ORIGINAL RESEARCH |
https://doi.org/10.5005/jp-journals-10005-2731 |
Microbial Evaluation of Plaque on Conventional Stainless Steel Crown and Titanium-coated Stainless Steel Crown on Primary Molars
1–3Department of Pedodontics & Preventive Dentistry, RajaRajeswari Dental College & Hospital, Bengaluru, Karnataka, India
Corresponding Author: Prasanna Kumar Bhat, Department of Pedodontics & Preventive Dentistry, RajaRajeswari Dental College & Hospital, Karnataka, India, Phone: 9980185581, e-mail: dr_prasannabhat@yahoo.com
ABSTRACT
Introduction: The extensive plaque formation on dental restoratives may contribute to secondary caries or periodontal inflammation. Therefore, it is important to know how different types of dental restoratives may prevent or promote the accumulation of microorganisms. Hence, this study aims to evaluate the oral hygiene and microbial adhesion on the titanium (Ti)—coated stainless steel crown (Ti-coated SSC) and conventional SSC on a primary molar.
Materials and methods: A total of 15 children aged 4–10 years who visited the Department of Pediatric and Preventive Dentistry and required performed crowns were selected for the study. The tooth was randomly restored with Ti-coated on one side SSC and conventional SSC on the other side. The subgingival plaque samples were taken from the lingual and buccal surfaces using Gracey Curette before and immediately after the cementation of crowns and after 1 week. The plaque index (PI) (PI, modified Silness, and Loe) was also recoded. The plaque samples were incubated in mitis salivarius bacitracin agar, and the total number of Streptococcus mutans (S. mutans) was counted and expressed in colony-forming units (CFU).
Results: The test results showed a statistically significant difference in the microbial count expressed in CFU and PI (PI, modified Silness, and Loe PI) between Ti-coated SSC and conventional SSC after 1 week of crown placement.
Conclusion: The microbial adhesion of S. mutans and plaque accumulation was seen less on the Ti-coated SSC when compared with conventional SSC, which was statistically significant.
Keywords: Microbial adhesion, Stainless steel crown, Titanium-coated stainless steel crowns
How to cite this article: Biradar R, Bhat PK, Nanjappa A. Microbial Evaluation of Plaque on Conventional Stainless Steel Crown and Titanium-coated Stainless Steel Crown on Primary Molars. Int J Clin Pediatr Dent 2024;17(9):1041–1043.
Source of support: Nil
Conflict of interest: None
INTRODUCTION
Stainless steel crowns (SSCs) have been widely used to restore primary teeth that are badly decaying and carious,1 and teeth requiring pulp therapy procedures or where other restorative materials are ineffective. SSCs are considered one of the best full-coverage restorative materials because of easy placement, they are inexpensive, and have the desirable longevity.2 Braff stated that SSCs were significantly superior to multisurface amalgams in the restorations of primary molars.3 Despite its poor esthetics, it has been extensively used due to its resistance.4
The development of periodontal disease and secondary caries is thought to be significantly influenced by the adherence and colonization of oral microorganisms on dental surfaces and restoratives.5 According to research done both in vivo and in vitro, Streptococcus mutans (S. mutans) is one of the bacteria that are isolated from plaque samples from natural to artificial surfaces during the early stages of the development of caries. The first step in a microorganism’s colonization process is the organism’s adherence to a host surface.6 Accordingly, the assessment of S. mutans adherence on dental surfaces and restorative materials is crucial to the effective completion of these procedures.7
Surface-related characteristics, such as roughness, free surface energy, surface tension, wettability, hydrophobicity, hydrophilicity, electrostatic interactions, and microhardness, are among the necessary materials used in dental restorations. These characteristics are clinically significant because they may have an impact on plaque accumulation and staining.6 Microorganisms will cling more readily to surfaces with higher surface free energy; conversely, a more hydrophobic surface will result in less predicted adherence of microorganisms.8
For primary teeth, the prefabricated crowns are available in various sizes and have a well-defined contour. Traditional prefabricated SSCs are widely utilized, and one of the most common issues connected to SSC is gingival tissue inflammation. Bacterial plaque causes gingivitis surrounding restorative materials.9
Titanium–nitride (TiN)—coated solar cells have been introduced recently.
The crown seems bright and golden because of the TiN coating. The coating might contribute to the surface’s increased hardness.10 On these kinds of crowns, the microbial plaque adherence is unknown, though.
Therefore, the purpose of this study is to compare the microbiological adhesion and oral hygiene of conventional SSCs with Ti-coated SSCs on primary molars.
MATERIALS AND METHODS
Fifteen children aged 4–10 years who require SSC on the lower right and left quadrant primary molars were selected from the Department of Pediatric and Preventive Dentistry to carry out the study. Institutional ethical committee approval was taken to carry out the study, and parents’ consent was taken for carrying out the study on these children.
A primary molar and its contralateral tooth in the same arch were randomly assigned to a certain crown treatment group in this multicenter split-mouth approach Ti-coated SSC (group I) and conventional SSC (group II).
