Debridement Paste

Abstract

The present invention relates to a new and inventive composition for implant cleaning and/or debridement of hard surfaces in the oral cavity, which comprises optimally activated nanoparticles of TiO.sub.2, having a mean particle diameter (D.sub.50) of about 10-100 nm at a concentration between 0.5-500 g/L, and H.sub.2O.sub.2, at a concentration of at the most 7.5% by volume, said composition being antibacterial, without causing microbial resistance, and anti-inflammatory, and wherein said composition further comprises solid microparticles, having a mean particle diameter (D.sub.50) of about 100-200 m at a concentration between 0.5-300 g/L, for improved mechanical debridement and/or cleaning of rough surfaces in the oral cavity and/or on an implant.

Claims

1.-25. (canceled)

26. A method of disinfecting a dental implant comprising titanium, the method comprising cleaning or debriding the implant with a composition comprising nanoparticles of TiO.sub.2 having a mean particle diameter of 10-100 nm; microparticles of TiO.sub.2 having a mean particle diameter of 100-200 m; and H.sub.2O.sub.2; wherein the nanoparticles are present in the composition in a concentration of 0.5-500 g/L of the composition; the microparticles are present in the composition in a concentration of 0.5-300 g/L of the composition; and the H.sub.2O.sub.2 is present in the composition in an amount of at most about 7.5% by volume of the composition.

27. A method according to claim 26, wherein said nanoparticles of TiO.sub.2 have a mean particle diameter of 20-30 nm.

28. A method according to claim 26, wherein said nanoparticles of TiO.sub.2are present in the composition at a concentration of about 10-300 g/L of the composition.

29. A method according to claim 26, wherein said nanoparticles of TiO.sub.2are crystalline.

30. A method according to claim 26, wherein said microparticles have mean particle diameter of 120-180 m.

31. A method according to claim 26, wherein said microparticles are present in the composition at a concentration of about 0.5-20 g/L of the composition.

32. A method according to claim 26, wherein said microparticles are biocompatible.

33. A method according to claim 26, wherein said H.sub.2O.sub.2 is present in the composition in a concentration of about 3 to about 7.5% by volume.

34. A method according to claim 26, wherein the composition is formulated as a suspension of solid particles in a liquid.

35. A method according to claim 26, wherein the composition further comprises an emulsifier and/or viscosity modifier.

38. A method according to claim 35, wherein said emulsifier and/or viscosity modifier is selected from the group consisting of glycerine, polyethylene glycols, polyoxyethylene polyoxypropylene block copolymer), polyglycol alginate, carboxyl methyl cellulose, glycerol, aloe vera gel, alginate, and chitosan.

39. A method according to claim 26, wherein the composition further comprises one or more detergent(s) selected from the group consisting of sodium dodecyl sulfate, sodium stannate, sodium pyrophosphate, oxine, and sodium lauryl sulfate.

40. A method according to claim 26, wherein the composition further comprises at least one flavoring oil.

41. A method according to claim 40, wherein the flavoring oil is selected from the group consisting of oils of spearmint, peppermint, wintergreen, sassafras, clove, sage, eucalyptus, marjoram, and cinnamon; methyl salicylate; and menthol.

42. A method according to claim 26, further comprising a step of mixing the microparticles, nanoparticles, and H.sub.2O.sub.2 prior to the cleaning/debriding step.

Description

FIGURE LEGENDS

[0036] FIG. 1: SEM pictures of the three surfaces used in this study (5000 in magnification).

[0037] FIG. 2: SEM pictures of the three surfaces inoculated with S.ep. and incubated at 35 C. for 16 hours. A biofilm covers all the surfaces (5000 of magnification).

[0038] FIG. 3: SEM pictures of the samples washed with NaCl for the control group or with H2O2+TiO2 for the test group. The biofilm is partially removed from the surfaces of the test group (5000 of magnification).

[0039] FIG. 4: Photospectrometry absorbance results assessing the safranin concentration from the SLActive surfaces (n=9, * if p-value<0.05).

[0040] FIG. 5: Photospectrometry absorbance results assessing the safranin concentration from the TiUnite surfaces (n=9, * if p-value<0.05).

[0041] FIG. 6: Photospectrometry absorbance results assessing the safranin concentration from the OsseoSpeed surfaces (n=9, * if p-value<0.05).

[0042] FIG. 7: Photospectrometry absorbance results assessing the biofilm re-growth after exposure of the samples to NaCl and H2O2+TiO2. The re-incubation of the samples for 4 hours showed a significantly lower bacterial re-growth due to the anti-bacterial effect of the nano-suspension compared to NaCl (n=9, * if p-value<0.05).

[0043] FIG. 8: Biomass assessed by measuring the absorbance intensity of the safranin staining from each surface exposed to the various chemical solutions. All groups were measured as statistically significant against each other (p<0.05), and the solution of the H2O2+TiO2 was removing most biofilm. Count index showing the presence of bacteria on the titanium surface (n=53).

DETAILED DESCRIPTION OF THE INVENTION

[0044] The present invention is directed to a composition comprising optimally activated nanoparticles of TiO.sub.2, as well as H.sub.2O.sub.2 and microparticles.

[0045] The presently described composition is a long sought for means for cleaning and/or debriding an implant and/or any hard tissue surface in the oral cavity for rapid treatment without damaging the to be cleaned surface structure, and essentially without leaving contaminating material residues, at the same time displaying an antimicrobial and/or anti-inflammatory effect. The present invention thus for the first time presents a composition for effectively cleaning and/or debriding implants and/or any hard tissue surface in the oral cavity, including difficult to access areas on rough implant surfaces in the oral cavity, which does not need any secondary activation, such as by UV light radiation.

[0046] The present invention is therefore directed to an antimicrobial and/or anti-inflammatory composition for implant cleaning and/or debridement of a hard surface in the oral cavity, which comprises [0047] a) nanoparticles of TiO.sub.2, having a mean particle diameter (D.sub.50) of 10-100 nm at a concentration between 0.5-500 g/L [0048] b) H.sub.2O.sub.2 at a concentration of at the most 7.5% by volume, and [0049] c) solid microparticles having a mean particle diameter (D.sub.50) of 100-200 m at a concentration between 0.5-300 g/L.

