Periodontology 2000, Vol.
8, 1995, 114-124
Printed iii Denmark All rights reserved
The effect of restorative and
prosthetic materials on dental
USAMANASSAR,
ANNEE. MEYER,
ROBERTE. OGLE& ROBERTE. BAIER
Periodontal health requires that the existing good
adhesion of soft tissue cells to hard tissues be main-
tained. Protection of the intraoral surfaces from ero-
sion, corrosion, and wear requires strong binding of
salivary macromolecules. These features also are im-
portant to restored teeth, prosthetics and implants.
Since the factors controlling biological adhesion are
uniform throughout nature, it is not surprising that
dental plaque accumulates on most of the same sur-
faces noted for good cell adhesion. The influence of
various dental materials on dental plaque is mani-
fested almost exclusively through their differences in
the strength of retention of plaque deposits. Such
deposits otherwise build up uniformly on all sur-
faces exposed to the same intraoral conditions. Ob-
servations that some materials are more plaque-
prone than others can be rationalized, and reliable
predictions made, with reference to the critical sur-
face tension of each material. Critical surface tension
is estimated from a simple series of contact angle
measurements. Reference to the materials’ hydro-
philic or hydrophobic properties alone is insuf-
ficient. Assessment of related factors, such as surface
roughness and moderate changes in chemical com-
position, also shows these to be of importance. The
intrinsically higher-energy surfaces of restorative or
prosthetic metals, alloys, glasses and ceramics favor
strong plaque retention. Intermediate-energy sur-
faces such as those of methacrylate-based com-
posites and dentures foster intermediate plaque re-
tention, which is increased by roughness. Low-en-
ergy and smooth surfaces of silicones, fluorinated
materials and any deliberately or inadvertently wax-
or oil-coated materials of any of the higher-energy
types all show lesser bioadhesion. The challenge for
current and future research is to better understand
how the interfacial conformations of salivary glyco-
proteins, which are the bioadhesives themselves, can
114
Copyright 0 Munksgaard 1995
PERIODONTOLOGY 2000
lSSN 0906-6713
be better controlled by the initial qualities of the re-
storative and prosthetic materials used.
As a result of protein deposition and subsequent
bacterial colonization and growth, the tooth sur-
face - especially in cracks, defects and stagnant
interdental regions - accumulates dental plaque and
becomes more susceptible to the development of
dental caries and periodontal disease. The formation
of plaque begins with the rapid nonselective depo-
sition of several salivary proteins onto all exposed
intraoral surfaces (10, 59) followed by desorption of
some and retention of others, to yield an amorphous
thin layer (less than 1 pm in thickness) known as the
acquired pellicle (45). These pellicle formation steps
are similar in pattern to those in which biological
films form on sutures and in artificial organs (10).
This initial stage of plaque formation is followed by
the nonspecific arrival, but generally different ac-
cumulation, of several oral bacteria (such as Strepto-
coccus mutans, Streptococcus sanguis, Lactobacillus
and Actinomyces viscosus) that may be present in the
intraoral pool.
The wide variety of restorative materials available
for use in the oral cavity (such as amalgam, glass ion-
omer cements, composite resins, acrylic resins, por-
celains, metals and alloys) experiences these early
events uniformly, even though their physical and
chemical properties clearly differ from one to another,
just as the surface roughness and surface chemistry of
a single material can differ from one product to an-
other. Yet, the end result is that the final composition
and retention of both acquired pellicle and built-up
plaque can be different from material to material and
product to product. Glantz (28) showed that the initial
surface properties of both teeth and restorative ma-
terials influence the adhesion strength of dental
plaque otherwise accumulated to the same amounts
on all these surfaces. Later, Baier & Glantz (10) showed

