U.S. patent application number 09/909157 was filed with the patent office on 2001-12-27 for curable compositions with antimicrobial properties.
Invention is credited to Montgomery, R. Eric, Nathoo, Salim A..
Application Number | 20010056133 09/909157 |
Document ID | / |
Family ID | 27372620 |
Filed Date | 2001-12-27 |
United States Patent
Application |
20010056133 |
Kind Code |
A1 |
Montgomery, R. Eric ; et
al. |
December 27, 2001 |
Curable compositions with antimicrobial properties
Abstract
Novel curable compositions are disclosed which include a
water-insoluble antimicrobial agent. The curable compositions are
useful in inhibiting the growth of bacteria on the surface of the
curable composition, within the curable compositions and in a
volume adjacent to the curable composition.
Inventors: |
Montgomery, R. Eric;
(Monterey, MA) ; Nathoo, Salim A.; (Piscataway,
NJ) |
Correspondence
Address: |
LERNER, DAVID, LITTENBERG,
KRUMHOLZ & MENTLIK
600 SOUTH AVENUE WEST
WESTFIELD
NJ
07090
US
|
Family ID: |
27372620 |
Appl. No.: |
09/909157 |
Filed: |
July 19, 2001 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
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09909157 |
Jul 19, 2001 |
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09255450 |
Feb 19, 1999 |
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6281265 |
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60075176 |
Feb 19, 1998 |
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60075246 |
Feb 19, 1998 |
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60094823 |
Jul 31, 1998 |
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Current U.S.
Class: |
523/113 ;
523/115; 523/116; 523/122 |
Current CPC
Class: |
C08L 33/00 20130101;
C08L 33/00 20130101; C08L 33/00 20130101; C08L 33/00 20130101; C08L
33/00 20130101; C08L 33/00 20130101; A61K 6/887 20200101; A61K 6/30
20200101; A61K 6/30 20200101; A61K 6/69 20200101; A61K 6/887
20200101; A61K 8/347 20130101; A61Q 11/00 20130101; A61K 8/8152
20130101; A61K 6/35 20200101; A61K 6/887 20200101; A61K 6/35
20200101; A61K 6/35 20200101; A61K 8/8164 20130101; A61K 6/30
20200101 |
Class at
Publication: |
523/113 ;
523/115; 523/116; 523/122 |
International
Class: |
A61F 002/00; C08K
003/00; A61K 006/08 |
Claims
1. A material for placement within an oral cavity, the material
comprising: a curable composition capable of being rendered from a
first malleable phase to a second phase with substantially resists
a change in size and shape; a water-insoluble antimicrobial agent
releasable from the material in a manner to create a zone of
inhibition within which growth of bacteria is inhibited.
2. A material as set forth in claim 1, wherein the curable
composition includes a free radical polymerization initiator which,
when activated, renders the composition into the second phase.
3. A material as set forth in claim 1, wherein the water-insoluble
antimicrobial agent is provided at a concentration sufficient to
substantially prevent microbial growth on the material when the
material comes into contact with the oral cavity.
4. A material as set forth in claim 3, wherein the water-insoluble
antimicrobial agent is selected from the group consisting of
halogenated diphenyl ethers, halogenated salicylanilides, benzoic
esters, halogenated carbanalides, and phenolic compounds.
5. A material as set forth in claim 1, wherein the water-insoluble
antimicrobial agent is provided at a concentration of between about
0.10% by weight and less than 4% by weight of the composition.
6. A method for forming an antimicrobial material for placement
within an oral cavity, the method comprising: providing a curable
composition capable of being rendered from a first malleable phase
to a second phase which substantially resist change in size and
shape; forming a mixture between the composition in its first phase
and an antimicrobial agent; curing the mixture so as to render the
composition into its second phase, and allowing the curable
composition to release the antimicrobial agent to produce a zone of
inhibition within which the growth of bacteria is inhibited.
7. A material as set forth in claim 6, wherein the water-insoluble
antimicrobial agent is a member selected from the group consisting
of halogenated diphenyl ethers, halogenated salicylanilides,
benzoic esters, halogenated carbanalides, and phenolic
compounds.
8. A material as set forth in claim 6, wherein the water-insoluble
antimicrobial agent is provided at a concentration of between about
0.10% by weight and less than 4% by weight of the composition.
9. A curable composition for use in forming an artificial
prosthesis comprising: a mixture of a polymerization system and a
water-insoluble antimicrobial agent which remains inert to the
polymerization system, the mixture capable of being cured to
produce an artificial prosthesis characterized as having a zone of
inhibition of growth of bacteria surrounding the artificial
prosthesis.
10. The curable composition of claim 9, wherein the polymerization
system includes a polymerizable monomer or prepolymer, a
crosslinking agent, a filler and a polymerization initiator.
11. The curable composition of claim 10, wherein the polymerizable
monomer is selected from the group consisting of methyl
methacrylate, ethyl methacrylate, n-propyl methacrylate, isopropyl
methacrylate, n-butyl methacrylate, isobutyl methacrylate,
hydroxyethyl methacrylate, hydroxypropyl methacrylate, hydroxybutyl
methacrylate, propylene glycol monomethacrylate, poly(ethylene
glycol) monomethacrylate, isobornyl acrylate, isobornyl
methacrylate, methoxyethoxyethyl methacrylate, ethoxyethoxyethyl
methacrylate, tetrahydrofurfuryl methacrylate, and acetoxyethyl
methacrylate.
12. The curable composition of claim 11, wherein the prepolymer is
selected from the group consisting of
2,2-bis[4'-(3"-methacryloyl-2"-hydr- oxypropoxy)phenyl]propane
(bis-GMA), ethoxylated bisphenol A dimethacrylate, and urethane
dimethacrylate.
13. The curable composition of claim 12, wherein the crosslinking
agent is selected from the group consisting of ethylene glycol
dimethacrylate, diethylene glycol dimethacrylate, trimethylene
glycol dimethacrylate, trimethyolpropane trimethacrylate,
1,4-butanediol dimethacrylate, 1,12-dodecanediol dimethacrylate,
and polyethylene glycol dimethacrylate.
14. The curable composition of claim 13, wherein the filler is a
finely divided material or powder and is a member selected from the
group consisting of quartz, colloidal silica, alumina,
hydroxyapatite, fluoroaluminosilicate glass, titanium dioxide,
pyrogenic silica, precipitated silica, glasses, ceramics,
poly(methyl methacrylate), poly(ethyl methacrylate), poly(butyl
methacrylate), poly(ethyl-co-methyl methacrylate), poly (methyl
vinyl ether-co-maleic anhydirde), poly(acrylic acid),
poly(methacrylic acid), poly(vinyl pyrollidone), poly(vinyl
acetate), poly(vinyl butyryl), polyethylene, polypropylene, and
polytetrafluoroethylene.