All standard protocols were followed for crown preparation, crown adaptation, and cementation. The subgingival plaque samples were taken from the lingual and buccal surfaces using Gracey curette and transferred in Eppendorf tubes containing 0.3 mL saline before and immediately after the cementation of crowns and after 1 week.
The plaque index (PI) (modified Silness and Loe PI) was also measured at the initial visit and after 1 week. The collected samples suspended in saline were spread onto the surface of mitis salivarius bacitracin agar (MSBA) plates with the help of a sterile platinum loop in a streaky manner. MSBA plates were incubated aerobically at 37°C for 48 hours, and a count of S. mutans was conducted, with the results reported in colony-forming units (CFU).
RESULTS
Streptococcus mutans (S. mutans) count immediately after the placement of the crown was nil for both Ti-coated SSC and conventional SSC groups. The microbial adhesion and PI were less in Ti-coated SSC when compared to conventional SSC, which was statistically significant.
DISCUSSION
For the dentist, restoring severely decaying primary teeth is typically a difficult task. For a restoration to be successful, it should have the following qualities—it should be natural-looking, durable, affordable, and easy to place.11 According to evaluations in the literature, performed SSCs have a higher success rate than massive multisurfaced amalgam restorations.3,12 As SSCs are less expensive, less technique-sensitive, long-lasting, and robust than massive multisurface restorations, they are a cost-effective option.13
According to the inclusion criteria, patients who needed bilateral preformed crowns were chosen for the current study in order to standardize the clinical setting and eliminate the possibility that systemic diseases could be the cause of increased microbial adhesion and have an impact on gingival health. Antibiotic use in the past was not allowed for this study because it can alter the oral ecology that Fukuda et al. and Dasanayake et al. suggest14,15 who discovered that the continuous use of broad-spectrum antibiotics may alter the makeup of the typical commensal bacteria in the oropharynx and nose (viridans streptococci).
This study employed a split-mouth study design, wherein Ti-coated SSC and conventional SSC were treated in similar oral environments and hygiene behaviors. The brushing method was imparted to the patient on the day of the placement of the crown. The study was limited to primary mandibular molars. All accepted procedures for crown adaptation, preparation, and cementation were adhered to in this investigation.
Since S. mutans is one of the most prevalent bacteria in the oral cavity, it has been chosen as a typical oral bacterium. Furthermore, S. mutans is thought to be one of the main causes of dental caries because it was found in early dental plaque. Furthermore, one of the main contributing factors to the development of secondary caries is S. mutans’ adherence to dental restorative materials.
In the current investigation, S. mutans was found and measured in the patient plaque samples using MSBA. Because S. mutans can tolerate sucrose and bacitracin at analytical concentrations, MSBA is a selective medium for S. mutans.
When the microbial count and PI were seen on the crowns between the initial placement and 1st week, there was a statistically significant difference seen (Tables 1 and 2) between the Ti-coated SSC and conventional SSC. On the Ti-coated SSC, however, the S. mutans count was lower than on the conventional SSC.
Time | Groups | N | Mean | Standard deviation | Mean difference | p-value |
---|---|---|---|---|---|---|
Before | Group I | 15 | 32230.00 | 46921.09 | −900.00 | 0.88 |
Group II | 15 | 33130.00 | 46338.20 | |||
1 week | Group I | 15 | 531.00 | 495.59 | −3079.00 | 0.02* |
Group II | 15 | 3610.00 | 4418.26 |
*, statistically significant
Time | Groups | N | Mean | Standard deviation | Mean difference | p-value |
---|---|---|---|---|---|---|
Before | Group I | 15 | 1.77 | 0.25 | −0.14 | 0.36 |
Group II | 15 | 1.91 | 0.45 | |||
1 week | Group I | 15 | 1.11 | 0.12 | −0.31 | 0.002* |
Group II | 15 | 1.42 | 0.20 |
*, statistically significant
The microbial growth is affected by the properties of SSCs, such as surface roughness and surface energy.16 Bacterial adhesion occurs more frequently in restorations with larger surface areas and rougher surfaces.4 Stainless steels have the highest surface tension and energy, which boost plaque-retention capability, according to a study by Eliades et al.,17 which was in accordance with our study.
Where in a clinical study conducted by Mollabashi et al. showed that coating orthodontic wires made of stainless steel with Ti dioxide is efficacious in reducing bacterial adhesion.18 Similar results were seen in our study, where Ti-coated SSC showed decreased microbial adhesion and PI.
The S. mutans adherence on Ti dioxide-coated orthodontic wires was reduced as a result of the breakdown of organic molecules on the bacterial surface. As a result, the bacterial cell wall becomes more brittle, degrades, alters osmotic pressure, destroys cellular organelles, and ultimately disintegrates.18
CONCLUSION
In the present study, there was a minimal follow-up period; thus, long-term follow-up studies need to be conducted to substantiate the results of the present study.
ORCID
Aishwarya Nanjappa https://orcid.org/0000-0002-9879-8705
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