that this result reflected differences in how adsorbed
organic films modify the adhesiveness of experimen-
tal solid surfaces placed in the oral cavity They
showed that the pattern of packing of the molecules
forming oral films depends on the type of substratum
at which the molecules arrive. Fig. 1-3 show oral ap-
pliances used by Baier & Glantz to study films formed
in vivo. Adamczyk & Spiechowicz (1) demonstrated
that build-up of plaque on different materials under
actual clinical conditions differs in chemical compo-
sition as a function of the variable manner in which
plaque accumulates on different materials. These dif-
ferences emerge, as Jendresen & Glantz (37) demon-
strated, from a situation in which initial differences in
the apparent surface properties of restorative ma-
terials are diminished after a short time in the mouth.
It is important, therefore, to examine the very initial
physical and chemical surface properties of dental in-
terfaces to better understand the observed influence
of different types of restorative materials on plaque
formation in comparison with oral hard tissues.
Methods
To follow the interactions of salivary components
with dental and restorative surfaces, it is important
to have methods allowing study of the formation of
biofilms on solid test surfaces from solution. The bi-
ofilm formation events can be achieved under both
static and dynamic conditions (21, 46). The coated
and uncoated germanium test plates (Harrick Scien-
tific, Ossining, NY) used in this research favorably
modeled intraoral restorative surfaces and have also
been shown to accurately model the interactions be-
tween saliva and teeth (22). They are ideal for exten-
sive in situ analyses of adsorbed films by the follow-
ing techniques.
Multiple attenuated internal reflection infrared
spectroscopy is used to obtain chemical compo-
sition of covalently bound moieties such as hy-
droxyl, amine, amide, phosphate, hydrocarbon
and carbonate. The technique is nondestructive
and can detect monolayers as thin as 1 nm (7, 14,
46).
Thin-film ellipsometry is used to measure the op-
tical thickness and refractive indices of thin inor-
ganic and organic films (2, 44).
Comprehensive contact angle measurements are
used to determine a material’s critical surface ten-
sion (64). Baier (5) demonstrated this property to
Effect of restorative and prosthetic materials on plaque
be directly related to biological adhesion. Contact
angle data also are used to determine the relative
polarity of a surface (32). Contact angle measure-
ments of only water can be extremely misleading
(8). Fig. 4 shows a droplet of one diagnostic liquid
on denture material (20).
Scanning electron microscopy is used for textural
analysis of the sample, and energy-dispersive X-
ray analysis - performed in the same instrument -
is used for a general elemental analysis. Classical
cross-sectional techniques (histochemical and/or
ultrastructural) also can provide important data
about interactions between living matter and ma-
terials. Atomic force microscopy and scanning
tunnelling microscopy are likely to provide ad-
ditional insights to interfacial events in the near
future (26, 38).
The techniques described above are performed
under ambient conditions or moderate vacuum con-
ditions. Some newer analyses for elemental and
chemical composition of surfaces and thin films re-
quire high- and ultra-high vacuum techniques ( 5 3 ) ;
these include X-ray photoelectron spectroscopy,
scanning auger microscopy and secondary-ion mass
spectrometry.
Dental plaque formation: the
effect of surface energy
There have been few detailed studies about the for-
mation of dental plaque on practical restorative ma-
terials whose surface properties were known in the
exact conditions that are used clinically (20, 49). As
a discussion aid, the term high-energy materials re-
fers, in the following text, to solids that are very hard,
have high melting points and strong intermolecular
forces and are basically crystalline in structure.
When clean (in high temperature, high vacuum en-
vironments), these materials can have specific sur-
face free energy values as high as 500 to 5000 mN/
m. Generally, however, dental restorative materials
and dental enamel are described as high-energy ma-
terials when they have composite surface energies
above 50 mN/m (7),as indicated by measured criti-
cal surface tensions. On the other hand, the term
low-energy materials describes substances that are
usually soft, have low melting points and weak inter-
molecular forces and also have poor crystallinity.
The surface energies of such materials are usually
less than 30 mN/m, again as judged by contact
115
Nassar et al.

