Optimizing citric acid protocol to control implant‐related infections: Anin vitroandin situstudy

Abstract

Objective The present study aimed to establish an optimized protocol for biofilm removal from titanium (Ti) surfaces using citric acid (CA) solutions. Background Biofilm accumulation is the main factor to trigger peri‐implant infections and to increase the risk of treatment failures. Although CA has been suggested as the anti‐infective agent with highest potential for biofilm removal on Ti, there is no consensus that CA could improve the anti‐infective treatment and its effect. Methods Physical and chemical alterations, electrochemical behavior, cytotoxicity, and antimicrobial effect of CA on Ti discs were evaluated using four concentrations (1, 10, 20, and 40%) and two application methods (immersion and rubbing). Negative control using 0.9% NaCl was used in all experiments. To evaluate whether different application times can have similar response, polymicrobial biofilm (microcosm model) was formed on Ti and treated with CA for 1, 2, 4, and 8 min. An in situ study was conducted to verify whether the established protocol is equally effective in biofilms formed on machined and sandblasted, large‐grit, and acid‐etched (SLA) Ti surfaces. Results CA 40% induced significantly higher surface alterations observed by confocal images and profilometry. In general, rubbing protocol decreased the surface roughness and increased the wettability (p < 0.05), exhibiting better surface cleaning by biofilm removal. CA 10% presented no indirect cytotoxicity and, when applied by rubbing for 8 min, presented proper in vitro antibacterial action and potential corrosion inhibition. When CA 10% was rubbed on Ti surfaces for 4 min, it displayed optimum cleaning ability as 8 min, working equally to remove in situ biofilm on machined and SLA surfaces. Conclusions The application of CA 10% by rubbing for at least 4 min demonstrated to be a promising protocol to eliminate biofilms formed in smooth and rougher surfaces, which could improve implant‐related infection therapies.

Insight Into Corrosion of Dental Implants: From Biochemical Mechanisms to Designing Corrosion-Resistant Materials

“…As the biofilm develops, oxidation reactions due to bacterial acidic metabolites and oxygen level deficiency may occur between the biofilm-covered Ti surface (cathodic area) and the exposed Ti (anodic area), increasing the corrosion rate of the implant material [ 17 ]. Additionally, biofilm decontamination by mechanical debridement and chemical methods, such as citric acid rubbing, may also induce Ti release from the implant surface [ 30 , 31 ].…”

Antimicrobial efficiency and cytocompatibility of different decontamination methods on titanium and zirconium surfaces

“…While Er:YAG laser (AlMoharib et al, 2021; Eick et al, 2017) and air‐abrasive devices (Keim et al, 2019; Leung et al, 2022; Tuchscheerer et al, 2021) proved to be effective, curettes and sonic / ultrasonic devices cleaned the surfaces poorly (AlMoharib et al, 2021; Keim et al, 2019; Sahrmann et al, 2015). Chemotherapeutic agents such as chlorhexidine, phosphoric acid (Dostie et al, 2017) citric acid (Cordeiro et al, 2021; Kotsakis et al, 2016), and NaOCl‐EDTA (Kotsakis et al, 2016) demonstrated modest and favorable antimicrobial effects on biofilms on titanium surfaces. Thereby, a few of the aforementioned studies used multispecies biofilm models (Cordeiro et al, 2021; Eick et al, 2017) or plaque samples from subjects (AlMoharib et al, 2021; Dostie et al, 2017; Wheelis et al, 2016).…”

“…Chemotherapeutic agents such as chlorhexidine, phosphoric acid (Dostie et al, 2017) citric acid (Cordeiro et al, 2021; Kotsakis et al, 2016), and NaOCl‐EDTA (Kotsakis et al, 2016) demonstrated modest and favorable antimicrobial effects on biofilms on titanium surfaces. Thereby, a few of the aforementioned studies used multispecies biofilm models (Cordeiro et al, 2021; Eick et al, 2017) or plaque samples from subjects (AlMoharib et al, 2021; Dostie et al, 2017; Wheelis et al, 2016). Furthermore, there is growing but still limited evidence about cytocompatibility of decontamination methods (Kotsakis et al, 2016; Ungvári et al, 2010; Wheelis et al, 2016).…”

Preventing Peri-implantitis: The Quest for a Next Generation of Titanium Dental Implants

“…Processing of titanium and its alloys has been done through several approaches. These include, but are not limited to, new alloy formation, laser or UV treatment, antimicrobial peptides, plasma spraying, anodization, silanization, antimicrobial coatings, and photolithography. ,− Most of these studies have reported comparisons of the attachment behavior of multiple species on the modified and control surfaces. The bacterial species tested in several studies have been categorized under the yellow (early), orange (intermediate), or red complexes (late colonizers), Table .…”