Titanium Particles

[0050] A ceramic is an inorganic, non-metallic solid, typically prepared by the action of heat and subsequent cooling.

[0051] Titanium dioxide is the naturally occurring oxide of titanium and has the chemical formula TiO.sub.2. Titanium dioxide occurs in nature as well-known minerals rutile, anatase and brookite. The most common form is rutile. Rutile, anatase and brookite all contain six coordinated titanium. Rutile has a primitive tetragonal unit cell, with unit cell parameters a=4.584A, and c=2.953. It therefore has a density of 4240 kg/m3.

[0052] Anatase has tetragonal shaped crystal structure. Although the degree of symmetry is the same for rutile and anatase, there is no relation between the interfacial angles of the two minerals, except, of course, in the prism-zone of 45 and 90. The common pyramid of anatase, parallel to the faces of which there are perfect cleavages, has an angle over the polar edge of 82 9, the corresponding angle of rutile being 56 52.

[0053] Brookite has an orthorhombic shaped crystal structure.

[0054] Anatase and brookite both convert to rutile upon heating when heated above 915 C.

[0055] Preferably, the TiO.sub.2 in the composition of the invention is predominantly in the anatase form. By predominantly is meant that at least 50% of the TiO.sub.2 nanoparticles are in anatase form. More preferably, at least 60% of the TiO.sub.2 nanoparticles are in the anatase form, even more preferably at least 70%, yet more preferably at least 80%. Also, at least 85%, such as 90 or 95%, of the TiO.sub.2 may be in anatase form. The remainder of the TiO.sub.2 may be in rutile and/or brookite form.

[0056] As mentioned above, it has previously been disclosed that TiO.sub.2, when activated by UV-light, forms the free radical TiOOH.sup.. In the present invention, surprisingly, ceramic TiO.sub.2 is activated to form the free radicals in the presence of H.sub.2O.sub.2 without necessitating any initial activation by UV-light. It was found that a specific ratio of surface exposure of TiO.sub.2 nanoparticles to H.sub.2O.sub.2 , facilitated by selecting a sufficient size of TiO.sub.2 nanoparticles at a sufficient concentration will allow for optimal, i.e. spontaneous and feed-back activation of TiO.sub.2 to form the free radicals on the surface of TiO.sub.2. When the nanoparticles of TiO.sub.2 are mixed with the H.sub.2O.sub.2 their surface is activated and radicals such as TiOH.sup., Ti--peroxide and Ti-.sup.2-peroxide are formed (Teruhisa O., et al. 2001). The composition of the invention may therefore also be denoted as a composition comprising activated nanoparticles of TiO.sub.2, i.e. nanosized TiOH.sup., Ti-peroxide and/or Ti-re-peroxide particles, wherein activated means that the formation of the free radical at the surface of at least part of the TiO.sub.2 nanoparticles has taken place.

[0057] A possible mechanism of a catalytic redox reaction on the surface of the TiO.sub.2 nanoparticles is:

2TiO.sub.2+2O.sub.2.sup.+2H.sup.+.fwdarw.Ti.sub.2O.sub.3+2O.sub.2+H.sub.2O (I)

2 TiO.sub.2+H.sub.2O.sub.2.fwdarw.Ti.sub.2O.sub.3+O.sub.2+H.sub.2O (II)

Ti.sub.2O.sub.3+OONO.sup..fwdarw.2 TiO.sub.2+NO.sub.2.sup.(III)

Ti.sub.2O.sub.3+H.sub.2O.sub.22 TiO.sub.2+H.sub.2O (IV)

[0058] (See e.g. Suzuki R, et al., 2003 and Tengvall P, et al. 1989)

[0059] The Composition

[0060] The new and inventive composition for implant cleaning and/or debridement of hard surfaces in the oral cavity, presented herein, comprises nanoparticles of TiO.sub.2, having a mean particle diameter (D.sub.50) of about 10-100 nm at a concentration between 0.5-500 g/L TiO.sub.2, and H.sub.2O.sub.2, at a concentration of at the most 7.5% by volume, as well as solid microparticles, having a mean particle diameter (D.sub.50) of about 100-200 m, at a concentration between 0.5-300 g/L.

[0061] The TiO.sub.2 particles in the composition of the invention are of nanosize. The particles have a mean particle diameter (D.sub.50) of about 100 nm or less. Preferably, the mean particle diameter is about 5-100 nm, such as 5-90 nm, 5-80 nm, 5-70 nm, 5-60 nm, 5-50 nm, 5-40 nm, 5-30 nm, 10-100 nm, 10-50 nm, 10-40 nm, 10-30 nm, 20-30 nm, or 15-25 nm. Presently preferred is a mean particle diameter of about 20-30 nm, such as selected from the group consisting of 20, 21, 22, 23, 24, 25, 26, 27, 28, 29 and 30 nm.

[0062] The selected range of size of the TiO.sub.2 nanoparticles used in the present invention ensures that the particles are so small that they are easily pinocytozed by macrophages. However, the herein selected nanoparticles of TiO.sub.2 are still not so small that they may penetrate cell walls and/or membranes on their own volition.

[0063] The concentration of TiO.sub.2 nanoparticles in the composition of the invention is about at least 0.5 g/L. Preferably the concentration of TiO.sub.2 nanoparticles is about 0.5-500 g/L, such as 0.5-10 g/L, 0.5-5 g/L, 0.5-4 g/L, 10-300 g/L TiO.sub.2, 15-250 g/L TiO.sub.2, or about 50-200 g/L TiO.sub.2. The concentration of TiO.sub.2 nanoparticles in the composition of the invention may therefore be e.g. at least 0.5, 1, 2, 3, 4, 5, 10, 15, 20, 25, 50, 60, 70, 80, 90, 100, 200, 210, 220, 250 or 500 g/L. In one embodiment, the TiO.sub.2 concentration is up to 4 g/L.