116

angles and critical surface tension data. Waxes, poly-
mers, and many other organic materials are good
examples (12, 47). Fluorocarbons, such as common
Teflon@-basedproducts, are in a special very-low-
energy category of their own, with critical surface
tensions less than 20 mN/m. The unfortunate fact is
that most common restorative polymers and metals
or alloys under practical clinical conditions express
intermediate surface energies (between 30 and 50
mN/m) and cannot be so readily compared with one
another as either the high- or low-energy groups.
Every fluid, including saliva, rapidly spreads on
smooth, clean, high-energy materials at ordinary
temperatures unless another film (having a critical
surface tension value less than the surface tension
of the liquid) has already formed on that solid sur-
face (64).The fact that tooth and restorative metal or
porcelain surfaces rapidly acquire such films (dental
Fig. 1. Fixture used by Baier & Glantz (10) to study the
initial stages of plaque formation in vivo. Small test plates
(germanium plates used for Multiple attenuated internal
reflection infrared spectroscopy are shown here) are
placed in acrylic pouches. Saliva flows freely through slits
in the bottoms of the pouches. Test plates are perpendicu-
lar to the occlusal plane.
Fig. 2. Another fixture used for study of early plaque for-
mation. In this device, the test pieces are in the occlusal
plane.
Fig. 3. To model the oral cavity more closely, test materials
(light-coloredregions in this photo) can be inserted in bite
splints. After exposure, bite splint and test pieces are re-
turned to the laboratory and analyzed for differential
plaque accumulation.
Fig. 4. Photo of a liquid droplet on denture material. The
angles of contact between several diagnostic liquids and
the restorative material are used to determine “critical
surface tensions” and material polarities, as typical sur-
face-energy characteristics that correlate with plaque
build-up and retention.
Fig. 5. ’ b o test plates of different surface energy after
side-by-sideexposure to a Streptococcus CC5A culture (48)
for 24 hours. Before exposure, both plates were equally
smooth and shiny. After exposure, only the low-energy
plate remained smooth, since poor adhesion of the
plaque-forming organisms made it impossible for rough
deposits to be retained.
Fig. 6. Scanning electron microscopic photo of the same
low-energy test plate shown in Fig. 5. Note absence of
microorganisms and spontaneous retraction of the “ac-
quired pellicle” from the low-energy surface (original
magnification: x 2000).
Fig. 7. An illustration of a half-denture reline with two dif-
ferent materials for simultaneous exposure to the same
clinical plaque-forming environment (20).
Effect of restorative and prosthetic materials on plaque
pellicle) explains why they actually behave as low-
to-intermediate-energy materials, despite their in-
trinsically higher energies when clean. Only the
freshly acid-etched enamel surface, briefly devoid of
pellicle and organic constituents, can be considered
to be a temporarily high-energy mineral surface. The
surface analysis techniques mentioned above were
used to investigate the effects of the surface prop-
erties of different dental restorative materials on pel-
licle formation and plaque retention; this showed
that clean cobalt-chromium alloys, stainless steels,
dental porcelains, silicate and phosphate cements
and corroded silver amalgam also are all high-energy
materials. When clean upon first exposure to the oral
environment, they display maximum adhesive prop-
erties with respect to arriving organic substances
and water (28).
It is important to note that specification of just the
degree of hydrophobicity is not a useful discriminant
for dental plaque build-up. In a clinical study using
five different hydrophobic materials, Glantz (28, 29)
found that the maximum weight of plaque capable
of remaining adherent to a prosthetic material de-
pends more directly on the value of the surface free
energy of the material than on its relative wettability
by water or aqueous solutions. Summarizing Glantz’s
work, a stronger force per unit area is required to
remove biofilms from the surfaces of clean metallic
and ceramic dental restorative materials than from
the surfaces of pellicle-coated enamel or dentin or
from the surfaces of resins coating an adjacent tooth
surface. The frequency of secondary caries may be
higher than primary caries because plaque can
achieve a larger volume and can adhere more tightly
to the higher-energy surfaces of some restorative
materials than to pellicle-coated enamel and dentin.
Glantz et al. (30) developed a clinical method to
measure contact angles directly on living tooth sur-
faces to determine their adhesiveness in situ. Jendr-
esen et al. (35-37) extended this work to selected re-
storative materials. The results indicated that teeth
and restorative materials can exhibit similar “clin-
ical” adhesive properties soon after coverage by the
acquired pellicle, despite considerable differences
among their initial surface chemical properties. The
formation of the acquired pellicle on all solid sur-
