Bacterial Biofilm Bioremediation of the Human Jawbone before Implant Installation - the Paradigm Shift is Resident Microbial Population Shift

Author(s): Stephen Nelson, Anand Deva, Honghua Hu, Anita Jacombs, Georgina Luscombe, Karen Vickery, Andre Viljoen

Our previously published, peer reviewed research examines the fact that the human jawbone, like multiple other body spaces, is not sterile, but rather, it supports permanent, native, living, microbial communities, which may range in community structure from homeostatic (healthy, stable, and ecologically diverse), to a graded spectrum of pathologic communities, often depending on the history of the previously supported tooth. The health or otherwise of human jawbone can be recognised radiographically, with healthy bone showing a moderate to medium intact cortical plate without sclerotic thickening, which confines spongy bone with trabecular connectivity varying in open or more closed mesh anatomy with variation in thickness or trabecular density. The presence of lytic (radiolucent) or sclerotic (radiopaque) areas within the trabecular space are both biomarkers of diseased bone, often seen post-extraction, which support pathologic biofilm communities. We have previously identified 5 bone qualities which directly relate to the health/disease of the resident biofilm communities. The primary requirement for enduring osseointegration is that the installation of the dental implant must occur into a healthy, disease-free bone-bed, which supports non-pathogenic biofilm communities. Accepting that only ecologically healthy bone is suitable for implant installation, is it possible to return diseased bone to ecological and architectural health and normalcy, suitable for enduring osseointegration? In this paper we will present a surgical technique, named Regenerative Surgical Debridement (RSD), as a method of returning diseased bone to health, making it suitable for implant installation. Using statistical NMDS ordination of the pyrosequencing data taken from both the pre- and post- RSD bone beds, we present case studies showing complete and partial population shift of diseased microbial communities that ordinate close/ closer to our health-control communities, with a radiographic return to normal bony architecture and anatomy. We suggest that the presence of native, beneficial resident bacteria does not elicit an immunobiological response as they are a tolerated population. In the presence of symbiotic colonisation of these beneficial health microbiota and a pathogen-evading, smooth (Sa<1 micron), uniform, commercially pure titanium surface (that bio-mimics the surface topography and microarchitecture of the heathy human cell), we can progress to passive osteoblastic implant anchorage, where neither the microbial presence nor the biomaterial surface, elicit chronic inflammation, (outside of an initial, brief, surgically-induced inflammation), which beneficial bacterial sRNA may suppress, causing only a short-term (pulse-type) disturbance of the resident population