Efficiency of biofilm removal by combination of water jet and cold plasma: an in-vitro study

Abstract

Background Peri-implantitis therapy is a major problem in implantology. Because of challenging rough implant surface and implant geometry, microorganisms can hide and survive in implant microstructures and impede debridement. We developed a new water jet (WJ) device and a new cold atmospheric pressure plasma (CAP) device to overcome these problems and investigated aspects of efficacy in vitro and safety with the aim to create the prerequisites for a clinical pilot study with these medical devices. Methods We compared the efficiency of a single treatment with a WJ or curette and cotton swab (CC) without or with adjunctive use of CAP (WJ + CAP, CC + CAP) to remove biofilm in vitro from rough titanium discs. Treatment efficacy was evaluated by measuring turbidity up to 72 h for bacterial re-growth or spreading of osteoblast-like cells (MG-63) after 5 days with scanning electron microscopy. With respect to application safety, the WJ and CAP instruments were examined according to basic regulations for medical devices. Results After 96 h of incubation all WJ and CC treated disks were turbid but 67% of WJ + CAP and 46% CC + CAP treated specimens were still clear. The increase in turbidity after WJ treatment was delayed by about 20 h compared to CC treatment. In combination with CAP the cell coverage significantly increased to 82% (WJ + CAP) or 72% (CC + CAP), compared to single treatment 11% (WJ) or 10% (CC). Conclusion The newly developed water jet device effectively removes biofilm from rough titanium surfaces in vitro and, in combination with the new CAP device, biologically acceptable surfaces allow osteoblasts to grow. WJ in combination with CAP leads to cleaner surfaces than the usage of curette and cotton swabs with or without subsequent plasma treatment. Our next step will be a clinical pilot study with these new devices to assess the clinical healing process.

In-Vitro Biofilm Removal Efficacy Using Water Jet in Combination with Cold Plasma Technology on Dental Titanium Implants

“…The CAP discharge properties were comparable to the formerly used plasma source kINPen 09 [ 32 ]. The ability of CAP to enhance the wettability on titanium implant surfaces was previously presented [ 58 ], which supports human cell attachment and possibly subsequent healing processes [ 46 , 52 , 59 , 60 , 61 ]. For implant treatment, the CAP device was hand-held and moved in angles between 20° and 90° horizontally and vertically along the implant (fixed in the microtiter plate model, see above) for 120 s ( Figure 1 c).…”

Effects of Cold Atmospheric Plasma Pre-Treatment of Titanium on the Biological Activity of Primary Human Gingival Fibroblasts

“…This is in line with other findings [ 22 ]. The improvement in initial attachment demonstrated in this study provides the opportunity for use of cold atmospheric plasmas in implantology, both in primary implant placement and in the regeneration of lost attachment due to peri-implantitis [ 33 , 34 ]. Additionally, cold atmospheric plasmas can be used for the disintegration of biofilms on implant surfaces [ 35 ].…”

The applications of cold atmospheric plasma in dentistry

“…Currently, there are no evidencebased guidelines or protocols for the nonsurgical and surgical therapy of peri-implantitis. [74,75] The microbiota associated with peri-implantitis is dominated by wellknown periodontal pathogens such as P. gingivalis, T. forsythia, and Treponema denticola, suggesting that similar antimicrobial strategies used in periodontal disease, such as manual or mechanical biofilm removal, may be applied. [67,76] However, the complex geometries of the implant surface and peri-implant defects create an additional challenge for successful instrumentation and decontamination.…”

“…It also has the potential to perform biocompatible surface modifications, influencing cell adhesion, or enabling the addition of antibacterial coatings and promoting wound healing properties. [75,77] Studies have shown that using cold plasma alone or in combination with mechanical pretreatment can effectively decontaminate surfaces under specific conditions. [9] For instance, Carreiro et al studied the effect of LTP on P. gingivalis biofilm and a reconstituted human gingival epithelium.…”

“…It also has the potential to perform biocompatible surface modifications, influencing cell adhesion, or enabling the addition of antibacterial coatings and promoting wound healing properties. [ 75,77 ]…”