15. The curable composition of claim 14, wherein the polymerization
initiator is a member selected from the group consisting of benzoyl
peroxide, lauroyl peroxide, 5-alkyl barbituric acid, and 5-aryl
barbituric acid.
16. The curable composition of claim 9, wherein the water-insoluble
antimicrobial agent is a member selected from the group consisting
of halogenated diphenyl ethers, halogenated salicylanilides,
benzoic esters, halogenated carbanalides, and phenolic
compounds.
17. The curable composition of claim 9, wherein the curable
composition is fashioned into an oral prosthesis.
18. The curable composition of claim 17, wherein the oral
prosthesis is a denture or filling.
19. The curable composition of claim 9, wherein the curable
composition is fashioned into an artificial fingernail or
artificial toenail.
20. The curable composition of claim 9, wherein the water-insoluble
antimicrobial agent is initially present in an amount greater than
0.1% by weight of the artificial prosthesis.
21. The curable composition of claim 9, wherein the water-insoluble
antimicrobial agent is initially present in an amount between about
0.1% and 4% by weight of the artificial prosthesis.
22. The curable composition of claim 9, wherein the water-insoluble
antimicrobial agent is initially present in an amount less than 4%
by weight of the artificial prosthesis.
23. A method for inhibiting the growth of bacteria associated with
a human in an area directly adjacent to a hardened artificial
prosthesis comprising: fashioning a hardened artificial prosthesis
including a water-insoluble antimicrobial agent; placing the
artificial prosthesis in an aqueous environment susceptible to the
growth of bacteria; allowing the artificial prosthesis to establish
a zone of inhibition in a manner to inhibit the growth of bacteria
within the zone of inhibition.
24. The method of claim 23, wherein the bacteria is S. mutans or P.
Aeruginosa.
25. The method of claim 23, wherein the water-insoluble
antimicrobial agent is initially present in an amount greater than
0.1% by weight of the artificial prosthesis.
26. The method of claim 23, wherein the water-insoluble
antimicrobial agent is initially present in an amount between about
0.1% and 4% by weight of the artificial prosthesis.
27. The method of claim 23, wherein the water-insoluble
antimicrobial agent is initially present in an amount less than 4%
by weight of the artificial prosthesis.
28. An artificial prosthesis for use in an aqueous environment
comprising: a mixture of a polymerization system and a
water-insoluble agent which remains inert to the polymerization
system; the mixture capable of being cured to produce an artificial
prosthesis characterized as having a zone of inhibition of growth
of bacteria surrounding the artificial prosthesis.
29. An artificial fingernail comprising: a mixture of a
polymerization system and a water-insoluble antimicrobial agent
which remains inert to the polymerization system; the mixture
capable of being cured to produce an artificial fingernail
characterized as having a zone of inhibition of growth of bacteria
surrounding the artificial prosthesis.
30. A method of preventing demineralization of surface enamel on a
tooth comprising fashioning a hardened artificial prosthesis
including a water-insoluble antimicrobial agent; placing the
artificial prosthesis adjacent the tooth; allowing the artificial
prosthesis to establish a zone of inhibition in a manner to inhibit
growth of bacteria within the zone of inhibition so as to prevent
demineralization of the tooth.
Description
CROSS-REFERENCE TO RELATED APPLICATIONS
[0001] This application claims the benefit of U.S. Provisional
Application No. 60/075,176, filed Feb. 19, 1998, U.S. Provisional
Application No. 60/075,246, filed Feb. 19, 1998, U.S. Provisional
Application No. 60/094,823, filed Jul. 31, 1998 and hereby
incorporates the subject matter of those applications by reference
in their entireties for all purposes.
BACKGROUND OF THE INVENTION
[0002] This invention relates to improvements in curable
compositions intended for use or placement in direct contact with a
biological surface. More specifically, this invention discloses
curable compositions with antimicrobial properties, together with
methods for their use, which are useful for preventing microbial
growth on one or more surfaces of the curable composition or within
the curable composition or adjacent to the curable composition
after curing and subsequent placement in contact with a biological
surface.
[0003] Materials science has provided us with a plethora of
compositions that can be transformed from an initial, malleable
state to a final, non-malleable state, generally through the
process of heating, the application of pressure, and/or the
inducement of polymerization. Such compositions provide us with an
array of materials that may be first molded into a desired shape,
then subsequently induced to transform into a final, non-deformable
shape identical (or nearly so) to the original molded shape. Such
processes may employ heat or pressure (or both) to transform
materials into a desired shape by manipulation of the physical
properties of the material itself, or may alternatively utilize
initiators and/or activators to begin a polymerization reaction
throughout the shaped mass. Alternatively, a curing process may
occur simply as a composition absorbs moisture from the surrounding
environment. Such curing processes are seen in certain types of
adhesives, such as urethanes-based caulks and denture
adhesives.
[0004] The class of materials known as acrylics (which, for the
purpose of this disclosure, shall mean compositions comprised
wholly or in part of acrylate and/or methacrylate monomers and/or
polymers, alone or in combination with each other and/or other
unsaturated and/or saturated compounds) has gained acceptance as
being particularly suited for the formation of prosthetics to be
placed into contact with the body. In particular, acrylics have
been used to form dental restorative materials, dentures, temporary
crown and bridge materials, and artificial fingernails and
toenails, as well as having been employed as adhesion promoters at
the interface between a biological surface (herein defined as any
external or internal surface of a living organism) and a prosthetic
(in order to provide the extended wear time required of, for
instance, a permanent dental restorative material). Curable acrylic
compositions, when properly initiated or catalyzed, undergo
free-radical addition reaction polymerization, which is exothermic
(i.e., generates heats) in character.
[0005] As biological surfaces are invariably populated by a wide
variety of microorganisms, inert objects (such as prosthetics or
adhesives), when placed in contact with such surfaces are subject
to surface colonization and, often, subsequent penetration by those
same microorganisms. In addition, fluid infiltration at the
interface between the biological and non-biological surfaces
presents ideal conditions for the growth of microorganisms. In the
absence of any protective mechanism to prevent such colonization,
objects in contact with biological surfaces often become populated
with a higher density of microorganisms than the original
biological surface itself. Thus a prosthetic can become a breeding
ground for potentially harmful microorganisms and subsequently
itself become a source of infection to adjacent living tissue. For
example, the occluded interface or margin between an inert object
and a biological surface, due to the accumulation of moisture there
(and often, the exclusion of oxygen, which results in an
environment conducive to the growth of anaerobic microorganisms),
can foster the development of microbial colonies in higher numbers
than the same biological surface would have in a non-occluded
state.