faces in the mouth brings the properties of not only
tooth surfaces to similar states but also many re-
storative materials that differ originally in their sur-
face chemistry.
The tenacity of biological films’ retention, includ-
ing bacteria and other cells, is not a straight-line re-
lationship to the surface energies (again, judged by
117
Nassar et al.
the initial critical surface tensions) of restorative and
prosthetic materials. Within the range of materials
available for clinical dentistry, those having initial
critical surface tensions between 20 and 30 mN/m
are the least retentive to protein- and cell-rich films,
such as dental plaque (7, 11, 14, 22, 23, 54). Medical
grade silicones (methyl silicones, in particular) and
silicone and polyurethane copolymers are examples
of these minimally bioadhesive (that is, “bioabhes-
ive”) materials. Some polished metal samples, when
found to be relatively nonadhesive, were shown to
have been contaminated with low-energy waxy
polishing compounds (19). Fig. 5 shows two test
plates exposed in uitro to Streptococcus strain CC5A
(48) for 24 hours. The smooth (shiny) plate had a
critical surface tension of 22 mN/m and retained no
cells. The other plate (critical surface tension greater
than 30 mN/m) was as smooth as the first before
exposure to the cell culture but appeared rough
upon removal due to the thick carpet of adherent
microorganisms it acquired despite its initial
smoothness. Thus, surface roughness can be sec-
ondary to surface energy when plaque adhesion
dominates. Fig. 6 is a scanning electron microscopic
view of the low-energy plate after being removed
from the CC5A culture; note the poor adhesion be-
tween the film and the substratum. Different modes
of sterilization also can affect the surface properties
of dental materials (13, 24). Fluid shear stresses,
either during biofilm formation or afterward as a
rinse, can significantly affect the amount of retained
mass and its overall structure, but do not change the
relative strengths of bioadhesion noted above (46).
The effect of surface texture and
other factors on plaque
accumulation
In addition to the important effects of differences in
surface free energy on plaque accumulation, surface
texture is another important factor in the facilitation
of plaque accumulation on tooth and material sur-
faces. After three and six days of plaque formation
on materials having differences in both surface
roughness and surface energy, Quirynen et al. (52)
found that rough surfaces usually retained more
plaque than smooth materials. After 6 days, there
was no significant difference in plaque accumulation
between rough materials of both low and intermedi-
ate surface free energy, but the smooth, low-energy
118
substrata were covered by less plaque than the
smooth, intermediate-energy substrata. These find-
ings agree with the study of Lindquest & Emilson
(39), which showed that intrinsically rougher sur-
faces of composite resins tended to be more colon-
ized by S. mutuns than smoother, intrinsically higher
surface energy amalgam and gold. Lundin & Emilson
(40) also showed that the proportion of S. mutuns in
plaque on composite restorations was higher than
that in plaque on normal enamel. Thus, an “over-
spread” of plaque microorganisms from rougher re-
storative materials may actually “inoculate” the
smoother surfaces of enamel, gold, or porcelain.
Dummer & Harrison (25) found that “polished”
(rougher) composite restorative material mechanic-
ally harbored more plaque mass than unpolished
composite and other materials (polished and unpol-
ished amalgam, polished gold and glazed porcelain);
here is a case in which “polishing” does not mean
the same for all materials. Increased surface rough-
ness results from loss and exposure of superficial
filler particles during the composite polishing pro-
cess. Gunyakti et al. (33) reached the same con-
clusion. McCollum et al. (43) showed in vitro and in
uivo that, when cleaning procedures (avoiding metal
instruments) do not increase surface roughness on
titanium implants, there is no increased surface
coverage by plaque (43). McCartney (42) recom-
mended, for this reason, that metallic scalers be
avoided on titanium because of the ease of scratch-
ing the implant surface, making plaque and calculus
retention easier. Smales (58) also reported that the
amount of plaque retained on different restorations
correlates with surface roughness in the absence of
other surface chemical differences.
In addition to different levels of surface roughness
serving as confounding variables, the surface charac-
teristics and adhesive properties of a material in the
oral cavity also may vary due to several other factors,
such as
fillers (size, proportion and form of particles pres-
ent);
porosity;
handling (polishing residues, other contami-
nation);
corrosion (due to anatomic considerations, mech-
anical forces and chemicals present in the oral
cavity, or due to oral hygiene procedures by either
the patient (18) or the dentist); and
leachable components (such as copper, silver,
mercury or fluoride) that may inhibit plaque for-
mation.
 Effectof restorative and prosthetic materials on plaque

