms and the conditions present in the environment. The selection of the model depends on the question to be answered. In dentistry, single species, multispecies, or microcosms originating from saliva or dental biofilm are used to culture biofilms. Microorganism selection depends on the focus of the study, for example caries biofilms mostly include Streptococcus mutans, an endodontic biofilm consists mostly of Enterococcus faecalis, and defined anaerobes are used in periodontal/peri-implant biofilms. In contrast to single-species biofilm models in medicine, where the lowest concentration of the antimicrobial that kills microorganisms is measured, the common analyzed variables are counts of colony-forming units or the percentage of dead bacteria determined by confocal laser scanning microscopy after applying a differentiating stain. All the models are helpful to evaluate new antimicrobial treatment options. Conclusions regarding the antimicrobial activity tendency of the therapeutics can be drawn. However, there are limitations of the model and ultimately a new therapy has to be proven in randomized controlled clinical trials.