Dental caries caused by cariogenic biofilms is a significant challenge in modern dentistry, especially with aligner treatments, where biofilms can easily build up during prolonged use and lead to serious risks. Traditional antimicrobial methods focus on bacterial killing and often overlook the vital task of removing the biofilm matrix, allowing the quick reattachment of bacteria. In this study, we introduce an osmotic-driven biofilm removal strategy that harnesses osmotic dynamics to remove entire biofilm structures physically. Internal osmotic pressure is generated by a precisely designed cationic copolymer, triggering controlled detachment of the biofilm matrix. When tested in vitro on Streptococcus mutans biofilms grown on dental aligners and in hard-to-reach interproximal spaces, our method eliminated biofilms more efficiently than traditional cleaning methods. The technique showed concentration-dependent cytotoxicity, highlighting the need for further polymer optimization. Overall, our osmotic-driven biofilm removal strategy significantly advances biofilm control strategies, offering a novel solution for improving oral health and presenting a potential physical removal method for medical settings.
AlansariRAFaydhiDAAshourBSAlsaggafDHShumanMTGhoneimSHLinjawiAIMarghalaniHYDauseRR. 2019. Adult perceptions of different orthodontic appliances. Patient Prefer Adherence. 13:2119–2128.
2.
AlhedeMAlhedeMQvortrupKKraghKNJensenPStewartPSBjarnsholtT.2020. The origin of extracellular DNA in bacterial biofilm infections in vivo. Pathog Dis. 78(2):ftaa018. doi:10.1093/femspd/ftaa018
3.
BerneCEllisonCKDucretABrunYV. 2018. Bacterial adhesion at the single-cell level. Nat Rev Microbiol. 16(10):616–627.
4.
BichuYMAlwafiALiuXAndrewsJLudwigBBichuAYZouB.2023. Advances in orthodontic clear aligner materials. Bioact Mater. 22:384–403.
5.
BieserAMTillerJC. 2011. Mechanistic considerations on contact-active antimicrobial surfaces with controlled functional group densities. Macromol Biosci. 11(4):526–534.
6.
BorisovaDHaladjovaEKyulavskaMPetrovPPispasSStoitsovaSPaunova-KrastevaT.2018. Application of cationic polymer micelles for the dispersal of bacterial biofilms. Eng Life Sci. 18(12):943–948.
7.
BusscherHJJagerDFingerGSchaeferNvan der MeiHC. 2010. Energy transfer, volumetric expansion, and removal of oral biofilms by non-contact brushing. Eur J Oral Sci. 118(2):177–182.
8.
ChengYFengGMoraruCI. 2019. Micro- and nanotopography sensitive bacterial attachment mechanisms: a review. Front Microbiol. 10:191. doi:10.3389/fmicb.2019.00191
ColomboAPVTannerACR. 2019. The role of bacterial biofilms in dental caries and periodontal and peri-implant diseases: a historical perspective. J Dent Res. 98(4):373–385.
11.
CottetHGareilPViovyJL. 1998. The effect of blob size and network dynamics on the size-based separation of polystyrenesulfonates by capillary electrophoresis in the presence of entangled polymer solutions. Electrophoresis. 19(12):2151–2162.
12.
DuSZhaoPWangLHeGJiangX.2023. Progresses of advanced anti-fouling membrane and membrane processes for high salinity wastewater treatment. Results Eng. 17:100995. doi:10.1016/j.rineng.2023.100995
13.
EffendySZhouTEichmanHPetrMBazantMZ. 2021. Blistering failure of elastic coatings with applications to corrosion resistance. Soft Matter. 17(41):9480–9498.
14.
FlemmingHCvan HullebuschEDNeuTRNielsenPHSeviourTStoodleyPWingenderJWuertzS.2023. The biofilm matrix: multitasking in a shared space. Nat Rev Microbiol. 21(2):70–86.
15.
FlemmingHCWingenderJ.2010. The biofilm matrix. Nat Rev Microbiol. 8(9):623–633.
16.
GeiselSSecchiEVermantJ.2022. The role of surface adhesion on the macroscopic wrinkling of biofilms. Elife. 11:e76027. doi:10.7554/elife.76027
17.
GraessleyWW.1980. Polymer chain dimensions and the dependence of viscoelastic properties on concentration, molecular weight and solvent power. Polymer. 21(3):258–262.
18.
HutchinsonJWThoulessMDLinigerEG. 1992. Growth and configurational stability of circular, buckling-driven film delaminations. Acta Metall Mater. 40(2):295–308.
19.
JakubovicsNSShieldsRCRajarajanNBurgessJG. 2013. Life after death: the critical role of extracellular DNA in microbial biofilms. Lett Appl Microbiol. 57(6):467–475.
20.
JiangSCaoZ.2010. Ultralow-fouling, functionalizable, and hydrolyzable zwitterionic materials and their derivatives for biological applications. Adv Mater. 22(9):920–932.
21.
KeYZhuYZhuM.2019. A comparison of treatment effectiveness between clear aligner and fixed appliance therapies. BMC Oral Health. 19(1):24. doi:10.1186/s12903-018-0695-z
22.