[0064] The present inventors found an increased anti-bacterial effect with a higher concentration of TiO.sub.2 concentration up to 4 g/L. After this concentration, no increase in antibacterial effect was observed with more TiO.sub.2 added. However, the composition of the invention may still comprise 0.5-500 g/L TiO.sub.2 nanoparticles as a higher concentration of nanoparticles of TiO.sub.2 will potentially aid the mechanical debridement. Also, it was surprisingly found that, if the TiO.sub.2 concentration was held constant, there is an increased anti-bacterial effect with higher H.sub.2O.sub.2 concentration. However, for in situ use, the H.sub.2O.sub.2 concentration is limited to approximately at the most comprising 7.5 Vol % of H.sub.2O.sub.2 in order not to affect biological tissue negatively.

[0065] The concentration of H.sub.2O.sub.2 in the composition of the invention is at the most about 7.5% by volume, preferably about at the most 3-7.5% by volume, such as 3, 4, 5, 6, 7% by volume.

[0066] One advantage with the use of the activated nanoparticles of TiO.sub.2 (i.e. comprising the radicals as described above) is that after they have performed their task, e.g. killed microorganisms, they return to their less active state, i.e. unactivated TiO.sub.2. This can e.g. be compared to silver ions that continue to be biologically active, which also means that they continue to be toxic to the environment as they are not inactivated after they have performed their tasks. The TiO.sub.2 nanoparticles in the composition of the invention may however be reactivated to form the active radical species, e.g. by the careful application of UV-light Also the TiO.sub.2 nanoparticles are anti-inflammatory even when they are not in their active state and may as such also have a lasting anti-inflammatory effect.

[0067] The composition described herein is antibacterial, unselectively and essentially without causing microbial resistance, and anti-inflammatory, and due to said composition, in addition to nanoparticles of TiO.sub.2 and H.sub.2O.sub.2 further comprising solid microparticles, having a mean particle diameter (D.sub.50) of about 80-250 m at a concentration between 0.5-300 g/L, such as selected from the group consisting of 10, 15, 25, 50, 100, 200 and 300 g/L, it also displays improved mechanical means for debridement and/or cleaning of rough implant surfaces, which e.g. may have been modified by machining, blasting, acid etching, or by combinations of these procedures.

[0068] Therefore, the present invention provides compositions comprising solid microparticles, having a mean particle diameter (D.sub.50) of about 80-250 m, such as between 80-180, 120-180, 100-200, or between 100-150 m. Preferably, the solid microparticles have a mean particle diameter (D.sub.50) of about 120-180 m, such as 120, 125, 130, 135, 140, 145, 150, 155, 160, 165, 170, 175, and 180 m.

[0069] The concentration of solid microparticles in the composition of the invention is preferably 10-200 g/L , such as between 10-25, 10-50, 50-100, 50-150, 10-180, 100-150, 100-200, 150-200 or between 100-150 g/L, such as selected from the group consisting of approximately 10, 15, 25, 50, 80, 100, 120, 150, 180 and 200 g/L.

[0070] The microparticles are preferably biocompatible and solid (hard) and may also be biodegradable.

[0071] The solid microparticles may be selected from the group of material consisting of TiO.sub.2, zirconium oxide, diamond dust (carbons), polymers, polylactic acid (beans), mineral, ceramic, dialuminium trioxide, calcium carbonate, calcium phosphate, apatite crystals, bone ceramic particles (hydroxyapatite/calcium phosphate), titanium, zirkonium, aluminium oxide, carborundum, pumice, and silica. The choice of material for the solid microparticles is preferably made depending on which material, e.g. a metal implant or a hard tissue surface, is to be cleaned/debrided by the composition of the invention, in order to fit the roughness of the material to allow for efficient cleaning/debriding of the material while still not damaging it.

[0072] Even in the case wherein the microparticles are made of TiO.sub.2, the addition of microparticles to the composition of the invention will not essentially effect the optimized ratios between nanoparticles and H.sub.2O.sub.2 specified herein.

[0073] One advantage with the selection of the above specified size of the microparticles is that surface treatment of implants typically results in a diameter size of indents formed which is between 80-180 m. Therefore, the presence of the solid microparticles in the composition of the invention makes the composition particularly suitable for the in situ cleaning and/or debridement of implants in the oral cavity as the microparticles are of a size that allows their entry into the indents to clean these, while still being large enough to not cause inflammatory reactions and/or to be encapsulated by the body in fibrous capsules.

[0074] A presently preferred composition of the invention comprises 5 Vol % H.sub.2O.sub.2 and 25 g/L nanoparticles (having a mean particles diameter (D.sub.50) of 30 nm) and 20 g/L of solid macroparticles (having a mean particle diameter (D.sub.50) of 100 m).

[0075] Another equally preferred composition of the invention comprises 4-5 Vol % H.sub.2O.sub.2 and 20-25 g/L nanoparticles (having a mean particles diameter (D.sub.50) of 30 nm) and 15-20 g/L of solid macroparticles (having a mean particle diameter (D.sub.50) of 100 um).

[0076] An antimicrobial and/or anti-inflammatory composition according to the present invention is typically formulated as a suspension of solid particles in a liquid.

[0077] In one embodiment, the antimicrobial and/or anti-inflammatory composition according to the present invention further comprises one or more emulsifier(s) and/or viscosity modifier(s). Said emulsifier and/or viscosity modifier may be selected from the group consisting of glycerine, glycols, polyethylene glycols (PEG), polyoxyethylene polyoxypropylene block copolymer (pluronic polyols), polyglycol alginate (PGA), CMC (carboxyl methyl cellulose), glycerol, Aloe Vera gel, alginate and citosan.

[0078] The antimicrobial and/or anti-inflammatory composition according to the present invention may comprise one or more detergent(s) selected from the group consisting of SDS (sodium dodecyl sulfate), sodium stannate, sodium pyrophosphate, oxine and SLS (sodium lauryl sulfate).

[0079] The antimicrobial and/or anti-inflammatory composition according to the invention may further comprise one or more flavouring oil(s), such as, but not limited to oils of spearmint, peppermint, wintergreen, sassafras, clove, sage, eucalyptus, marjoram, cinnamon and methyl salicylate and menthol.

[0080] In a preferred aspect, the composition of the invention consists of said nanoparticles of TiO.sub.2, H.sub.2O.sub.2 and microparticles of the sizes and concentrations specified herein.