[0006] One example of this interfacial phenomenon is recurrent
caries, which is thought to be caused by the infiltration of
microorganisms, in particular, those responsible for dental caries
(tooth decay), into the interface margin between a dental
restorative material (such as an amalgam or resin-based composite)
and the natural tooth surface. In the process of preparing, placing
and finishing a dental restoration, the marginal adaptation of the
restorative material, in addition to the quality and strength of
the bond between the restoration and the natural tooth surface, is
of paramount importance to the restoration's longevity as a
permanent prosthetic. If the adhesion of the restorative material
is inadequate, or the shape of the restorative material is slightly
non-conforming, oral fluids such as saliva, which constantly bathe
the restoration, are able to infiltrate into the interface between
the restorative material and the natural tooth. Microorganisms are
carried along with the infiltrating fluids and may colonize the
marginal space. The metabolites of certain microorganisms, such as
Streptococcus mutans species, are potentially harmful to the
natural tooth structure, and erosion of the tooth at the interface
(recurrent caries and possible restoration failure) may occur over
time.
[0007] Recurrent caries have been shown to be a major cause in the
failure of dental restorations. The failure is thought to occur due
to penetration of pathogenic organisms such as S. mutans into the
tooth structure along the cavity wall through microleakage and/or
accumulation of bacteria at the margins, or interface, between the
restorative material and the tooth. The incidence of recurrent
caries around restorations involving enamel can be reduced by using
fluoride containing restorative materials. However, the amount of
fluoride released has been shown to decrease significantly with
time and thus cariostatic ability of these restorative materials
over a long term remains unclear. To overcome this advantage,
attempts have been made to supplement restorative materials with
antimicrobial agents. Addition of chlorhexidine, a water soluble
cationic antimicrobial agent to composite restorative materials
have largely been unsuccessful because of the loss of efficacy and
deterioration of physical properties. Attempts have also been made
to add other types of antimicrobial agents to restorative
materials. Recently, Imazato, et al., U.S. Pat. No. 5,733,949
incorporated methacryloyloxydodecylpyridinium bromide (MDPB) to
experimental composites and showed that the attachment of S. mutans
to surfaces of the restorative material was reduced. However,
unlike chlorhexidine, no zone of inhibition was evident by the disk
diffusion method, indicating that the agent is not released or is
released at sub MIC levels. This finding suggests that MDPB has a
potential disadvantage because it does not solve the problem of
permeation of bacteria through the enamel-restoration interfaces
and destroying bacteria in the cavity preparation.
[0008] The incidence of recurrent caries around restorations
involving enamel can be reduced by using fluoride containing
restorative materials. The purpose of the fluoride is to convert
hydroxyapatite to fluorapatite, which is more resistant to acid
attack. The major disadvantage with the use of fluoride is that it
does not have significant antimicrobial activity and is easily
washed away or diffuses away due to its high degree of solubility
in the surrounding aqueous medium of the oral cavity.
[0009] To overcome one of the disadvantages indicated above,
attempts have been made to add antimicrobial agents that are more
effective against oral microorganisms than fluoride to dental
materials, such as denture acrylics and denture soft liners.
Chlorhexidine and its acetate or gluconate salts are water-soluble
cationic antimicrobial agents capable of inhibiting or killing a
wide variety of oral pathogens. However, incorporation of
chlorhexidine salts in such compositions resulted in the rapid
release of the highly water-soluble antimicrobial agent and
subsequent impairment of the cured material's physical properties.
See, for example, J. McCourtie, et al., Effect of Saliva and Serum
on the Adherence of Candida Species to Chlorhexidine-treated
Denture Acrylic in Journal of Medical Microbiology, Vol. 21,
(1986), 209-213, in addition to M. Addy, In Vitro Studies into the
Use of Denture Base and Soft Liner Materials as Carriers for Drugs
in the Mouth in Journal of Oral Rehabilitation, Vol. 8, (1981),
131-142.
[0010] Attempts have also been made to add other types of
antimicrobial agents to restorative materials. Recently, Imazato,
et al., U.S. Pat. No. 5,733,949 incorporated
methacryloyloxydodecylpyridinium bromide (MDPB) to experimental
composites and showed that the attachment of S. mutans to surfaces
of the restorative material was reduced. However, unlike
chlorhexidine, no zone of inhibition was evident by the disc
diffusion method, indicating that the agent is not released or is
released at sub minimum inhibitory concentration (MIC) levels. This
finding suggests that MDPB has a potential disadvantage because it
does not solve the problem of permeation of bacteria through the
enamel-restoration interfaces and destroying bacteria in the cavity
preparation.
[0011] It has been shown that demineralization of surface enamel is
caused by acid production from S. mutans and other cariogenic
organisms, while demineralization along the cavity wall is caused
by a combination of acid attack on outer enamel surfaces and
additional acid attack through the gaps or microleakage between the
cavity wall and the restoration. Both types of acid attack can be
prevented by cariostatic agents deposited on the outer surfaces, at
the cavity walls and in the areas of microleakage. Hence, the
presence of cariostatic agents or antimicrobial agents may reduce
or eliminate caries formation via reducing the solubility of enamel
or inhibition of bacterial activity.
[0012] Attempts have also been made to add water-insoluble
antimicrobial agents to dental materials for the purpose of
inhibiting surface growth. See J. Osaka Univ. Dent. Sch., vol. 35,
pp. 5-11, 1995. In JP Patent Application 3-118309, triclosan was
added to the monomer of a light-curable composite material and the
material subsequently cured with a curing light. The release of the
triclosan into the surrounding medium was extremely low (0.02
micrograms/ml) for most of the compositions tested. As a result,
the investigators did not observe the reduction of bacteria around
disks made from the various triclosan-impregnated compositions
until the triclosan concentration was well in excess of 1% by
weight, namely 4% by weight. Only at 4% by weight triclosan, was
there a slight (<1 mm) zone of bacterial inhibition around the
disk prepared from a light-cured composite restorative material.
The cured composition was ineffective at levels below 4% triclosan
in inhibiting or destroying bacteria in the medium surrounding
(i.e., not in direct contact with) the restoration.
[0013] Dental restorative materials, especially resin-based
composites (which are generally composed of a fluid matrix carrier
based on modified acrylic monomers and/or polymers, together with a
dispersed inorganic phase composed of glass, silica, and other
finely divided materials), are able to support the growth of
microorganisms on surfaces exposed to the oral environment. Such
surfaces are seen to accumulate plaque and tartar to a degree often
greater than an exposed natural tooth surface. Again, such
accumulation may have an impact on the health of adjacent natural
hard and soft tissue surfaces, for instance, the irritation of
gingival tissues adjacent to a heavily colonized restorative
surface.
[0014] Another example of this interfacial phenomenon occurs in the
artificial fingernail art. Artificial fingernails are often formed
by dipping an artist's brush into a liquid acrylic monomer, which
contains a polymerization initiator (typically a tertiary amine
such as dimethyl-p-toluidine). The wetted brush is then contacted
with a reservoir containing an acrylic polymer, which also contains
a polymerization initiator (such as benzoyl peroxide). The
resulting slurry of liquid and powder that adheres to the brush is
transferred to the natural fingernail surface and the
polymerization initiators interact to cause polymerization of the
slurry into a hard mass within a period of about three to seven
minutes.
