Early Biofilm Formation on Rough and Smooth Titanium Specimens: a Systematic Review of Clinical Studies

Abstract

Objectives: There is a concern whether the enhancement on implant surface roughness is responsible for higher biofilm formation, which acts as an aetiological factor for peri-implant diseases. The aim of the present systematic review was to answer the following question: "Are rough surfaces more susceptible to early biofilm formation when compared to smoother surfaces on titanium specimens?". Material and Methods: The research was performed on PubMed, Web of Science and Scopus, up to August 2021. Eligibility criteria included studies that analysed human biofilm formation on titanium specimens with distinct surface roughness (smooth vs minimally, moderate, or rough) over the experimental times of 1 or 3 days. Roughness average (Ra) and biofilm analysis parameters were extracted from selected articles. Risk of bias was evaluated using the Checklist for Quasi-Experimental Studies. Results: Of 5286 papers, 5 were included and analysed. Smooth titanium surfaces included machined and anodized titanium/ Ti-6Al-4V; machined and acid etched TiZr. Minimally, moderately, or rough surfaces comprised titanium and titanium alloys (TiZr, Ti-6Al-4V), that received surface treatments (anodization, acid-etching, blasting, hydroxyapatite-coating). No statistically significant difference on biofilm formation on rough and smooth titanium surfaces was reported by 3 studies, while more contamination on rough titanium surfaces was stated by 2 investigations. An isolated smooth surface has also been associated to higher contamination. Moderate to high quality methodological assessment of studies were identified. Conclusions: It is not possible to assume that rough surfaces are more susceptible to early biofilm formation than smooth titanium surfaces. Additional studies are required to study this multifarious interaction.

Evaluation of Adhesion and Viability of Human Gingival Fibroblasts on Strontium-Coated Titanium Surfaces: an in vitro Study

“…Rough surfaces enable more cell adhesion and proliferation compared to smooth ones, but they also allow undesirable bacterial adhesion and biofilm formation. 14,15 Previous studies demonstrated that increasing the roughness of implant components in contact with soft tissues might cause peri-implant tissue inflammation. 14,15,31 Moreover, gingival fibroblasts on smooth polished surfaces were spread without specific orientation, leading to poorer adhesion and proliferation.…”

“…14,15 Previous studies demonstrated that increasing the roughness of implant components in contact with soft tissues might cause peri-implant tissue inflammation. 14,15,31 Moreover, gingival fibroblasts on smooth polished surfaces were spread without specific orientation, leading to poorer adhesion and proliferation. 32 In this study, Sr-coated wafers have shown increased cell attachment and viability and, thus, could possibly provide a solution for low cell attachment to the smooth surfaces.…”

“…5 Even though a rough surface increases BIC and fibroblast cell adhesion, it is associated with a higher risk of peri-implant infections due to bacterial attachment and biofilm formation. 14,15 Other strategies involving multifunctional coatings on Ti implant surfaces, eg, antibiotics, antimicrobial peptides, and polysaccharides have been proposed for peri-implant infection prevention. [16][17][18] However, there are some concerns regarding using such strategies, eg, cytotoxicity, coating stability, and bacterial resistance, further accentuating the need for the development of multifunctional coatings improving the osseointegration and periimplant soft tissue adhesion, while preventing peri-implant infections simultaneously.…”

Generating bioactive and antiseptic interfaces with nano-silver hydroxyapatite-based coatings by pulsed electrochemical deposition for long-term efficient cervical soft tissue sealing

“…70 Usually, less bacterial adhesion on smooth surface was always in contradiction to better adhesion and bioactive induction to natural mesenchymal cells. Gingival cells gained adhesive advantage because the surface roughness of coating in the 1.5Ag/CaP group was regarded as ''moderate rough'', 71 which was proven to have stronger cellular adhesion and response than smoother or rougher surfaces. 72 However, because of the poor post-operation self-nursing in Beagles, it is necessary to further tackle the problem that the Ag-HA coatings cannot eradicate bacterial biofilms or prevent and reduce bacterial adherence.…”

Biological properties of Cu-bearing and Ag-bearing titanium-based alloys and their surface modifications: A review of antibacterial aspect

“…In addition, the methods commonly used to quantify the microbial biofilm or to observe the morphological changes include colony forming unit (CFU), scanning electron microscopy (SEM), confocal laser scanning microscopy (CLSM), real-time quantitative polymerase chain reaction, fluorescence in situ hybridization (FISH), etc. (Scheeren Brum et al, 2021). The methods like crystal violet assay, percentage transmission (%T) or percent transmittance (%T) and XTT reduction assay are characterized by high reliability, low-cost effectiveness and high sensitivity (Dhale et al, 2014).…”