Surface Tension (rnN/rn)

Dummer & Harrison (25) speculated that unpolished
0 10 20 30 40 50 60 70 80
amalgam retained less plaque than polished amal- -4 1.000
gam and all other materials studied due to its mer- -- 0.800
u
cury-rich surface layer. Svanberg et al. (60) reported --0.600
<
that plaque collected from silver and glass ionomer --0.400 <
cement restorations had a significantly lower per- --0.2002
0
centage viable count of S. mutans than conventional --0.000 &
amalgam restorations, suggesting that plaque form- -- -0.200 ;
-- -0.400:
ing on the glass ionomer cement might have a lower
0 no coating-- - -- -0.600
potential to induce recurrent caries due to its release 0 hydrophobic, rnethyloted coating- -- -0.800
0

hydrophilic. PEO coating -.

of silver and, possibly, fluoride (34, 61). On the other
hand, significant differences were not found in
fluoride content in sound or etched enamel before
and after placement of fluoride-containing glass ion-
omer cement in the mouth; neither the amount of
plaque nor the fluoride content of the plaque of ad-
jacent teeth varied significantly from that of control
teeth (55).Similarly, Van Dijken et al. (62,63) showed
no significant differences among plaque masses ad-
jacent to composite resins, glass ionomer cement
and enamel (and the number of S. mutuns and
Lactobacillus in saliva adjacent to these materials).
Therefore, it becomes clear that differences in clin-
ical plaque accumulations are more fundamentally
related to the balance of retentive and removal forces
than to differences in the colonizing populations.
This was demonstrated, for example, in the work of
r-1.000
Fig. 8. Contact angle data plots for three materials evalu-
ated by Olsson et al. (50). nYo different coatings (hydro-
phobiclmethylated and hydrophilic/polyethylene oxide)
were applied to ceramic crowns. The controls were unco-
ated ceramic crown material; no special procedures were
used to clean the controls, so the substrata did not have
high surface energies. The cosines of the average contact
angles are plotted against the liquidlvapor surface tension
of each diagnostic liquid eight different diagnostic liquids
were used to characterize the Olsson samples. The critical
surface tension for each sample is defined by the intercept
of the plotted line with the surface tension axis.
Chindavanig (20), who used different materials as
custom-fabricated, half-denture relines (Fig. 7) to
study the clinical accumulations of Candida albicuns
in human volunteers.

I
~

I I I I 1

very low energy low energy medium energy high energy

1 I
I I
I I metals,

Relative
t cerarni cs

Amount of Relative
Plaque Strength of
Retained Connective
Under Tissue
Clinical Adhesion
Conditions (Ref. 14)

I
I I
I I I I I I
I I 1 I I

0 10 20 30 40 50 60 70
Critical Surface Tension (mN/m)
Fig. 9. Graph of the relative strength of biological adhesion as a function of the initial critical surface tensions of dental
prosthetic and restorative materials.

119
Nassar et al.

Table 1. Summary of studies of effects of materials on dental plaque

Material Conditions Outcome Reference
Porcelain fused to gold 109 patients, 510 teeth, up Porcelain, gold, natural teeth all give Carnivale et al.
to %year follow-up similar plaque & gingival indices (18)
Ceramic crowns: uncoated, 1 patient, no oral hygiene Low-surface-energy coatings, de- Olsson et al. (50)
coated with polyethylene for 5-7 days, plaque spite hydrophobicity, more plaque-
oxide, and methylated samples from natural teeth resistant than natural teeth, clean
and crowns crowns, and hydrophilic polyethy-
lene oxide coatings
Glass: uncoated, coated In vitro incubation in Most retention of protein and bac- Olsson et al. (50)
with polyethylene oxide parotid saliva and in teria on material of intermediate
and methylated S. mutans suspension hydrophobicity and highest surface
energy
Titanium abutments Osseointegrated implant Plaque and calculus more easily re- McCartney (42)
abutments; routine moved from unscratched surfaces
cleaning than from root surfaces
Titanium implants treated 12 patients, 4 abutments Similar plaque coverage on all McCollum et al.
for 30 s with plastic scaler, each, no oral hygiene for 1 surfaces (43)
air-powder abrasive, or week
rubber-cup polishing with
pumice
Porcelain, gold, amalgam, 108 in uitro samples; Less plaque mass on amalgam than Dummer &
composite plaque-like on all other materials; most mass on Harrison (25)
polished composite
Porcelain, metal alloy, 20 patients, 1 hour to 1 More plaque mass (closely packed) Adamczyk &
acrylic resin month (plaque accumu- on metal alloy, less on acrylic (more Spiechowicz (1)
lation rate) loosely distributed); least mass (very
loose packing) on smooth porcelain
surface
Gold, stainless steel (6R60), 12 patients, 1-7 days Close correlation between initial Glantz (28)
polyethylene terephthalate surface free energy of material and
polymer, polyethylene, plaque-adhesive properties
polytetrafluoroethylene
(Teflon@)
Gold, amalgam, composite 114 patients, 14,859 plaque Composite (intermediate surface Lindquest &
samples over a 1-year free energy) retained more plaque Emilson (39)
period than higher-energy materials
Type 111 gold alloys, silver- 11 patients, 5-year study All metal alloy specimens similar in Marzouk et al.
palladium plaque accumulation; substantial (41)
variation among patients
Amalgam, composite 10 patients, dentures, 2 One composite retained more Smales (58)
days plaque than the other two com-
posites and more than the amal-
gams; good correlation between sur-
face roughness and plaque mass
Amalgam, composite 60 plaque samples (30 Composite and unpolished amal- Gunyakti et al.
from patients with metallic gam are more colonized by S. mut- (33)
restorations, 30 from ans than are polished metallic sur-
patients with nonmetallic faces
restorations
Composite, glass ionomer 12 patients, 48-hour Both materials retained plaque with Hallgren et al. (34)
cement, tooth enamel plaque sampled, up to 4 increased prevalence of S. mutans
weeks evaluation and Lactobacillus (compared with
enamel), with more around ortho-
dontic brackets attached with com-
posite (areas with low shear stress)
Cont.