[0015] Although the natural fingernail surface is typically
prepared in such a fashion as to attempt to assure the exclusion of
microorganisms prior to placement of the artificial fingernail
slurry, oftentimes the preparative procedure results in a natural
nail surface that is less than sterile. Even if sterile conditions
on the natural fingernail surface were achievable in practice
(which they are not), an insufficient bond strength between the
polymerized artificial fingernail and the natural nail surface will
result in the potential for fluid infiltration into the interfacial
space created by a partial separation. Such fluid infiltration can
result, as in the dental restorative example above, in the
colonization of the natural fingernail/artificial fingernail
interface by externally-derived microorganisms (such as Pseudomonas
aeruginosa, which has been identified as the most common source of
nail infections).
[0016] Another example of the problems associated with surface
colonization of acrylic prosthetics is found in dentures. The
extended wear time achieved by more modern denture adhesive
formulations has resulted in a longer residence time for dentures,
which are based on acrylic polymers. The preparation of a denture
is a process well-known in the art and is more fully described in
references such as Phillip's Science of Dental Materials, K. J.
Anusavice, ed. 10th Edition, 1996 (W.B. Saunders & Co.). A
typical denture is prepared by taking an impression of a patient's
edentulous arch, creating a dental cast from the impression, and
then creating a resin record base on the casting. Subsequently, wax
is added to the record base and the artificial teeth are positioned
in the wax. A pressure container, called a "flask" is chosen and
the completed tooth arrangement is encased in an investment medium.
The flask is then opened and the wax eliminated. The denture base
material is then introduced into the mold cavity and the complete
assembly polymerized by either a combination of heat and pressure,
or alternatively through a chemical curing process. The flask is
opened and the finished denture removed.
[0017] Extended denture retention time has resulted in a longer
period during which oral microorganisms can utilize the denture
adhesive composition and then enter the surface of the denture
itself as a growth medium. Growth of oral microorganisms within
denture adhesive compositions and on the surfaces of dentures have
been identified as causes of oral malodor associated with denture
use. Microorganism growth on the denture can be promulgated by the
adjacent growth in the denture adhesive. Dentures-induced
stomatitis (DIS) and inflammatory papillary hyperplasia (IPH) are
conditions that are known to result from dentures with
microorganism-contaminated surfaces (see, for example, E.
Budtz-Jorgensen, et al., in Quantitative Relationship between Yeast
and Bacteria in Denture-Induced Stomatitis, Scandinavian Journal of
Dental Research, Vol. 91(2) (1983), 134-142).
[0018] In order to provide additional comfort to wearers of
dentures, soft relining materials are often employed to facilitate
better adaptation of the attachment surface (generally in the
region of the palate) and to provide a "cushion" between the hard
denture surface and the point of attachment in the oral cavity.
Soft reliners are typically self-curing (autopolymerizing) acrylic
materials that utilize acrylic monomers and/or polymers with a
relatively low glass transition temperature (T.sub.g).
Alternatively, plasticizers such as dibutyl phthalate are used to
provide elasticity to the cured soft reliner composition. The high
flexibility and softness of such materials results in a greater
degree of porosity, thus increasing the likelihood of microbial
colonization. In particular, it has been shown that soft reliner
materials support the growth of Candida albicans, a fungal organism
thought to be associated with denture stomatitis. Previous attempts
to limit the growth of microorganisms in soft reliner materials
have been made though the inclusion of water-soluble antimicrobial
agents such as zinc undecylenate and undecylenic acid.
[0019] The durability of the antimicrobial effect in prior art
compositions containing one or more water-soluble antimicrobial
agents is relatively poor, presumably due to the rapid rate at
which the agent is released from the material into the surrounding
aqueous medium. More often than not, the presence of a
water-soluble molecule within a cured composition will contribute
to the deterioration of said composition's physical properties; it
is presumed that the voids left in a cured composition's polymeric
structure by the solubilized antimicrobial can render the material
unsuitable for its intended purpose.
[0020] There is thus a need for improved compositions and methods
that address the problems associated with acrylic prosthetics and
adhesives place in contact with a biological surface.
[0021] In particular, there is a need for improved compositions and
methods for their use that prevent the growth of microorganisms at
the interface between a biological surface and a non-biological
surface.
[0022] Furthermore, there is a need for improved curable
compositions and methods for their use that can inhibit or kill
microorganisms in the surrounding medium in which they are
placed.
BRIEF SUMMARY OF THE INVENTION
[0023] The present invention discloses curable compositions with
antimicrobial properties, together with methods for their use as or
in conjunction with prosthetics placed in contact with a biological
surface. Said biological surface is a potential source of microbial
contamination, and the inventive compositions and methods are
useful in substantially inhibiting surface colonization by
microorganisms, as well as colonization within the curable
composition itself. Prosthetic materials formed from the inventive
compositions including a water insoluble antimicrobial agent and
placed in contact with a potential source of microorganisms in an
aqueous environment have unexpectedly been shown to substantially
prevent the growth of microorganisms adjacent thereto. In addition,
the prosthetic materials formed from the inventive compositions
have further been shown to advantageously substantially prevent the
growth of microorganisms within a volume surrounding the prosthetic
material. That volume is referred to herein as a "zone of
inhibition" and is defined as the volume immediately adjacent to
the prosthetic material and extending a distance away from the
prosthetic material sufficient to inhibit the growth of
microorganisms within the zone. The zone of inhibition is
determined in part by the degree of crosslinking of the curable
composition, the concentration of the water insoluble antimicrobial
agent within the cured composition, and the release of the water
insoluble antimicrobial agent from the cured composition when
placed in an aqueous environment. The zone or volume of inhibition
is characterized by a concentration gradient of the water insoluble
antimicrobial agent extending away from the cured composition. This
aspect of the present invention is particularly advantageous as the
cured compositions of the prosthetic materials or adhesives not
only prevent surface colonization of microorganisms thereon, but
also prevents colonization of microorganisms at locations a
distance away from the prosthetic material, such as adjoining or
contacting biological or prosthetic material or spaces between the
compositions of the present invention and adjacent biological or
prosthetic material.
