Biofouling on Titanium Implants: A Novel Formulation of Poloxamer and Peroxide for In situ Removal of Pellicle and Multispecies Oral Biofilm

Abstract

Eradicating biofouling from implant surfaces is essential in treating peri-implant infections, as it directly addresses the microbial source for infection and inflammation around dental implants. This controlled laboratory study examines the effectiveness of the four commercially available debridement solutions (EDTA (Prefgel®), NaOCl (Perisolv®), H2O2 (Sigma-Aldrich), and Chlorhexidine (GUM® Paroex®)) in removing the acquired pellicle, preventing pellicle re-formation, and removing of a multi-species oral biofilm growing on a titanium implant surface, and compare the results with the effect of a novel formulation of a peroxide activated Poloxamer gel (Nubone® Clean). Evaluation of pellicle removal and re-formation was conducted using Scanning Electron Microscope (SEM), Energy Dispersive X-ray Spectroscopy (EDX), and X-ray photoelectron spectroscopy (XPS) to assess the surface morphology, elemental composition, and chemical surface composition. Hydrophilicity was assessed through contact angle measurements. The multi-species biofilm model included Streptococcus oralis, Fusobacterium nucleatum, and Aggregatibacter actinomycetemcomitans, reflecting the natural oral microbiome's complexity. Biofilm biomass was quantified using safranin staining, biofilm viability was evaluated using confocal laser scanning microscopy, and SEM was used for morphological analyses of the biofilm. Results indicated that while no single agent completely eradicated the biofilm, the Poloxamer gel activated with H2O2 exhibited promising results. It minimised re-contamination of the pellicle by significantly lowering the contact angle, indicating enhanced hydrophilicity. This combination also showed a notable reduction in carbon contaminants, suggesting the effective removal of organic residues from the titanium surface, in addition to effectively reducing viable bacterial counts. In conclusion, the Poloxamer gel + H2O2 combination emerged as a promising chemical decontamination strategy for peri-implant diseases. It underlines the importance of tailoring treatment methods to the unique microbial challenges in peri-implant diseases and the necessity of combining chemical decontaminating strategies with established mechanical cleaning procedures for optimal management of peri-implant diseases.