[0081] An antimicrobial and/or anti-inflammatory composition according to the present invention can be mixed before application and eventual storage, or stored separately and mixed directly or shortly before and/or at the time of application. The application therefore, in another aspect is directed to a kit comprising a first container comprising component a), a second container comprising component b), and a third container comprising component c), wherein a) comprises nanoparticles of TiO.sub.2, having a mean particle diameter (D.sub.50) of 10-100 nm at a concentration between 0.5-500 g/L, b) comprises H.sub.2O.sub.2 at a concentration of at the most 7.5% by volume, and c) comprises solid microparticles having a mean particle diameter (D.sub.50) of 100-200 m at a concentration between 0.5-300 g/L. Optionally such a kit may also comprise instructions for the preparation of the composition of the invention. The kit may also comprise one or more devices for the application of the composition to a subject. Such a device may e.g. be a syringe or an implant cleaning and/or debridement tool for cleaning and/or debriding an implant in the oral cavity. Preferably the implant cleaning and/or debridement tool comprises an elongated base member formed of at least two wires being twisted with each other, and a plurality of bristles fixed between said twisted wires and extending away from said twisted wires, whereby said bristles are positioned in a cleaning section at a first end of said base member; and that said bristles consist of titanium and/or a titanium alloy. A kit of the invention may also comprise the composition of the invention in one container and an implant cleaning and/or debridement tool for cleaning and/or debriding an implant in the oral cavity. One example of such an implant cleaning/debridement tool for cleaning a dental implant and/or debriding a hard tissue surface is disclosed in U.S. Pat. No. 6,345,406, another example is given in WO 2009/083281. The kit may consist of a), a second container comprising component b), and a third container comprising component c). Also, the kit may consist of a), a second container comprising component b), and a third container comprising component c) and a implant cleaning/debridement tool for cleaning a dental implant and/or debriding a hard tissue surface. Alternatively, the kit may consist of a container consisting of the composition of the invention and an implant cleaning and/or debridement tool for cleaning and/or debriding an implant in the oral cavity.

[0082] The implant cleaning/debridement tool disclosed in WO 2009/083281 has bristles with diameters of 0.2 mm. The composition of the invention is particularly suitable to be used with this tool as the size of the solid microparticles in the composition will allow for an efficient cleaning of an implant and/or hard surface in the oral cavity. For this aspect, the microparticles optimally have a size about 150 m, such as between 100 and 150 m, because the body tends to integrate particles in fibrous capsules when the particles are between 10-100 m.

[0083] Periimplantitis is a typical complication related to orodental rehabilitation through the use of implants, i.e. a peri-implant disease, which is well-known to the person skilled in the art as an inflammatory reaction in which there is a loss of the bony support of the implant accompanied by inflammation. The aetiology of the disease is conditioned by the status of the tissue surrounding the implant, implant design, degree of roughness, the poor alignment of implant components, external morphology and excessive mechanical load.

[0084] The presently described antimicrobial and/or anti-inflammatory composition for the first time offers the means for an effective and rapid cleaning of an implant and/or for debriding a hard surface in the oral cavity essentially without damaging of the anatomical structure or of the implant and/or hard surface itself, and essentially without leaving contaminating material residues on the treated surface.

[0085] The invention therefore in one aspect is directed to the antimicrobial and/or anti-inflammatory composition as defined herein and/or the kit for preparing the composition of the invention as defined herein, for use as a medicament.

[0086] Thus, the present invention relates to the use of an antimicrobial and/or anti-inflammatory composition according to the present invention for cleaning and/or debriding an implant in the oral cavity, such as an implant in situ, a hard surface in the oral cavity, such as an outer surface of a hard tissue in the oral cavity, a surgically exposed hard surface in the oral cavity, a wound in the oral cavity, such as a wound resulting from periimplantitis or a surgical wound, a periodontal defect and/or periodontal wound, and/or an oral hard tissue defect. The invention also relates to the use of the antimicrobial and/or anti-inflammatory composition as defined herein and/or the kit for preparing the composition of the invention as defined herein, for the preparation of a medicament and/or a pharmaceutical and/or cosmetic composition, for cleaning and/or debriding an implant in the oral cavity, such as an implant in situ, a hard surface in the oral cavity, such as an outer surface of a hard tissue in the oral cavity, a surgically exposed hard surface in the oral cavity, a wound in the oral cavity, such as a wound resulting from periimplantitis or a surgical wound, a periodontal defect and/or periodontal wound, and/or an oral hard tissue defect. The invention is also directed to the antimicrobial and/or anti-inflammatory composition as defined herein or the kit for preparing the composition of the invention as defined herein for use for cleaning and/or debriding an implant in the oral cavity, such as an implant in situ, a hard surface in the oral cavity, such as an outer surface of a hard tissue in the oral cavity, a surgically exposed hard surface in the oral cavity, a wound in the oral cavity, such as a wound resulting from periimplantitis or a surgical wound, a periodontal defect and/or periodontal wound, and/or an oral hard tissue defect.

[0087] Another presently preferred embodiment is directed to the use of an antimicrobial and/or anti-inflammatory composition according to the present invention together with an implant cleaning and/or debridement tool, for cleaning an implant and/or debriding a hard surface in the oral cavity. Said implant cleaning and/or debridement tool is e.g. characterized by comprising an elongated base member formed of at least two wires being twisted with each other, and a plurality of bristles fixed between said twisted wires and extending away from said twisted wires, whereby said bristles are positioned in a cleaning section at a first end of said base member; and that said bristles comprise or consist of titanium and/or a titanium alloy.

[0088] Many medical implants, such as e.g. dental implants, orthopedic implants and vascular stents, are metallic, i.e. they are made of a metal material. The present invention consequently relates to the use of an antimicrobial and/or anti-inflammatory composition according to the present invention, alternatively together with an implant cleaning and/or debridement tool, for cleaning and/or debriding an implant made of a metal material.

[0089] Examples of metal materials commonly utilized for constructing metallic medical implants are steel, titanium, zirconium, tantalum, niobium, hafnium and alloys thereof. In particular, titanium and titanium alloys have proven to be suitable to utilize for constructing medical implants.

