Introduction: Biofilm is linked through a variety of mechanisms to the pathogenesis of chronic wounds. However, accurate biofilm detection is challenging, demanding highly specialized and technically complex methods rendering it unapplicable for most clinical settings. This study evaluated promising methods of bedside biofilm localization, fluorescence imaging of wound bacterial loads, and biofilm blotting by comparing their performance against validation scanning electron microscopy (SEM). Methods: In this clinical trial, 40 chronic hard-to-heal wounds underwent the following assessments: (1) clinical signs of biofilm (CSB), (2) biofilm blotting, (3) fluorescence imaging for localizing bacterial loads, wound scraping taken for (4) SEM to confirm matrix encased bacteria (biofilm), and (5) PCR (Polymerase Chain Reaction) and NGS (Next Generation Sequencing) to determine absolute bacterial load and species present. We used a combination of SEM and PCR microbiology to calculate the diagnostic accuracy measures of the CSB, biofilm blotting assay, and fluorescence imaging. Results: Study data demonstrate that 62.5% of wounds were identified as biofilm-positive based on SEM and microbiological assessment. By employing this method to determine the gold truth, and thus calculate accuracy measures for all methods, fluorescence imaging demonstrated superior sensitivity (84%) and accuracy (63%) compared to CSB (sensitivity 44% and accuracy 43%) and biofilm blotting (sensitivity 24% and accuracy 40%). Biofilm blotting exhibited the highest specificity (64%), albeit with lower sensitivity and accuracy. Using SEM alone as the validation method slightly altered the results, but all trends held constant. Discussion: This trial provides the first comparative assessment of bedside methods for wound biofilm detection. We report the diagnostic accuracy measures of these more feasibly implementable methods versus laboratory-based SEM. Fluorescence imaging showed the greatest number of true positives (highest sensitivity), which is clinically relevant and provides assurance that no pathogenic bacteria will be missed. It effectively alerted regions of biofilm at the point-of-care with greater accuracy than standard clinical assessment (CSB) or biofilm blotting paper, providing actionable information that will likely translate into enhanced therapeutic approaches and better patient outcomes.

The current investigation evaluated a novel acid-etching solution containing hydrochloric acid (HCl), hydrofluoric acid (HF), nitric acid (HNO₃), orthophosphoric acid (H₃PO₄), and sulfuric acid (H₂SO₄) designed for etching zirconia ceramics. Achieving reliable bonding to zirconia is challenging due to its chemical inertia, unlike lithium disilicate, which can be effectively conditioned with HF etching. One hundred and twenty specimens of zirconia and lithium disilicate underwent etching with the experimental solution for six different durations: control, 20 s, 60 s, 5 min, 30 min, and 1 h. Surface roughness was assessed using 3D optical profilometry and scanning electron microscopy (SEM). The roughness of both materials increased with etching time; however, lithium disilicate demonstrated a significantly greater response, with Ra values rising from 0.18 µm (control) to 1.26 µm (1 h), while zirconia increased from 0.21 µm to 0.60 µm. ANOVA revealed significant effects depending on the ceramic type, time, and their interaction (p < 0.001). SEM images revealed non-selective etching of lithium disilicate, suggesting potential over-etching. The novel acid-etching solution improved surface roughness, especially in lithium disilicate ceramics. An application duration of one hour appears optimal for zirconia, improving surface characteristics while reducing damage; however, further research is required to assess its clinical safety and long-term effects on the mechanical properties of this dental ceramic.

Ismail HS, et al. Restor Dent Endod. 2022 Sep;47:e36. https://doi.org/10.5395/rde.2022.47.e36

Background: This study investigated a new multi-acid-etching formulation for zirconia ceramics, containing hydrochloric, hydrofluoric, nitric, orthophosphoric, and sulfuric acids. The solution was tested on polycrystalline (5Y-TZP zirconia), lithium disilicate, hybrid ceramic, and feldspathic porcelain to assess compatibility, etching selectivity, and surface conditioning. Methods: Two-hundred-and-forty CAD/CAM specimens were etched for 20 s, 60 s, 30 min, or 1 h, and their surface roughness and etching patterns ware evaluated using 3D optical profilometry and scanning electron microscopy (SEM). Results: A positive correlation was observed between etching time and surface roughness (Ra values). The most pronounced changes were observed in lithium disilicate and feldspathic porcelain, with Ra values increasing from 0.733 ± 0.082 µm (Group 5) to 1.295 ± 0.123 µm (Group 8), and from 0.902 ± 0.102 µm (Group 13) to 1.480 ± 0.096 µm (Group 16), respectively. Zirconia increased from 0.181 ± 0.043 µm (Group 1) to 0.371 ± 0.074 µm (Group 4), and the hybrid ceramic from 0.053 ± 0.008 µm (Group 9) to 0.099 ± 0.016 µm (Group 12). Two-way ANOVA revealed significant effects of material and etching time, as well as a significant interaction between the two factors (p < 0.001). SEM observation revealed non-selective etching pattern for the lithium disilicate groups, indicating a risk of over-etching. Conclusions: The tested etching solution increased surface roughness, especially for the lithium disilicate and feldspathic porcelain specimens. In zirconia, one-hour etching improved surface characteristics with minimal observable damage. However, additional studies are necessary to validate the mechanical stability and bond effectives of this approach.