Aragonite toothpaste for management of dental calculus: A double-blinded randomized controlled clinical trial.

OBJECTIVES: Aragonite from animal origin such as cuttlefish bone powder is an abrasive with hardness properties ideal for calculus removal. The purpose of this randomized controlled trial was to test the efficacy of a cuttlebone-derived aragonite toothpaste in removing dental calculus. MATERIALS AND METHODS: Eighty-one patients who fulfilled the inclusion criteria were blindly and randomly assigned into two study groups. The intervention treatment group (n = 40) received cuttlebone toothpaste (Dr. D-Tart) and the control group (n = 41) received an off-the-shelf commercial toothpaste (Crest). Evaluations were performed before and after scaling and polishing procedures done at 3 months in order to evaluate the toothpaste's ability to remove calculus and to prevent calculus formation. Calculus, stains, plaque, and gingival indices scores, and patient satisfaction surveys were compared at baseline (first visit), 3, and 9 months, using generalized linear models and Wald's χ2 test. RESULTS: At the end of the 3-month period, the intervention group showed a 30% reduction in total calculus compared to the baseline score (p = .0006) and 45% less total calculus compared to the control group (p = .0001). Six months after scaling, the mean calculus score for Crest users was 42% higher than that for Dr. D-Tart users (p = .0692). There was a significant improvement in the gingival health of cuttlebone toothpaste users at the observed intervals, and both kinds of toothpaste achieved comparable results in terms of plaque and stains removal. CONCLUSIONS: Aragonite toothpaste can remove calculus, prevent calculus formation, and improve gingival health. Patients are generally satisfied with the performance of the aragonite toothpaste. CLINICAL SIGNIFICANCE: Animal-derived aragonite toothpaste (Dr. D-Tart) shows promising efficacy in removing calculus, preventing calculus formation, and for the improvement of gingival health. CLINICAL TRIAL ID: A08-M35-16B.

Advanced inorganic nanocomposite for decontaminating titanium dental implants.

Oral hygiene and regular maintenance are crucial for preserving good peri-implant health. However, available prophylaxis products and toothpastes, which are optimized for cleaning teeth, tend to contaminate and abrade implant surfaces due to their organic components and silica microparticles, respectively. This study aims to develop an organic-free implant-paste based on two-dimensional nanocrystalline magnesium phosphate gel and hydrated silica nanoparticles (20-30% w/w) for cleaning oral biofilm on titanium dental implants. The surface chemistry, morphology, and bacterial load of contaminated Ti disks before and after decontamination using prophylaxis brushing with toothpaste and implant-paste were characterized by X-ray photoelectron spectroscopy (XPS), scanning electron microscopy, and fluorescence spectroscopy. Both commercial toothpastes and implant-paste remove bacteria, however, only implant-paste protects Ti metal from abrasion and removes organic contaminants. XPS showed a significant decrease of carbon contamination from 73% ± 2 to 20% ± 2 after mechanical brushing with implant-paste compared to 41% ± 11 when brushing with commercial toothpastes (p < 0.05). Fluorescence microscopy revealed that bacteria load on biofilm contaminated Ti (44 × 103 ± 27 × 103 /µm2 ) was significantly reduced with the implant-paste to 2 × 103 ± 1 × 102 /µm2 and with a commercial toothpaste to 2.9 × 103 ± 7·102 /µm2 . This decay is relatively higher than the removal achieved using rotary prophylaxis brush alone (5 × 103 ± 1 × 103 /µm2 , p < 0.05). Accordingly, this novel implant-paste shows a great promise as an efficient decontamination approach. © 2018 Wiley Periodicals, Inc. J. Biomed. Mater. Res. Part B, 2018. © 2018 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater 107B: 761-772, 2019.

Decontamination of titanium implants using physical methods.

OBJECTIVES: Current decontamination methods of titanium (Ti) implant present limited success in achieving predictable re-osseointegration. We hypothesized that even though these techniques could be useful in elimination of bacteria, they might be unsuccessful in removing organic contaminants and restoring the original surface composition. The aim of this study was to assess the effect of four decontamination methods on the surface chemistry and bacterial load of biofilm-contaminated implant surfaces in order to improve implant surface decontamination. MATERIAL AND METHODS: The ability of clinically available methods such as metal and plastic curettes, Ti brushes and Er: YAG laser to decontaminate Ti implant surfaces was assessed. Surface morphology, chemical composition and properties of machined Ti discs (Ø 5.0 and 1.0 mm thick) were analysed before and after oral biofilm contamination using scanning electron microscope and X-ray photoelectron spectroscopy. The presence and viability of bacteria were evaluated with live-dead assays. RESULTS: Biofilm contamination created an organic layer rich in hydrocarbons and bacteria that covered entirely the Ti surfaces. This organic layer has tightly adhered to Ti surfaces and could not be completely removed with any of the methods assessed. Ti brushes achieved greater elimination of organic contaminants and bacteria than curettes and Er: YAG laser; however, none of them was able to restore the original surface chemistry. Alternatively, Er: YAG laser-treated surfaces showed the lowest live-to-dead bacterial ratio. CONCLUSIONS: Ti brushes were more effective than curettes (metal or plastic) and Er: YAG laser in decontaminating Ti implant surfaces, although none of these techniques was able to completely eliminate surface contamination. Er: YAG laser was more effective than curettes and Ti brushes in killing the biofilm bacteria.