[0090] On the other hand, both medical and dental implants can at least partially, as well as in full (full-ceramic implants) consist of porcelain and/or ceramic, such as of zirconium oxide and/or hydroxyapatite, or any other ceramic or porcelain material known to the person skilled in the art as being suitable for implantry. Thus, the present invention equally relates to the use of an antimicrobial and/or anti-inflammatory composition according to the present invention, alternatively together with an implant cleaning and/or debridement tool, for cleaning and/or debriding an implant made of, or comprising porcelain and/or ceramic. Consequently, the present invention is also directed to the use of a composition of the invention for the preparation of a medicament and/or a pharmaceutical and/or cosmetic composition for the cleaning and/or debridement of an implant made of or comprising porcelain and/or ceramic. Also, the invention is directed to a composition of the invention alternatively for use for cleaning and/or debriding an implant made of or comprising porcelain and/or ceramic.

[0091] Dental implants are typically utilized in dental restoration procedures in patients having lost one or more of their teeth. A dental implant comprises a dental fixture, which is utilized as an artificial tooth root replacement. Thus, the dental fixture serves as a root for a new tooth. The dental fixture is typically a screw, i.e. it has the shape of a screw, and it is typically made of titanium, a titanium alloy, zirconium or a zirconium alloy. The screw is surgically implanted into the jawbone, where after the bone tissue grows around the screw and the screw is fixated in the bone with the bone in close contact with the implant surface. Once the implant screw is firmly anchored in the jawbone, it may be elongated by attachment of an abutment to the screw. The abutment may, just as the screw, be made of titanium, a titanium alloy, zirconium or a zirconium alloy. The shape and size of the utilized abutment are adjusted such that it precisely reaches up through the mucosa after attachment to the screw. A dental restoration such as a crown, bridge or denture may then be attached to the abutment. Alternatively, the implant screw has such a shape and size that it reaches up through the mucosa after implantation, whereby no abutment is needed and a dental restoration such as a crown, bridge or denture may be attached directly to the screw.

[0092] The present invention consequently relates to the use of an antimicrobial and/or anti-inflammatory composition according to the present invention, alternatively together with an implant cleaning and/or debridement tool, for cleaning and/or debriding any parts of a dental implant, selected from the group consisting of dental fixture such as a screw, abutment, and dental restoration such as a crown, bridge or denture. Consequently, the present invention is also directed to the use of a composition of the invention for the preparation of a medicament and/or pharmaceutical and/or cosmetic composition for cleaning and/or debriding any parts of a dental implant, selected from the group consisting of dental fixture such as a screw, abutment, and dental restoration such as a crown, bridge or denture. Also, the invention is directed to a composition of the invention for use for cleaning and/or debriding any parts of a dental implant, selected from the group consisting of dental fixture such as a screw, abutment, and dental restoration such as a crown, bridge or denture.

[0093] The present invention further relates to the use of an antimicrobial and/or anti-inflammatory composition according to the present invention, alternatively together with an implant cleaning and/or debridement tool, for cleaning and/or debriding orthopaedic implants, such as orthopaedic implants which are utilized for the preservation and restoration of the function in the musculoskeletal system, particularly joints and bones, including alleviation of pain in these structures, and/or for cleaning and/or debriding vascular stents, i.e. tubular implants arranged for insertion into blood vessels in order to prevent or counteract a localized flow constriction. Consequently, the present invention is also directed to the use of a composition of the invention for the preparation of a medicament for cleaning and/or debriding orthopaedic implants, such as orthopaedic implants which are utilized for the preservation and restoration of the function in the musculoskeletal system, particularly joints and bones, including alleviation of pain in these structures, and/or for cleaning and/or debriding vascular stents. Also, the invention is directed to a composition of the invention for use for cleaning and/or debriding orthopaedic implants, such as orthopaedic implants which are utilized for the preservation and restoration of the function in the musculoskeletal system, particularly joints and bones, including alleviation of pain in these structures, and/or for cleaning and/or debriding vascular stents.

[0094] The surface of medical implants such as e.g. dental implants, orthopedic implants and vascular stents, or the vicinity thereof, has sometimes to be cleaned after placing. This is particularly important when an infection or contamination occurs, causing a progressive degenerative process in the bone adjacent to the implant known as periimplantitis. In these cases the surface of the ailing implant has to be cleaned from microbes and contaminants to stop the progression of the disease and ensure re-integration of the implant. Failure to clean the implant surface will eventually lead to loss of bone and implant, and make further alternative treatments difficult and sometimes even impossible. Furthermore, the surface of vascular stents may have to be cleaned during implantation in order to remove coagulum, and the interior of vascular stents, i.e. the cavity within vascular stents, may have to be cleaned in an endoscopic procedure during a later treatment due to restenosis, i.e. blocking of the blood vessel.

[0095] The present invention therefore relates to the use of an antimicrobial and/or anti-inflammatory composition according to the present invention, alternatively together with an implant cleaning and/or debridement tool, for cleaning and/or debriding an implant or the vicinity thereof after placing. Consequently, the present invention is also directed to the use of a composition of the invention for the preparation of a medicament for cleaning and/or debriding an implant or the vicinity thereof after placing. Also, the invention is directed to a composition of the invention for use for cleaning and/or debriding an implant or the vicinity thereof after placing.

[0096] In addition, for different reasons, it may be advantageous or necessary to debride surgically exposed hard tissue surfaces. For example, debriding of surgically exposed hard tissue surfaces may be advantageous or necessary to perform before regenerative treatment, i.e. in order to prepare the hard tissue surfaces for regenerative treatment. Examples of conditions, which may be associated with a treatment in which debridement of a surgically exposed hard tissue surface is advantageous or necessary to perform in order to prepare the surface for regenerative treatment, are: periimplantitis, periodontitis lesions, marginal periodontitis, apical periodontitis, furcation defects, apical granulomas and cysts, bone cysts, bone tumors, bone granulomas, bone cancers, (infected) extraction sockets, alveolitis sicca (dry socket), cleaning of apicectomy defects, localized osteomyelitis, trauma induced defects, resection or revision of implants, resection or revision of fractures, and removal of temporary bone implants (such as orthopaedic bone plates, retainers and screws). Furthermore, debridement of articular surfaces in joints affected by arthritis and debridement of such surfaces before regenerative treatment for cartilage and ligaments is instituted may also be advantageous or necessary to perform.