120
 Effect of restorative and prosthetic materials on Dlaque

Table 1. Continued
Material Conditions Outcome Reference
Composite, glass ionomer 16 patients, 2-week plaque Critical salivary concentration to Van Dijken et al.
cement, tooth enamel formation on 1-year-old isolate Lactobacillus and S. mutans (63)
Class V restorations (sub- from glass ionomer cement and
gingival cervical margins) composite was same as for enamel
Composite resin, fresh and 10 patients, 18-hour More plaque accumulated on glass Forss et al. (27)
aged glass ionomer ce- plaque ionomer cement than on composite
ment, silver glass ionomer
cement
Glass ionomer cement, 25 patients, fluoride con- No significant difference in fluoride Seppa et al. (55)
tooth enamel tent in materials and ad- content in sound and etched enamel,
jacent plaque; up to 4 before and after glass ionomer ce-
weeks ment placement; fluoride content of
approximate plaque similar for glass
ionomer cement and control enamel
Composite, glass ionomer 16 patients, 0-14 days Plaque mass and degree of gingivitis Van Dijken &
cement, tooth enamel adjacent to composite were not sig- Sjostrom (62)
nificantly greater than for glass ion-
omer cement and enamel
Amalgam, silver glass ion- 20 patients, 3-5 weeks Percentage viable S. mutuns in Svanberg et al.
omer cement plaque samples from new silver/ (60)
glass ionomer cement was less than
in plaque from new amalgam
Composite resin, tooth en- 48 patients, no oral hy- Number of S. mutuns in plaque from Lundin & Emilson
amel giene for one day composite greater than in plaque (40)
from enamel controls
Acrylic resin: heat-cured, 8 patients, 7-10 days with- Materials with similar surface free Ogle et al. (49)
light-cured, auto-polymer- out denture hygiene energies accumulated similar Chindavanig (20)
ized (all materials shown to amounts of plaque, despite differ-
have similar surface free ences in surface texture and chemi-
energies) cal composition
FEP Teflon@,cellulose ace- 16 patients, 6 days of un- Differences in surface free energies Quirynen et al.
tate; both in smooth and disturbed plaque accumu- are reflected for smooth surfaces; (52)
roughened forms lation roughness obscures these differ-
ences when sufficient mechanical
challenge is applied

Discussion of clinical findings
Table 1 summarizes the dental restorative material
studies mentioned earlier, including the respective
conditions and types of evaluations applied, and the
outcomes related to plaque and/or pellicle forma-
tion. Several of the studies ranked plaque formation
as a function of surface roughness but did not in-
clude any other pre-exposure characterization data
(such as surface free energy, porosity or leachable
components) for the materials used. The presence of
a wide variety of dental materials that have different
characteristics certainly does lead to differences in
the accumulation of plaque on those materials, as
frequently noted clinically. Better knowledge of spe-
cific parameters of the surface quality of each ma-
terial is required to assess the wide range of effects
that restorations and prosthetics can exert - through
their differing plaque-retention strengths - on the
surrounding environment. Similarly, the adhesional
bond strengths of calculus to intraoral surfaces must
be addressed (16).
Regarding the surface quality of a material, critical
surface tension is the most accessible descriptor that
correlates with the retention of biological deposits
on the material (5). Fig. 8 graphs the contact angle
data plots for the three materials utilized by Olsson
et al. (50) in their in uivo and in uitro studies. Note
that critical surface tension is defined from the work
of Zisman (64) as the intercept, of the line plotted
through the data for a particular sample, with the
top axis (where the contact angle=O"). Taking these
critical surface tension values, then, Fig. 9 graphi-
cally illustrates how plaque retention and other bio-