[0024] A wide variety of compositions, for example those formed
from materials known as acrylics, are available which are intended
for placement and use within the oral cavity for extended periods
of time. For the purpose of this disclosure, the term acrylic shall
be interpreted to mean any monomeric or prepolymeric compound or
mixture of compounds having at least one unsaturated moiety capable
of undergoing a polymerization reaction that produces a higher
molecular weight compound. The polymeric materials resulting from
the aforementioned polymerization reaction will also be termed an
acrylic. Unsaturated moieties include acrylate, methacrylate,
and/or vinyl groups. Many of these compositions form prostheses
such as dentures and temporary restorative materials and must be
shaped to conform to an individual's dentition or mouth to allow
for comfortable wear after extended periods of time. In order to
accomplish this goal, many of these compositions are provided in a
curable form, so that after being shaped to an individual's needs,
a chemical reaction can be initiated which will render the once
malleable mass into a composition that resists a change in shape
and size. According to the present invention, one or more water
insoluble antimicrobial agents can be included within the
ingredients forming the curable composition and then the
ingredients can be cured to form the prosthesis or adhesive of the
present invention. The antimicrobial agents remain inert to
monomers or prepolymers which may be used to produce the cured
composition. According to one embodiment, an antimicrobial agent is
mixed together with one or more composition ingredients. Once all
of the intended ingredients are mixed or otherwise combined
together, the monomers or prepolymers are polymerized to produce a
cured composition which incorporates the antimicrobial agent. The
cured composition is crosslinked to an extent such that it allows
the antimicrobial agent to inhibit the growth of bacteria within a
volume or zone of inhibition surrounding the cured composition. In
this manner, the cured composition includes an antimicrobial agent
and further includes a zone or volume of inhibition surrounding the
cured composition within which the growth of microorganisms is
inhibited.
[0025] The compositions of the present invention are curable
through a variety of polymerization reactions that may be initiated
by, for example, heat, light and/or chemical catalysts. The cured
compositions when placed in an oral cavity are unique in their
ability to allow the antimicrobial agent to inhibit microbial
growth on and within the cured composition and within a volume or
zone of inhibition of the cured composition after placement in the
oral cavity, and according to one embodiment of the invention, at
concentrations of the antimicrobial agent of less than 4% by weight
of the curable composition.
[0026] In general, the class of antimicrobials broadly described as
water-insoluble, non-cationic antibacterial agents have utility in
the present inventive compositions and methods. More specifically,
useful antimicrobial agents are selected from the group consisting
of halogenated diphenyl ethers, halogenated salicylanilides,
benzoic esters, halogenated carbanalides, and phenolic compounds.
The most preferred antimicrobial agents are substantially
water-insoluble members of either the halogenated diphenyl ether
group or the phenolic group, in particular those compounds
described in detail in U.S. Pat. Nos. 4,894,220 and 5,800,803,
which are incorporated herein by reference. A preferred
antimicrobial compound is triclosan. It is to be understood that
the present invention is not intended to be limited to the specific
antimicrobial agents described herein and in U.S. Pat. Nos.
4,894,220 and 5,800,803 incorporated by reference, but that one of
skill in the art would readily identify useful antimicrobial agents
based upon the disclosure herein.
[0027] In general, the concentration of the water-insoluble
antimicrobial compound will be at least about 0.10% by weight of
the ingredients of the curable composition as a whole, depending
upon the solubility of the antimicrobial compound in the curable
composition. However, any concentration of a substantially
water-insoluble antimicrobial agent that provides for inhibition of
microorganisms on the surface of, and at some finite distance from,
a cured composition placed in contact with a biological surface is
contemplated to be within the scope of the present invention. It is
understood that different curable compositions will have an effect
on the release rate of the antimicrobial agent, and as such, the
curable composition carrier and the antimicrobial agent are
interrelated with respect to the concentration of antimicrobial
agent required.
[0028] Accordingly, it is an object of the present invention to
provide improved acrylic compositions and methods for their use
that can limit or prevent the growth of microorganisms on one or
more of its surfaces for an extended period of time.
[0029] It is a further object of this invention to provide improved
curable acrylic compositions and methods for their use that can
limit or prevent the growth of microorganisms at one or more of its
surfaces when exposed to or in contact with a potentially infective
biological surface.
[0030] It is yet another object of this invention to provide
antimicrobial acrylic compositions that can be shaped and
subsequently cured in situ on a biological surface.
[0031] It is yet another object of this invention to provide
antimicrobial acrylic compositions that can be shaped and
subsequently cured prior to being placed in contact with a
biological surface.
[0032] It is still a further object of this invention to provide
compositions and methods for their use for the purpose of
preventing microbial contamination at the interface between a
biological surface and a non-biological surface in contact
therewith.
[0033] Other objects, features and advantages of certain
embodiments of the present invention will become more fully
apparent from the following description taken in conjunction with
the accompanying claims and figures.
DETAILED DESCRIPTION OF CERTAIN PREFERRED EMBODIMENTS
[0034] The principles of the present invention may be applied with
particular advantage to obtain curable compositions and methods
useful in inhibiting the growth of microorganisms on or within a
volume surrounding a prosthesis intended to be placed adjacent to
or contacting biological tissue. Applications of the present
invention include prostheses intended to be placed within an oral
cavity, adhesives used to secure dental prostheses, as well as
cosmetic prostheses such as artificial fingernails and adhesives
related thereto.
[0035] According to one embodiment of the present invention, the
curable compositions of the present invention may be prepared
according to methods well-known in the art using commercially
available curable compositions intended for use in oral cavities,
such as Herculite XRV (Kerr Corporation, Orange, Calif.). Although
any commercially available curable composition intended for
placement in the oral cavity is contemplated to be within the scope
of the invention, the antimicrobial curable compositions described
herein are preferable of the class of (meth)acrylate monomers and
polymers, containing free radical polymerization initiators
appropriate to the desired mode of cure (heat, light, etc.)
According to the present invention, the compositions cure in a
manner to produce a matrix allowing activity of the antimicrobial
agent outside of the cured composition itself. This can occur
through release mechanisms such as elution, diffusion or other
release mechanisms having first, second, or third order kinetic
release rates. While not intending to be bound by any particular
scientific theory, it is believed that the compositions are cured
in manner to produce a cross linked polymer system allowing for the
continued and sustained release of the antimicrobial agent. Curable
compositions used as denture materials, denture reline materials
(both soft and hard), denture adhesives, permanent restorative
materials, adhesion promoting agents, luting cements, and cavity
liners are seen to unexpectedly benefit from the inclusion of
water-insoluble antimicrobial compounds of the present invention in
a manner to produce a volume or zone of inhibition within which the
growth of bacteria is inhibited.
[0036] Commercially available curable compositions used as dental
composite resins and artificial fingernail compositions generally
consist of a polymerizable monomer such as an acrylate or
prepolymer species, a powdered filler, and a polymerization
initiator and or catalyst species. It is possible to formulate the
inventive compositions in one part, or single component form, or
alternatively compositions may be provided that include separate
components, for instance, as a liquid and a powder, or
alternatively as two pastes. The two components are intended to be
mixed together shortly before the intended polymerization reaction
is to take place. Additional components may also be included, such
as crosslinking comonomers, polymerization initiators,
polymerization accelerators, photoinitiators, UV light absorbers,
pigments, dyes and the like. It is to be understood that
embodiments of the present invention are not to be limited to any
particular curable composition, but that one of skill in the art
will identify suitable curable compositions based upon the
disclosure herein.
