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ePaper created 2016-03-24, 17:16:09 | version 1.38.0
implants 1 2016 | research 08 Material and Methods Two test phases were performed: a) Phase I: Decontamination procedure of brand- new sterile implants, which have been inoculated with bacteria and subsequently coated with antimi- crobial gel. b) Phase II: Decontamination procedure of brand- new sterile implants placed in a plastic jaw with sim- ulated bone defects after subsequent inoculation with bacteria and final exposure to antimicrobial gel. Phase I: Decontamination procedure to implants inoculated with bacteria To evaluate general suitability of the decontami- nation process, brand-new ITI implants (Institut Straumann AG, Basel, Switzerland) were microbio- logically processed and analysed at the Institute for Medical Diagnostics Bioscientia (Freiburg, Ger- many). Implant contamination—microbial procedure: The implants were exposed and inoculated with a bacterial suspension (overnight cultures of MRSA ATCC 33591): By means of sterile forceps, the implants were placed in 10 ml peptone yeast extract broth each. The tubes were incubated for 48 h at 36 °C and 5–10 % CO2 . After 48 h of incubation, the liquid was removed by means of vacuum filtration and the implant was transferred back to the initial container with sterile forceps for immediate further process- ing. Exclusively, implants with a medium bacterial growth were used for further examinations, im- plants with low or very low bacterial growth were excluded. Two test series were conducted with four implants each. Decontamination procedure with contaminated whole implant bodies: After completion of the microbiological work, three out of four implants were confronted with an- timicrobial gel for two min in the sense of a decon- tamination procedure and immediately transferred to the Institute for microbiological analysis. One im- plant served as positive control, without conduction of the decontamination procedure. –– Antimicrobial Gel: An antimicrobial gel known for its application in periodontology was used (PERI SOLV, REGEDENT AG, Zurich, Switzerland). It is typicallyusedforadjuvantcleaninganddecontam- ination of the outer tooth root area and the surrounding tissue.10 Furthermore, in the literature the gel is described to feature a softening effect towards degenerative tissue before debridement ofperiodontalpockets.9 Accordingtothemanufac- turer, the gel does not affect healthy tissue9 and, however, features an antimicrobial effect.2,7 –– Gel composition: The gel contains amino acids (glutamic acid, leucine and lysine), carboxymethyl cellulose, titanium dioxide as well as ultra pure water and features a pH value below 10. The trans- parent liquid represents a 0.95 % sodium hypo chlorite solution and is admixed immediately be- fore the application. After mixing hypochlorite and amino acids, so-called Chloramines (NCA), a short-lived active substance class, are formed. These substances are part of the body's own im- mune system.9 –– Gel Preparation: The set (gel and liquid) is stored in the refrigerator. One hour prior to planned applica- tion, the set is removed from the refrigerator to al- low the contents of the kit to warm up to room temperature. Both components (gel and liquid) are arranged in separate syringes and are connected by means of screwing (Luer-lock connection). Both components were thoroughly mixed by mov ing the stamps back and forth 10–15 times. The activated and operational gel was finally left in the transparent syringe. A non-invasive/blunt appli- cation tip is attached and the implants are coated with the gel. Bacterial growth on implant Implant 1 Implant 2 Implant 3 Implant 4 control A: MRSA – – – + + + B: MRSA – + – + + + Figs. 2a–f: SEM analysis: Brand- new, sterile implants were inoculated and incubated with a microbial suspension. Figure 2a shows a scanning electron micrograph of this starting material. Figure 2b shows the bacterial turf on an implant thus processed. After Perisolv application, many areas showed a detached bacterial coating, the implant surface is virtually free from bacterial turf (c & d). These “exposed spots” feature an unchanged implant structure (e & f), therefore Perisolv application does not alter the implant surface per se. Table 1: Results of Phase I. Fig. 2a Fig. 2b Fig. 2c Fig. 2d Fig. 2e Fig. 2f 12016