Figure 2.

Steps of biofilm formation on titanium biomaterial

Dental implant surfaces made of titanium biomaterial provide the substrate for polymicrobial biofilm formation in the oral environment. Titanium surface is immediately coated by proteins from saliva (supra-mucosal segment) and plasma (sub-mucosal segment) after implant insertion. (1) Protein adsorption on the surface forms a layer with a composition directly affected by the chemical and physical properties of the surface. This layer is the main mediator of microbial adhesion through adhesin-receptor interactions. (2) Initial colonizers, mainly Streptococcus species, adhere on the surface binding to the protein layer. (3) Subsequently, co-aggregation processes and interaction between different species promote biofilm accumulation. (4) This synergistic interaction among organisms continues to contribute to the biofilm structure. These microbial communities are gradually embedded in the extracellular matrix, formed mainly by exopolysaccharides, eDNA, and proteins. This biofilm environment (structure) enhances the microbial interaction and cooperation, antimicrobial resistance, and nutrients/biomolecule retention-diffusion (created by BioRender®).