121
Nassar et al.
adhesion results plot out (6,9). Indeed, it is a univer-
sal finding in a variety of physiological and environ-
mental systems that the relative strengths of
biological adhesion follow the up-and-down trend il-
lustrated (material critical surface tension is ex-
pressed quantitatively on the x-axisin units of mN/
m). Fig. 9 is portioned into four different zones: 1)
materials with a very low surface energy (for ex-
ample, such fluorocarbons as polytetrafluoroethy-
lene) that allow marginal adhesion; 2) low-energy,
often methyl-rich materials (such as methyl silicone)
that allow only very weak biological adhesion (the
zone of “bioabhesion”); 3 ) medium-energy ma-
terials, the range of most common synthetic poly-
mers, that engage relatively strong biological ad-
hesive bonds; and 4) high-energy materials (uncoat-
ed enamel, metals, alloys and ceramics) that sustain
the strongest adhesion with biological macromol-
ecules and cells. Glantz et al. (31) noted that good
boundary lubrication of masticatory surfaces prob-
ably requires the high-energy binding of salivary
macromolecules. Thus, the disadvantages of plaque
accumulation may be secondary consequences of
the need for preservation of tooth structure from
wear-induced loss. Baier et al. (4) noted that cell ad-
hesion, like that of gingival crest and connective
tissue cells, also is strongest to materials with a high
critical surface tension and, thus, should insure the
best periodontal integrity. Again, plaque binding
qualities of the same materials follow inevitably.
Hydrophobic and hydrophilic
surfaces
Glantz (28) showed that hydrophilicity and critical
surface tension values of amalgam can increase
upon treatment with weak lactic acid solution,
whereas treatments with certain aqueous fluoride
solutions decrease the wettability of enamel and
dentin. The latter treatments also render these
usually medium-energy materials into low-energy
materials, while surface properties of enamel and
dentin were variably affected by the application of
lactic acid (depending on the strength of the acid
and the duration of exposure). Fluoride-treated en-
amel showed increased adhesive properties after
being treated with lactic acid solution for several
days.
It would be inappropriate to extend these obser-
vations to conclusions that all hydrophobic or all hy-
drophilic surfaces will behave the same (17). This is
122
obvious from noting the equally hydrophilic nature
of teeth and oral mucosa, which retain plaque dif-
ferently, or the similar hydrophobicities of the acrylic
resin of dentures and of silicone coatings, which also
support different plaque accumulations. It is found
that, through acquired pellicle formation, all dental
materials come to similar surface conditions during
salivary protein deposition. They also receive the
same arriving microorganisms and other particulate.
Conclusion
Differentiation of surface deposits into those that are
strongly retained, thicken and mineralize versus
those that cyclically delaminate back into the sali-
vary pool is based on the differing bound confor-
mations of the first deposited salivary molecules on
different materials. The concept of critical surface
tension is useful for grouping the common restora-
tive and prosthetic materials into presumptive
plaque-resistant and plaque-prone categories.
New dental products are emerging (51) based on
the surface energy concepts reviewed here, incorpor-
ating methylsilicone fluids into mouthwash, tooth-
paste, breqth spray and floss. The substantivity of the
silicone coatings delivered by these products, how-
ever, may be too low to be effective. A better hygienic
approach to dental plaque control, for the short run,
may be use of nonantimicrobial matrix liquefiers
that so weaken the plaque structure that it spon-
taneously collapses and washes away (3, 56, 57). It
remains a task for future work to decipher the influ-
ences of the interfacial properties on the first layers
of salivary macromolecules that provide the “glue
line” for binding of the otherwise uniform depositing
debris and microbial masses (15).
Acknowledgements
US NIDR Grant No. DE07760 supported the work of
Drs. Nassar, Meyer and Baier on this manuscript.
The IndustryKJniversity Center for Biosurfaces at
SUNY/Buffalo is also acknowledged for support of
previous, related projects.
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