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Ceramic materials are less exposed to the biofilm formation, especially due to the inert surface as well as the possibility of surface treatment, which also leads to smooth surfaces with low adherence of the bacterial strains (Bremer et al., 2011).

Diaz-Rodriguez et al. (2011) have been involved in developing bio-inspired SiC ceramics starting from a well-known procedure Si-melt infiltration of carbonaceous scaffolds derived from wood templates. They found that a special, porous morphology was achieved, with pores of about 85 pm, which is ideal for bone tissue engineering (Marques et al., 2014). Moreover, the unidirectional pores as well as the interconnected pore network make these materials potential candidates for tissue engineering. The antibiofilm/antibacterial properties are assured by the loading these materials with an antimicrobial agent such as vancomycin. The presence of this drug as well as the delivery rate is essential from the point of view of antibacterial and antibiofilm properties, the biofilm regression being of up to 92.2%, even for methicillin-resistant Staphylococcus aureus (MRSA).

Surface roughness, hydrophobicity, and biofilm formation capacity on feldspar ceramics were analyzed. Brentel et al. (2011) found that biofilm formation can be correlated with the surface roughness, being in a direct proportion with the biofilm formation as highlighted in Fig. 7.6. Based on their data, it can be observed that smoother

Surface roughness-thickness correlation

Figure 7.6 Surface roughness-thickness correlation.

Adapted based on Brentel, A.S., Kantorski, K.Z., Valandro, L.F., Fucio, S.B., Puppin-Rontani, R.M., Bottino, M.A., 2011. Confocal laser microscopic analysis of biofilm on newer feldspar ceramic. Oper. Dent. 36, 43-51.

layers are better from the point of view of biofilm formation. Based on their results (four groups with 10 samples, each), the volume of the formed biofilm seems to be proportional with the surface roughness. The glazed samples (roughness=0.53 ± 0.11 |im) exhibit the lowest biofilm deposition, while the glazed samples exposed to the diamond bur (roughness = 2.02 ± 0.12 |im) exhibit the highest biofilm deposition. Once the surface of the glazed samples was diamond burred, the polishing under various conditions reduced the surface roughness and thus the biofilm formation capacity, due to the lower adherence. Because many times the intraoral adjustment of the glazed ceramic materials is required, the proper polishing protocol with rubber tips and felt disk impregnated with fine-aluminum oxide particle-based paste provides similar biofilm formation on its surface, even if the surface is still rougher. It is most probably due to the more hydrophilic surface compared with the glazed ceramic.

Comparing biofilm formation in vivo, Lindel et al. (2011) carried out a complex study on 20 adolescent, divided into two groups, one using metal and another using ceramic brackets. For each group, 30 brackets were used and they found that biofilm formation is significantly lower when using ceramic compared with the metallic brackets, meaning 5.6 ± 2.4% compared with 12.5 ± 5.7%. Also, they found that biofilm formation is also dependents on intraoral location (second premolar, canine, or central incisor) as well as the bracket surface (buccal, occlusal, gingival, mesial, and distal).

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