[0097] The present invention thus relates to the use of an antimicrobial and/or anti-inflammatory composition according to the present invention, alternatively together with an implant cleaning and/or debridement tool, for cleaning and/or debriding surgically exposed hard tissue surfaces before regenerative treatment. Consequently, the present invention is also directed to the use of a composition of the invention for the preparation of a medicament and/or a pharmaceutical and/or cosmetic composition for cleaning and/or debriding surgically exposed hard tissue surfaces before regenerative treatment. Also, the invention is directed to a composition of the invention for use for cleaning and/or debriding surgically exposed hard tissue surfaces before regenerative treatment.

[0098] The antimicrobial and/or anti-inflammatory composition according to the present invention, alternatively together with an implant cleaning and/or debridement tool, may be utilized during surgery for cleaning of the surface of a metallic medical implant after infection and/or bone resorption. For example, it may be utilized for cleaning the surface of a metallic dental implant and/or a metallic orthopedic implant. Thus, it may be utilized for removing e.g. bacterial biofilm, debris, calculus or fibrous tissue from the surface of a dental implant, such as a titanium screw. Alternatively, it may be utilized together with a further cleaning agent (i.e. an antibacterial agent) in order to remove the bacterial biofilm from the vicinity of the dental fixture during implantation. It may also be utilized for cleaning the surface of, or the vicinity of, an abutment. Consequently, the present invention is also directed to the use of a composition of the invention for the preparation of a medicament for cleaning, e.g. removing bacterial biofilm, debris, calculus or fibrous tissue from the surface of a metallic dental implant, such as a titanium screw or an abutment, or a metallic orthopedic implant. Also, the invention is directed to a composition of the invention for use for cleaning, e.g. removing bacterial biofilm, debris, calculus or fibrous tissue the surface of a metallic dental implant, such as a titanium screw or an abutment, or a metallic orthopedic implant.

[0099] In addition, the antimicrobial and/or anti-inflammatory composition according to the present invention, alternatively together with an implant cleaning and/or debridement tool, may be utilized for removing cement remnants, bacterial biofilm, debris, calculus or fibrous tissue from the surface of an orthopedic implant or for removing plaque from the surface of a vascular stent. Alternatively, it may be utilized for cleaning the interior of a vascular stent, i.e. the cavity within a vascular stent, in an endoscopic procedure during a later treatment due to restenosis, i.e. blocking of the blood vessel.

[0100] A procedure involving use of the antimicrobial and/or anti-inflammatory composition according to the present invention, alternatively together with an implant cleaning and/or debridement tool, may, for example, involve the steps of: surgically exposing a hard tissue surface to be treated; removal of inflamed soft tissue; debriding the surface by means of applying the antimicrobial and/or anti-inflammatory composition according to the present invention, alternatively together with an implant cleaning and/or debridement tool; applying (regenerative) treatment as needed; replacing soft tissue; suturing for good primary closure and wound stability; and allowing the wound to heal.

[0101] In particular, the antimicrobial and/or anti-inflammatory composition according to the present invention, alternatively together with an implant cleaning and/or debridement tool, is an efficient tool for debridement of surgically exposed tooth root surfaces, furcation defects and bony defects before regenerative treatment (i.e. by means of, for example Straumann Emdogain, bone graft materials, autologous bone, membranes, etc.). the antimicrobial and/or anti-inflammatory composition according to the present invention, alternatively together with an implant cleaning and/or debridement tool, is especially effective for removing granulation tissue, and for removing concrements of calcified biofilms (plaques) and subgingival calcus.

[0102] The antimicrobial and/or anti-inflammatory composition according to the present invention, alternatively together with an implant cleaning and/or debridement tool, is advantageous to utilize for cleaning and/or debriding both hard metallic medical and/or dental implants having relatively hard surfaces, such as e.g. medical implants of steel, and soft metallic medical implants having delicate surfaces, such as e.g. medical and/or dental implants of titanium, a titanium alloy, zirconium or a zirconium alloy.

[0103] In addition, the antimicrobial and/or anti-inflammatory composition according to the present invention does not leave contaminants, i.e. material residues, incompatible with reintegration of the implanted structure. The use of nanoparticles of TiO.sub.2, having a mean particle diameter (D.sub.50) of 10-100 nm facilitates a biological removal of any material residues left after treatment, as these particles are small enough for the patient's macrophages for pinocytosis, while still being large enough to circumvent cell wall penetration. What is more, since titanium in itself is biocompatible, a foreign body response is usually not triggered. Thus, the inflammation risk is minimal.

[0104] In particular, a relatively rapid debridement procedure of surfaces, which are otherwise hard to clean and/or hard to reach by hand instrumentation, may be performed by means of the antimicrobial and/or anti-inflammatory composition according to the present invention, alternatively together with an implant cleaning and/or debridement tool. Rapid treatment ensures a better treatment outcome. As mentioned above, it is a well-known fact that the morbidity and frequency of adverse effects, such as e.g. post-surgery effects, are directly related to, and often proportional to, the time used for the debridement of surgically exposed hard tissue surfaces. Thus, rapid debridement treatment ensures a better total treatment outcome.

[0105] The use of the antimicrobial and/or anti-inflammatory composition according to the present invention, alternatively together with an implant cleaning and/or debridement tool, is especially favorable where the treatment plan for a defect includes placing of a titanium implant or any other device made of titanium, since only titanium and no other metallic ions or polymers that can provoke unwanted and/or adverse clinical and/or biological effects can contaminate the treated area, hampering the outcome of planned and/or future implant procedures.

[0106] Oral Hygiene

[0107] In oral hygiene and dentistry, debridement refers to the removal of plaque and calculus that have accumulated on the teeth, which can be performed routinely by the technician, for medical, hygienic, as well as for purely cosmetic reasons. Thus, in one embodiment, the antimicrobial and/or anti-inflammatory composition according to the present invention, again alternatively together with an implant cleaning and/or debridement tool, is used for removal of plaque and calculus that have accumulated on the patient's natural teeth, or tooth implants. The antimicrobial and/or anti-inflammatory composition according to the present invention comprises radicalized oxygens, and is thus particularly suitable for use in the bleaching of natural and/or artificial teeth.

