Background: With the rising demand for osseointegrated titanium implants for replacing missing teeth, often in\r\npatients with a history of periodontitis, implant-related infections have become an issue of growing concern. Novel\r\nmethods for treating and preventing implant-associated infections are urgently needed. The aim of this study was\r\nto investigate if different pH, atmosphere and surface properties could restrict bacterial adhesion to titanium\r\nsurfaces used in dental implants.\r\nMethods: Titanium discs with machined or anodized (TiUniteââ??¢) surface were incubated with a co-culture of\r\nStreptococcus mitis and Actinomyces oris (early colonizers of oral surfaces) at pH 5.0, 7.0 and 9.0 at aerobic or\r\nanaerobic atmosphere. The adhesion was analysed by counting colony forming (CFU) units on agar and by\r\nconfocal laser scanning microscopy (CLSM).\r\nResults: The CFU analysis showed that a pH of 5.0 was found to significantly decrease the adhesion of S. mitis, and\r\nan aerobic atmosphere, the adhesion of A. oris. S. mitis was found in significantly less amounts on the anodized\r\nsurface than the machined surface, while A. oris was found in equal amounts on both surfaces. The CLSM analysis\r\nconfirmed the results from the CFU count and provided additional information on how the two oral commensal\r\nspecies adhered to the surfaces: mainly in dispersed clusters oriented with the groves of the machined surface and\r\nthe pores of the anodized surface.\r\nConclusions: Bacterial adhesion by S. mitis and A. oris can be restricted by acidic pH and aerobic atmosphere. The\r\nanodized surface reduced the adhesion of S. mitis compared to the machined surface; while A. oris adhered equally\r\nwell to the pores of the anodized surface and to the grooves of the machined surface. It is difficult to transfer these\r\nresults directly into a clinical situation. However, it is worth further investigating these findings from an in vitro\r\nperspective, as well as clinically, to gain more knowledge of the effects acid pH and aerobic atmosphere have on\r\ninitial bacterial adhesion.
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