Biomaterials for the restoration of oral function are prone to biofilm formation, affecting oral health. Oral bacteria adhere to hydrophobic and hydrophilic surfaces, but due to fluctuating shear, little biofilm accumulates on hydrophobic surfaces in vivo. More biofilm accumulates on rough than on smooth surfaces. Oral biofilms mostly consist of multiple bacterial strains, but Candida species are found on acrylic dentures. Biofilms on gold and amalgam in vivo are thick and fully covering, but barely viable. Biofilms on ceramics are thin and highly viable. Biofilms on composites and glass-ionomer cements cause surface deterioration, which enhances biofilm formation again. Residual monomer release from composites influences biofilm growth in vitro, but effects in vivo are less pronounced, probably due to the large volume of saliva into which compounds are released and its continuous refreshment. Similarly, conflicting results have been reported on effects of fluoride release from glass-ionomer cements. Finally, biomaterial-associated infection of implants and devices elsewhere in the body is compared with oral biofilm formation. Biomaterial modifications to discourage biofilm formation on implants and devices are critically discussed for possible applications in dentistry. It is concluded that, for dental applications, antimicrobial coatings killing bacteria upon contact are more promising than antimicrobial-releasing coatings.

This study evaluates effects of aging on repair bond strengths of microhybrid, nanohybrid, and nanofilled composite resins and characterizes the interacting surfaces after aging. Disk-shaped composite specimens were assigned to one of three aging conditions: (1) thermocycling (5,000×, 5–55°C), (2) storage in water at 37°C for 6 months, or (3) immersion in citric acid at 37°C, pH 3 for 1 week; a non-aged group acted as the control. Two surface conditionings were selected: intermediate adhesive resin application (IAR-application) and chairside silica coating followed by silanization and its specific IAR-application (SC-application). Composite resins, of the same kind as their substrate, were adhered onto the substrates, and repair shear bond strengths were determined, followed by failure type evaluation. Filler particle exposure was determined by X-ray photoelectron spectroscopy and surface roughness analyzed using scanning electron and atomic force microscopy. Surface roughness increased in all composite resins after aging, but filler particle exposure at the surface only increased after thermocycling and citric acid immersion. Composite resin type, surface conditioning, and aging method significantly influenced the repair bond strengths (p < 0.05, three-way analysis of variance) with the least severe effects of water storage. Repair bond strengths in aged composite resins after IAR-application were always lower in non-aged ones, while SC-application led to higher bond strengths than IAR-application after thermocycling and water storage. In addition, SC-application led to more cohesive failures than after IAR-application, regardless the aging method.

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Composite restorations degrade during wear, but it is unknown how wear affects the composite surface and influences composite-to-composite bonding in minimally invasive repair. Here, it is hypothesized that in vitro exposure of composites to oral biofilm yields clinically relevant degradation of composite surfaces, and its influence on composite-to-composite bonding is determined. Biofilms on composite surfaces in vitro increased their roughness and decreased filler particle exposure, except for a microhybrid composite, similar to effects of clinical wear in palatal appliances. Failure shear stresses after intermediate-adhesive-resin application were significantly lower after aging by in vitro exposure to biofilms, while silica-coating maintained the same failure stress levels as in non-aged composites. Failure modes were predominantly cohesive after silica-coating, while intermediate-adhesive-resin application yielded more adhesive failure. It is concluded that in vitro exposure to oral biofilm is a clinically relevant aging condition, and that silica-coating is to be preferred for the repair of aged composites.