[0108] Microorganisms

[0109] The microorganisms most commonly associated with implant failure are spirochetes and mobile forms of Gram-negative anaerobes. Diagnosis can be based on changes of colour in the gum, bleeding and probing depth of peri-implant pockets, suppuration, x-ray and gradual loss of bone height around the tooth. The antibiotic therapy proven to be most efficacious in the antibiogram has so far been the association of amoxycillin and clavulanic acid. Additionally to bacterial infections, microbial infections in the oral cavity can of course also include fungal and/or viral infections.

[0110] An antimicrobial and/or anti-inflammatory composition according to the present invention is effective for killing bacteria, fungus and/or virus.

[0111] What is more, the composition described herein is antimicrobial, without causing microbial resistance, as well as anti-inflammatory. This is at least in part due to the fact that the radicals from the TiO.sub.2 surface attack the bacterial membrane. Thus, the radicals kill essentially any type of bacteria and the bacteria can thus not become resistant to this compound, in comparison to traditional antibiotics, which are more strain specific. Furthermore, once the radicals have killed the bacteria, they return to their original form TiO.sub.2.

[0112] Compared to other antimicrobial agents, TiO.sub.2 is particularly suitable for use in the oral cavity and of implant surfaces, due to properties such as stability, environmental safety, broad spectrum antibiosis and anti-inflammatory properties. Moreover, the TiO.sub.2 free radicals actively modulate immune responses, acribate macrophages and stimulate the healing process. This means that they do not just kill microorganisms, but stimulate the surgical wound in the healing process as well. Thus, the optimally activated nanosized TiO.sub.2 particles are particularly suitable for the next generation of bioactive antibacterial materials.

EXPERIMENTAL SECTION

Example 1

[0113] Paste for Titanium Surface Debridement:

[0114] A suspension was prepared by adding H.sub.2O.sub.2 (PERDROGEN 30% H.sub.2O.sub.2 (w/w), Sigma Aldritch AS, Oslo, Norway) at 5 vol %, 10 g/L of nanoparticles of TiO.sub.2 (Aeroxide P25, Evonik AG, Essen, Germany) and 20 g/L of microparticles of TiO.sub.2 (Hombitan, Kronos Titan Worldwide Inc, USA). The mean particle diameter (D.sub.50) was measured by laser (Mastersizer 2000, Malvern, Herrenberg, Germany) and the distribution showed a large peak with D.sub.50 of 40 nm and a second large peak at 100 m.

Example 2

[0115] Controlling Viscosity Paste for Titanium Surface Debridement:

[0116] A suspension was prepared as described in Example 1. The viscosity was altered by adding additionally 300 g/L of nanoparticles of TiO.sub.2 (Aeroxide P25, Evonik AG, Essen, Germany) and 1000 g/L of microparticles of TiO.sub.2 (Hombitan, Kronos Titan Worldwide Inc, USA). The suspension behaved like thick slurry.

Example 3

[0117] Controlling Viscosity Paste for Titanium Surface Debridement:

[0118] A suspension was prepared as described in Example 1. The viscosity was altered by adding 30 grams of a gelling agent polyoxyethylene polyoxypropylene block copolymer (Pluronic F-127, Sigma Aldritch, Oslo, Norway). The suspension behaved like thick slurry.

Example 4

[0119] Debridement of Titanium Surface:

[0120] A suspension was prepared as described in Example 1. Grit-blasted titanium surface with Sa value of 2 pm where contaminated with porphyromonas gingivalis. One group (n=6) was left untreated, and the other groups (n=6) where cleaned with a titanium bristle device, TiBrush, with saline water, EDTA, 3 vol % H.sub.2O.sub.2 and the suspension as described in example 1. Bacteria count after the cleaning showed significant reduction in bacteria numbers for the groups cleaned with the suspension as described in example 1 when compared to all other groups.

Example 5

[0121] Anti-Bacterial Effect of Activated TiO.sub.2 Nanoparticles on Aerobe Peri-Implantitis-Associated Bacteria: TiO.sub.2 grit-blasted titanium coins (Grade IV) with diameter of 6.2 mm will be contaminated by aerobe peri-implantitis-associated bacteria (Streptococcus mutans, S. sanguis, Actinomyces naeslundii). The surface will be cleaned with titanium bristle device, TiBrush for 3 minutes with the following cleaning solutions (EDTA, saline water, 3% vol H.sub.2O.sub.2 and the suspension as described in example 1.). The coins will be individually placed in 1.5 ml Eppendorf tubes containing 500 l of cell culture medium (without antibiotics) of from Invitrogen (GIBSCO MEM, Invitrogen, Carlsbad, Calif., USA). All the Eppendorf tubes containing the coins and the bacteria will be placed in an incubator, in the dark, at 37 C. for 20 hours. After 20 hours, all the samples will be taken out of the incubator. A Spectrometer (Perkin Elmer UV-Vis 200, Oslo, Norway) will be calibrated with only 700 l of cell media for the base line. Then, the three Eppendorf tubes containing only 500 l of cell media+10 l of the stock solution will be analyzed. Then, one by one the test tubes will be shaken and a volume of 400 l from each tube will be mixed with 300 l of cell media. The 1.5 ml cuvettes contained 700 l of liquid to be analyzed.

Example 6

[0122] Anti-Bacterial Effect of TiO.sub.2 Nano-Suspension

[0123] Removal of Multilayer Staphylococcus epidermidis from three types of rough surfaces.

[0124] Coin-shaped titanium implants (grade 2, 6.2 in diameter and 2 mm in height) were used in these experiments. The three groups selected correspond to commercial implant surfaces: SLActive (Straumann, Basel, Switzerland), TiUnite (NobelBiocare, Zurich, Switzerland), OsseoSpeed (AstraTech, Mlndal, Sweeden). They all have a specific topography (FIG. 1).