[0037] Specific monomers useful in the above applications include,
but are not limited to, methyl methacrylate, ethyl methacrylate,
n-propyl methacrylate, isopropyl methacrylate, n-butylmethacrylate,
isobutyl methacrylate, hydroxyethyl methacrylate, hydroxypropyl
methacrylate, hydroxybutyl methacrylate, propylene glycol
monomethacrylate, poly(ethylene glycol) monomethacrylate, isobornyl
acrylate, isobornyl methacrylate, methoxyethoxyethyl methacrylate,
ethyoxyethoxyethyl methacrylate, tetrahydrofurfuryl methacrylate,
acetoxyethyl methacrylate, and other monofunctional methacrylate
and acrylate compounds and the like.
[0038] Prepolymers, which are herein defined as polymerizable
compounds having one or more polymerizable groups, in addition to
having a molecular weight in excess of about 300 daltons, are
selected from the group including, but not limited to,
2,2-bis[4'-(3"-methacryloyl-2"-hydro-
xypropoxy)phenyl]propane(bis-GMA), ethoxylatedbisphenol A
dimethacrylate, and urethane dimethacrylate (the reaction product
of 1 mole of 2,2,4-trimethylhexamethylene diisocyanate with 2 moles
of hydroxethyl methacrylate) and the like.
[0039] Crosslinking comonomers include ethylene glycol
dimethacrylate, dethylene glycol dimethacrylate, trimethylene
glycol dimethacrylate, trimethyolpropane trimethacrylate,
1,4-butanediol dimehtacrylate, 1,6-hexanediol dimethacrylate,
1,12-dodecanediol dimethacrylate, polyehtylene glycol
dimethacrylate, and the like.
[0040] Suitable fillers include powdered, granular, particulate, or
otherwise finely divided inorganic materials, such as quartz,
colloidal silica, alumina, hydroxyapatite, fluoroaluminosilicate
glass, titanium disoxide, pyrogenic silica, preciptated silica and
a variety of glasses and/or ceramics that optionally contain small
amounts of heavy metals (barium, strontium, zirconium, etc.), as
well as powdered, granular, particulate, or otherwise finely
divided organic materials including polymers such as poly(methyl
methacrylate), poly(ethyl methacrylate), poly(butyl methacrylate),
poly(ethyl-co-methyl methacrylate), poly(methyl vinyl
ether-co-maleic anhydride), poly(acrylic acid), poly(methacrylic
acid), poly(vinyl pyrollidone), poly(vinyl acetate), poly(vinyl
butyryl), polyethylene, polypropylene, polytetrafluoroethylene, and
the like. Inorganic fillers may be surface-modified, for instance
with a methacrylate-functional silane compound, in order to improve
the compatibility after polymerization of the inorganic filler with
the surrounding organic fluid matrix.
[0041] Polymerization initiators may be advantageously employed in
the inventive compositions at a concentration from about 0.1% to
about 5.0% by weight and include perioxides, such as benzoyl and
lauroyl peroxide, in addition to 5-butyl barbituric acid,
1-benzyl-5-phenyl barbituric acid, and other 5-alkyl or 5-aryl
barbituric acid compounds and the like.
[0042] One or more polymerization accelerators that work in
conjunction with the initiator to promote or improve the speed of
polymerization may be advantageously included in the inventive
composition at a concentration of from about 0.1% to about 7.0% by
weight. Accelerators such as N,N-dimethyl-p-toluidine,
N,N-dihydroxyethyl-p-toluidine, ethyl-p-dimethylamino benzoate,
dimethylaminoethyl methacrylate, N-(2-cyanoethyl)-N-methyl aniline,
and other amino-functional compounds and the like are of particular
utility in this respect.
[0043] In order to achieve a normal level of storage stability,
especially for compositions that are cured through a free-radical
curing mechanism, it may be desirable to include a conventional
polymerization inhibitor. Examples of such inhibitors include
hydroquinone monomethyl ether (MEHQ) and
2,6-di-tert-butyl-4-methylphenol (BHT or butylated hydroxytoluene)
and the like. Some of the non-cationic water-insoluble
antimicrobial agents described herein, for instance, the phenolic
group-containing compounds, may have additional utility in this
respect, i.e., as both an antimicrobial agent and as a
polymerization inhibitor. Polymerization inhibitors may be included
up to and including about 1.0% by weight of the composition.
[0044] The compositions may additionally contain one or more
photoinitiators in order to render the composition's combined
liquid and solid components sensitive to light, thereby effecting
polymerization by actinic energy at a wavelength or wavelengths
corresponding to the spectrum of said photoinitiators. Examples of
useful photoinitiators include camphorquinone, benzil,
2-hydroxy-2-methyl-1-phenyl-propane-1-one (Darocure 1173, EM
Chemicals, Hawthorne, N.Y.), and 1-hydroxycyclohexyl phenyl ketone
(Irgacure 184, Ciba-geigy Corporation, Hawthorne, N.Y.) and the
like. The above photoinitiators may be included in the composition
at a level of from about 0.1% by weight to about 6.0% by
weight.
[0045] In order to prevent polymer degradation and yellowing from
UV light after the polymerization process has been completed, a UV
light absorber may be included in the composition at a level from
about 0.1% by weight to about 3.0% by weight. Examples of suitable
UV light absorbers found to have utility in the present inventive
compositions are 2(2'-hydroxy-5'-methyl phenyl)benzotriazole
(Tinuvin P, Ciba-Geigy Corporation, Hawthorne, N.Y.),
2-hydroxy-4-methoxybenzophenone and 2-cyano-3,3'-diphenylacrylic
acid 2'-ethylhexyl ester (Uvinul M40 and Uvinul N539, respectively,
BASF, Ludwigshafen, Germany) and the like.
[0046] The inventive compositions may also contain from about 0.5%
to about 5.0% of a pigment or dye, in order to adjust the color of
the resulting polymerized omposition. For example, a red lake
pigment and titanium disoxide are added to a denture base polymer
composition in order to provide pigmentation that closely matches
that of the oral mucosa. Suitable pigments and dyes include, but
are not limited to, titanium dioxide, zinc oxide, insoluble lakes,
and soluble dyes and the like. Pigments based on, for instance,
barium may be added in order to make the resulting polymerized
composition radiopaque to x-rays. Other radiopaquing fillers may
also be advantageously included.
