title: Erythritol/chlorhexidine combination reduces microbial biofilm and prevents its formation on titanium surfaces in vitro.
abstract: BACKGROUND
  The purpose of this in vitro study was to evaluate the antibiofilm activity of a novel air-polishing powder consisting of erythritol and chlorhexidine, assessing its ability to reduce previously grown microbial biofilm and to prevent biofilm formation on titanium surfaces.
  
  
  METHODS
  Clinical strains of Staphylococcus aureus, Pseudomonas aeruginosa, Bacteroides fragilis and Candida albicans isolated from peri-implantitis lesions were used. Biofilm was grown on sandblasted titanium discs and treated with erythritol/chlorhexidine. The antimicrobial activity was evaluated by determining the minimum inhibitory concentration and the minimum microbicidal concentration. The antibiofilm activity was assessed by semiquantitative spectrophotometric assay and by confocal laser scanning microscopy.
  
  
  RESULTS
  Erythritol/chlorhexidine displayed an inhibitory and a microbicidal activity against all the tested strains. The spectrophotometric analysis showed that the treatment was effective in both reducing the previously developed biofilm and decreasing biofilm formation on titanium surfaces. Confocal laser scanning microscopy analysis showed a significant reduction of the total biofilm volume, with an increase of the percentage of dead cells of all the microorganisms tested.
  
  
  CONCLUSIONS
  Erythritol/chlorhexidine displayed significant antimicrobial and antibiofilm activity against microorganisms isolated from peri-implantitis lesions. Due to its properties, it might represent a promising approach for the prevention and treatment of peri-implant diseases associated to microbial biofilm infections.
authors.affiliation: Laboratory of Clinical Chemistry and Microbiology, I.R.C.C.S. Galeazzi Orthopedic Institute, Milan, Italy.|Laboratory of Clinical Microbiology, Department of Biomedical Sciences for Health, University of Milan, Milan, Italy.
authors.forename: Lorenzo
authors.identifier: http://orcid.org/0000-0002-5206-540X
authors.initials: L
authors.lastname: Drago
authors.affiliation: Laboratory of Clinical Chemistry and Microbiology, I.R.C.C.S. Galeazzi Orthopedic Institute, Milan, Italy.
authors.forename: Monica
authors.initials: M
authors.lastname: Bortolin
authors.affiliation: Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy.|Dental Clinic, I.R.C.C.S. Galeazzi Orthopedic Institute, Milan, Italy.
authors.forename: Silvio
authors.initials: S
authors.lastname: Taschieri
authors.affiliation: Laboratory of Clinical Chemistry and Microbiology, I.R.C.C.S. Galeazzi Orthopedic Institute, Milan, Italy.
authors.forename: Elena
authors.initials: E
authors.lastname: De Vecchi
authors.affiliation: Laboratory of Clinical Chemistry and Microbiology, I.R.C.C.S. Galeazzi Orthopedic Institute, Milan, Italy.
authors.forename: Serse
authors.initials: S
authors.lastname: Agrappi
authors.affiliation: Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy.|Dental Clinic, I.R.C.C.S. Galeazzi Orthopedic Institute, Milan, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Del Fabbro
authors.affiliation: Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy.|Dental Clinic, I.R.C.C.S. Galeazzi Orthopedic Institute, Milan, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Francetti
authors.affiliation: Department of Public Health, Microbiology and Virology, University of Milan, Milan, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Mattina
mesh_terms: D018441:Biofilms / Q000187:drug effects*; D002176:Candida albicans / Q000187:drug effects; D002710:Chlorhexidine / Q000008:administration & dosage / Q000494:pharmacology*; D004202:Disinfectants / Q000008:administration & dosage / Q000494:pharmacology*; D004359:Drug Therapy, Combination; D004896:Erythritol / Q000008:administration & dosage / Q000494:pharmacology*; D006801:Humans; D011550:Pseudomonas aeruginosa / Q000187:drug effects; D013211:Staphylococcus aureus / Q000187:drug effects; D014025:Titanium
chemical_list: D004202:Disinfectants; D014025:Titanium; D002710:Chlorhexidine; D004896:Erythritol
keywords: biofilm; confocal laser scanning microscopy; erythritol; peri-implantitis