KleinMIDeBazLAgidiSLeeHXieGLinAHHamakerBRLemosJAKooH.2010. Dynamics of Streptococcus mutans transcriptome in response to starch and sucrose during biofilm development. PLoS One. 5(10):e13478. doi:10.1371/journal.pone.0013478
23.
KleinMIHwangGSantosPHCampanellaOHKooH.2015. Streptococcus mutans–derived extracellular matrix in cariogenic oral biofilms. Front Cell Infect Microbiol. 5:10. doi:10.3389/fcimb.2015.00010
24.
KooHAllanRNHowlinRPStoodleyPHall-StoodleyL.2017. Targeting microbial biofilms: current and prospective therapeutic strategies. Nat Rev Microbiol. 15(12):740–755.
25.
LemosJAPalmerSRZengLWenZTKajfaszJKFreiresIAAbranchesJBradyLJ. 2019. The biology of Streptococcus mutans. Microbiol Spectr. 7(1):10.1128/microbiolspec.gpp3-0051-2018. doi:10.1128/microbiolspec.gpp3-0051-2018
26.
LevriniLNovaraFMargheriniSTenconiCRaspantiM.2015. Scanning electron microscopy analysis of the growth of dental plaque on the surfaces of removable orthodontic aligners after the use of different cleaning methods. Clin Cosmet Investig Dent. 7:125–131.
27.
LiuQSongZ.2024. Incidence, severity, and risk factors for white spot lesions in adolescent patients treated with clear aligners. Orthod Craniofac Res. 27(5):704–713.
28.
MiraASimon-SoroACurtisMA. 2017. Role of microbial communities in the pathogenesis of periodontal diseases and caries. J Clin Periodontol. 44 Suppl18:S23–S38.
29.
MoradinezhadMAbbasi MontazeriEHashemi AshtianiAPourlotfiRRakhshanV.2024. Biofilm formation of Streptococcus mutans, Streptococcus sanguinis, Staphylococcus epidermidis, Staphylococcus aureus, Lactobacillus casei, and Candida albicans on 5 thermoform and 3D printed orthodontic clear aligner and retainer materials at 3 time points: an in vitro study. BMC Oral Health. 24(1):1107. doi:10.1186/s12903-024-04893-4
30.
MortazavianHFosterLLBhatRPatelSKurodaK.2018. Decoupling the functional roles of cationic and hydrophobic groups in the antimicrobial and hemolytic activities of methacrylate random copolymers. Biomacromolecules. 19(11):4370–4378.
31.
OhsumiTTakenakaSWakamatsuRSakaueYNarisawaNSenpukuHOhshimaHTeraoYOkijiT.2015. Residual structure of Streptococcus mutans biofilm following complete disinfection favors secondary bacterial adhesion and biofilm re-development. PLoS One. 10(1):e0116647. doi:10.1371/journal.pone.0116647
32.
PetersonBWHeYRenYZerdoumALiberaMRSharmaPKvan WinkelhoffAJNeutDStoodleyPvan der MeiHC, et al. 2015. Viscoelasticity of biofilms and their recalcitrance to mechanical and chemical challenges. FEMS Microbiol Rev. 39(2):234–245.
33.
SeibFPJonesATDuncanR.2007. Comparison of the endocytic properties of linear and branched PEIs, and cationic PAMAM dendrimers in B16f10 melanoma cells. J Control Release. 117(3):291–300.
34.
SeoBMMiuraMGronthosSBartoldPMBatouliSBrahimJYoungMRobeyPGWangCYShiS.2004. Investigation of multipotent postnatal stem cells from human periodontal ligament. Lancet. 364(9429):149–155.
35.
SerrageHJJepsonMARostamiNJakubovicsNSNobbsAH. 2021. Understanding the matrix: the role of extracellular DNA in oral biofilms. Front Oral Health. 2:640129. doi:10.3389/froh.2021.640129
36.
TanakaTSunS-THirokawaYKatayamaSKuceraJHiroseYAmiyaT.1987. Mechanical instability of gels at the phase transition. Nature. 325(6107):796–798.
37.
VenkitaramanARVacca-SmithAMKopecLKBowenWH. 1995. Characterization of glucosyltransferaseB, GtfC, and GtfD in solution and on the surface of hydroxyapatite. J Dent Res. 74(10):1695–1701.
38.
VickermanMMMansfieldJMZhuMWaltersKSBanasJA. 2015. Codon-optimized fluorescent mTFP and mCherry for microscopic visualization and genetic counterselection of streptococci and enterococci. J Microbiol Methods. 116:15–22.
39.
WeirT.2017. Clear aligners in orthodontic treatment. Aust Dent J. 62 Suppl 1:58–62.
ZhengSBawazirMDhallAKimHEHeLHeoJHwangG.2021. Implication of surface properties, bacterial motility, and hydrodynamic conditions on bacterial surface sensing and their initial adhesion. Front Bioeng Biotechnol. 9:643722. doi:10.3389/fbioe.2021.643722
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