[0047] According to the present invention, a water-insoluble
antimicrobial agent is included within the curable composition to
not only inhibit the growth of both gram negative and gram positive
bacteria on the surface of and within the cured composition in an
aqueous environment, but also to inhibit the growth of both gram
negative and gram positive bacteria within a volume surrounding the
composition, termed herein as a "zone of inhibition". The zone of
inhibition is used to define the area immediately adjacent and
radially or perpendicularly outward (in the case of a round object)
from an object in which the growth of a particular microorganism
(or mixture of microorganisms) is inhibited. When an object
possessing antimicrobial properties is placed on or within a growth
medium that has been inoculated with a microorganism, it is
observed that only in areas at a certain distance from the object
will the organisms grow. This is due to a concentration gradient of
antimicrobial compound that extends outward from the object,
decreasing in amount moving further away from the object. The
ability of antimicrobial compounds and objects containing such
compounds to inhibit the growth of microorganisms at some distance
from the surface of the releasing substrate can be determined using
a disk diffusion assay, such as a Kirby-Bauer test. It is a
convenient and relatively simple assay procedure for the
antimicrobial-releasing capacities of the inventive curable
compositions. The ability of the curable composition of the present
invention to inhibit the growth of bacteria in an aqueous
environment at locations away from the curable composition itself,
is especially surprising given that the antimicrobial agent of the
present invention is water insoluble, as compared to the use of
water soluble or slightly water soluble antimicrobial agents.
[0048] Water-insoluble antimicrobial compounds useful in the
present invention may be selected from the following group, which
includes halogenated diphenyl ethers, halogenated salicylanilides,
benzoic esters, halogenated carbanalides, and phenolic compounds.
The most preferred antimicrobial agents are substantially
water-insoluble members of either the halogenated diphenyl ether
group or the phenolic group, in particular those compounds
described in detail in U.S. Pat. Nos. 4,894,220 and 5,800,803,
which are incorporated herein by reference.
[0049] The most preferred water-insoluble antimicrobial agent
(herein defined as an antimicrobial compound having a solubility in
distilled water at 25.degree. C. of less than 1000 ppm) is
triclosan (trade name Irgasan DP300). Triclosan
(2,4,4'-trichloro-2'-hydroxydiphenyl ether, CAS No. 338034-5) is a
broad spectrum antimicrobial with a molecular weight of 289.5,
having very limited water solubility at physiological temperatures
(20 ppm in distilled water at 20.degree. C. and 20 ppm in distilled
water at 50.degree. C.). The safety of triclosan has been well
established and its use in oral care products, primarily
water-based toothpastes in which the triclosan, typically at a
concentration of about 0.30% by weight, has been solubilized.
[0050] According to one embodiment of the present invention, the
concentration of the water-insoluble antimicrobial compound will be
at least about 0.10% by weight of the ingredients formulating the
curable composition, depending upon the solubility of the
antimicrobial compound in the ingredients. According to an
alternate embodiment, the concentration of the antimicrobial agent
is less than 4%, including 3%, 2%, and 1%. More preferably, the
concentration of water-insoluble antimicrobial compound will be in
the range of between about 0.25% and about 5.0% and more preferably
in the range of about 0.3% to about 1.0%. In the broadest sense,
the concentration of an individual antimicrobial compound may vary
from about 0.01% to about 10% by weight of the cured composition,
in accordance with a particular composition's intended use or
purpose. The composition's physical properties prior to curing
(such as solvent content that, due to evaporation, will not
ultimately be part of the composition after placement onto a
biological substrate) and in a cured form (determined by the degree
of crosslinking) can greatly affect the amount of antimicrobial
compound required. In addition, the cured compositions include a
volume or zone of inhibition surrounding the cured composition
within which the growth of bacteria is inhibited. It is recognized
and in some cases desirable that the curable composition may be
manipulated in its ability to release the antimicrobial compound
into the surrounding medium. Such manipulation can be accomplished
by increasing or decreasing the amount of, for instance,
crosslinking in the cured composition, so as to prevent the
antimicrobial compound from being released out into the environment
too quickly. As differences in the water solubility of
antimicrobial compounds exist, some compounds may be advantageously
included in compositions that, when cured, release said
antimicrobial into the surrounding medium at various rates. In this
fashion, the cured composition becomes a partial determinant of the
rate of antimicrobial diffusion into the surrounding volume,
similar to a controlled-release device (such as an encapsulant or
transdermal patch).
[0051] In the broadest sense, the level of antimicrobial compound
optimally included in a particular inventive composition is the
minimum concentration which will, for an extended period of time,
prevent the growth of microorganisms on the surface of and within a
limited zone around the cured composition. An extended period of
time is herein defined as the amount of time during which the cured
composition is in contact with the biological surface and during
which the cured composition is exposed to potential colonization by
one or more microorganisms. Preferred extended times include from a
few days, to a few weeks to few months and even years.
[0052] The following examples are set forth as being representative
of the present invention. The examples are not to be construed as
limiting the scope of the invention as these and other equivalent
embodiments will be apparent to one of skill in the art in view of
the present disclosure, tables, figures and accompanying
claims.
EXAMPLE 1
[0053] A commercially available permanent restorative material was
modified to include a water-insoluble antimicrobial agent as
follows:
1 TABLE 1 Control AK Percent Ingredient Control A (Kneaded) B C D
Herculite XRV 100 100 99.75 99.5 99 Triclosan 0 0 0.25 0.5 1 TOTAL
100 100 100 100 100
[0054] In general, syringes of the Herculite XRV (Kerr Corporation,
Orange, Calif.) were emptied into a tared plastic weighing cup (on
a balance accurate to 0.001 grams) under low light conditions (this
material is a light-activated permanent restorative material
sensitive to light between the wavelengths of 400 and 500
nanomaters). The syringes were saved for refilling after admixture
with the triclosan. The correct amount of triclosan was calculated
and weighed out on an analytical balance accurate to 0.0001 grams.
The triclosan was combined with the restorative material under the
same low light conditions as above, the blending procedure
consisting of a thorough kneading, by hand, of the triclosan powder
into the putty-like restorative material. A total of 5 minutes of
kneading was done for each sample, after which the blended
restorative material was carefully placed back in to the original
syringe for storage. The control sample (A) was also kneaded (AK)
in the same fashion as for samples containing triclosan, in order
to maintain consistency in all testing. When required, compositions
A, AK, B, C, and D were shaped into discs and then cured to produce
representative examples of a dental prosthetic. The cured
composition containing the antimicrobial agent was studied to
determine whether the antimicrobial agent was released from the
cured composition at levels greater than the MIC (minimum
inhibitory concentration) for S. mutans at baseline and after two
weeks of washing.