[0125] These samples were inoculated with Staphylococcus epidermidis (S.ep.) in culture medium (Brain Heart Infusion or BHI) and left in the incubator at 35 C. for 16 hours. After the incubation period reached, all the samples were covered by a biofilm (FIG. 2).

[0126] The samples were gently rinsed three times for 2 minutes with NaCl, then exposed to NaCl (control group) or to the nano-suspension (H.sub.2O.sub.2+TiO.sub.2 prepared as described in example 1) (test group). The samples were again rinsed and analyzed using two methods in order to detect the biomass still attaching to the surfaces.

[0127] The first method employed was using a SEM at 5000 of magnification (FIG. 3).

[0128] By this visual and qualitative method, it is possible to detect a reduction of the biofilm density from the test group compared to the control group.

[0129] The second method used was by safranin staining the nucleus of the bacteria attaching on the surfaces after exposure to the solution. The staining pink color is then released from the surfaces and analyzed by using a spectrophotometer (Synergy HT Multi-Detection Microplate Reader, Biotek, Winooski, Vt., USA) at a wavelength of 530 nm. This method was performed on each samples (n=9) of each group (FIGS. 4, 5 and 6). A statistical analysis was conducted to determine if the data collected were statically significant (noted * if p-values<0.05).

[0130] From these results we could conclude that the amount of bacteria present on the surface of the samples was significantly lower after exposure to the nano-suspension (H.sub.2O.sub.2+TiO.sub.2) compared to NaCl, no matter the topography.

[0131] Safranin staining gives quantitative results regarding the chemical potential alone in removing a biofilm formed after 16 hours of incubation. However, it is not possible to detect whether or not these bacteria are dead or not. Therefore, in order to test if this chemical disinfection could stop the biofilm growth, an other test was conducted in order to determine the viability of the biofilm after the disinfection.

[0132] The method was similar to the safranin staining analysis, from the inoculation to the disinfection using both products (NaCl and nano-suspension). But this time, after the disinfection step, the samples were rinsed in NaCl and re-incubated at 35 C. for four hours in pure BHI medium. The medium was then collected and analyzed using the same spectrophotometer but this time at a wavelength of 600 nm. The intensity of the absorbance was compared between control and test groups (FIG. 7).

[0133] The results from this experiment lead to the conclusion that the nano-suspension of H.sub.2O.sub.2+TiO.sub.2 decreases the bacterial re-growth compared to NaCl solution.

[0134] Overall Conclusion:

[0135] The nano-suspension of H.sub.2O.sub.2+TiO.sub.2 decreases significantly the biomass presence from various commercialized dental implant surfaces as well as the bacterial re-growth compared to NaCl solution.

Example 7

[0136] Titanium disks preparation and surface modification chemically pure (cp) titanium disks (n=53) with a diameter of 6.2 mm and a height of 2 mm were grinded and polished (Phoenix 4000, Buehler GmbH, Duesseldorf, Germany) in seven sequences. Silicon carbide papers from P800 to P4000, a porous neoprene for final polishing as well as the abrasive colloidal silica suspension (OP-S) were supplied by the same manufacturer (Struers GmbH, Willich Germany).

[0137] After polishing, the disks were washed with NaOH at 40 vol. % and HNO3 at 50 vol. % in an ultrasonic bath to remove contaminants, then washed with deionized water to reach a neutral pH, and stored at room temperature in 70 vol. % ethanol. Thereafter, the coins were placed in Eppendorf tube and steam autoclaved for sterilization.

[0138] Three chemical decontamination agents were selected for the in vitro testing: sterile saline H.sub.2O (VWR, Oslo, Norway), Pref Gel, (Straumann Institut, Basel, Switzerland).0.2 vol % Chlorhexidine, 3 vol % H.sub.2O.sub.2 (VWR, Oslo, Norway) and a mixture of 3 vol % H.sub.2O.sub.2 and 2 g/L TiO2 (1 g nanoparticles: P25 Aeroxide, Degussa Evonik, Evonik Industries AG, Essen, Germany+1 g microparticles: Kronos 1171, Kronos Titan GmbH, Leverkusen, Germany).

[0139] In Vitro Testing: Biofilm Assay

[0140] 53 polished and sterile titanium disks per groups were inoculated. The control group was inoculated with brain heart infusion broth (BHI) only, while the test groups (five) were inoculated with the bacteria culture (10 l Staphylococcus epidermidis+5 ml BHI). The incubation time lasted for 24 h at 37 C. in an aerobic atmosphere. The discs were then transferred to new wells, rinsed with sterile saline water, then were exposed to the five selected chemical agents for two minutes, then rinse again with sterile saline water. The amount of biofilm present on the surface of the titanium samples was assessed by using the safranin staining method: 10 min exposure to a 0.1% solution of safranin, then rinsed with distilled water, air dried, and exposed to a solution of 30% acetic acid to release the colored biomass from the titanium surfaces. The intensity of the staining was analyzed using a Synergy HT Multi-Detection Microplate Reader (Biotek, Vt., USA) with a wavelength of 530 nm.

[0141] Statistical Analysis

[0142] A power analysis was performed on pilot data in order to find appropriate number of samples (SPSS 17.0 for Windows). One way ANOVA was used to compare all the groups. If the data set failed both equality and normality test and could not be normalized by transformation, non-parametric Kruskal-Wallis analysis of variance (ANOVA) on ranks was used instead. Significance differences between each groups (p-values<0.05) was found using the Dunn's test (SigmaPlot 11.0, Systat Inc, St-Louis, USA).

[0143] Results

[0144] Optical density analysis in the Synergy HT Multi Detection microplate Reader revealed that all the samples exposed to the chemical solutions had a statistically significant (p<0.05) increase of the biomass except for the group exposed to the 3 vol % H.sub.2O.sub.2 and 2 g/L TiO.sub.2 which was not significantly different than the control group (p>0.05).

[0145] All the groups were statistically significant between each others.

[0146] The suspension composed by a mixture of 3 vol % H.sub.2O.sub.2 and 2 g/L TiO.sub.2 (1 g nanoparticles+1 g microparticles) was the most effective in removing the biofilm from the contaminated titanium surfaces, significantly more effective than 3% H.sub.2O.sub.2 alone.

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