[0055] Specifically, composite restorative material (Kerr,
Herculite XRV.TM.) was obtained from Schein (Long Island, N.Y.). S.
mutans (ATCC 25175) were purchased from American Type Culture
Collection (Virginia). Brucella Broth (Difco) was obtained from
VWR, NJ. Tricloasn (Irgasan DP300) was obtained from CIBA Specialty
Chemicals Corp., High Point, N.C. Brucella Broth (Difco) was
rehydrated with double distilled water (28 g/l) and heated until a
clear solution was obtained. The nutrient was then sterilized in an
autoclave for 15 minutes at 15-LB pressure. The final pH of the
broth was 7.00 at 25.degree. C. The sterilized nutrient broth was
used to culture the bacteria. Freeze dried S. mutans were
reconstituted in sterilized polyethylene tubes with 5 ml rehydrated
Brucella Broth and incubated at 37.degree. C. for 2 days. After
establishment of growth, the bacterial were inoculated onto the
agar plates by streaking in four quadrants and allowed to grow at
37.degree. C. After testing for purity and establishment of growth,
100 ul of the reconstituted culture was diluted in 1 ml of sterile
water and its optical density was measured at 600 nm. Based on the
optical density, appropriate dilutions were made and 10.sup.2 CFUs
were transferred onto the agar plates and spread evenly to
establish a "lawn." Then the discs A, AK, B, C, and D (control,
kneaded control, 0.25%, 0.5%. 1.0% antibacterial agent) were placed
on the agar surfaces approximately 4 cm apart. The bacteria were
then allowed to grow at 37.degree. C. for 48 hours.
[0056] The discs were washed 5 times in 5 ml distilled water to
remove all the debris and washing continued for 2 weeks, 2 times
daily in 5 ml of distilled water. During this period, the discs
were stored in 5 ml distilled water at room temperature. To examine
if the antimicrobial agent was still present in these discs, the
experiment was repeated as described above.
[0057] A separate experiment was conducted using the bacteria P.
Aeruginosa, which is the most common source of fingernail and
toenail infections.
[0058] As shown in FIGS. 1 and 2, all of the samples containing
triclosan were observed to resist microbial colonization on the
surface of and in a well delineated zone around cured discs of the
restorative material, whereas the cured control samples without
triclosan exhibited marked growth of microorganisms on its surface
and in immediate contact with the disks. FIG. 1 depicts a zone of
inhibition wherein the growth of S. mutans is inhibited after 48
hours at 37.degree. C. Beginning at the top of FIG. 1 and moving
clockwise, the disks are identified as follows: 1.0% triclosan,
0.5% triclosan, 0.25% triclosan, 0.0% triclosan as a control and
0.0% triclosan as a kneaded control. FIG. 2 depicts a zone of
inhibition wherein the growth of P. Aeruginosa is inhibited after
48 hours at 37.degree. C. Beginning at the top of FIG. 2 and moving
clockwise, the disks are identified as follows: 0.25% triclosan,
1.0% triclosan, 0.5% triclosan, 0.0% triclosan as a control and
0.0% triclosan as a kneaded control.
[0059] Specifically, after two days at 37.degree. C., the disc agar
diffusion test showed concentration dependent zones of inhibition
before and after the two week wash. This indicated that the
antimicrobial agent is still active after curing and continues to
be released at the levels higher than the MIC of S. mutans after a
two week washing period. Control specimens did not show zones of
inhibition confirming that the antimicrobial activity was due to
the antimicrobial agent and not the constituents of the composite.
The sized of the "halos" identifying the zones of inhibition are
similar before and after the wash suggesting the rate of release is
similar, before and after the wash.
[0060] The zone of inhibition of the control and kneaded samples
was calculated to be 0. In contrast, the pre-wash discs containing
0.25% antimicrobial agent showed a mean zone of inhibition of 3.34
mm, the 2 week samples showed a zone of inhibition of 3.1 mm.
Similarly, the discs containing 0.5% antimicrobial agent showed
3.81 mm and 3.92 mm zones of inhibition for the pre-wash and the
post-wash specimens respectively. The discs containing 1.0%
antimicrobial agent showed mean zones of inhibition of 5.11
(pre-wash) and 6.1 mm (post-wash). These data are shown in Tables 3
and 4 below.
2TABLE 3 Zones of Inhibition (mm) Sample Petri Dish 1 Petri Dish 2
Mean Control 0 0 0 Control (Kneaded) 0 0 0 0.0025 3.32 3.36 3.34
0.005 3.83 3.8 3.81 0.01 5.1 5.12 5.11
[0061]
3TABLE 4 Zones of Inhibition (mm) after 2 week wash Sample Petri
Dish 1 Petri Dish 2 Mean Control 0 0 0 Control (Kneaded) 0 0 0
0.25% 3.1 3.1 3.1 0.50% 4.03 3.81 3.92 1.00% 5.6 6.6 6.1
[0062] In the present Example, an antimicrobial agent was mixed
with ingredients of a composition prior to polymerization. At least
a portion of the antimicrobial agent was inert to the
polymerization ingredients meaning that at least a portion of the
antimicrobial agent did not react with the polymerization
ingredients and remain bound within the cure composition. Instead,
the antimicrobial agent established a concentration gradient within
a zone of inhibition surrounding the cured composition. Other means
of incorporating the antimicrobial agent into the composite
material, for instance, dissolving the agent in the fluid monomer
phase of the composite material prior to the addition of the
inorganic filler, are anticipated to provide the same properties as
described in the present example.
[0063] The results of Example I indicate that the antimicrobial
agent is released into the surrounding media in sufficiently high
concentrations to inhibit growth of S. mutans and P. Aeruginosa.
The zone of inhibition studies showed a concentration dependent
zone of inhibition for both the washed and unwashed samples.
Furthermore, the zones of inhibition in both the two-week washed
and unwashed samples were similar, suggesting that the
antimicrobial agent is released slowly and steadily into the
surrounding media at concentration sufficiently high to inhibit the
growth of the organisms tested. Based upon the results shown in
Tables 3 and 4, higher concentrations of triclosan, such as up to
4%, should exhibit greater zones of inhibition than those shown in
tables. Zones of inhibition within the meaning of the present
invention include those calculated to be greater than 1 mm, within
the range of between about 1 mm to 10 mm, between 10 mm or less
that 1 mm are also considered within the scope of embodiments of
the present invention.
[0064] Accordingly, embodiments of the present invention include
the use of the antimicrobial curable compositions in the form of
dental restoratives to gradually release one or more antimicrobial
agents at the natural tooth/restoration interface to inhibit the
growth of S. mutans at the interface and in the cavity preparation.
In addition, the antimicrobial agent would be expected to have
further benefits by destroying residual S. mutans in the cavity
preparation. In addition, embodiments of the present invention
include the use of an antimicrobial curable composition in the form
of an artificial fingernail or toenail to gradually release one or
more antibacterial agents at the natural nail/artificial nail
interface to inhibit the growth of P. Aeruginosa at the interface.
The antimicrobial compositions of the present invention in the form
of dentin and enamel adhesives or "primers" based on
adhesion-promoting acrylic monomers, are useful in preventing the
interfacial infiltration of microorganisms and the subsequent
recurrent caries associated therewith.
[0065] According to an alternate embodiment of the present
invention, the antimicrobial compositions are used to reduce tooth
hypersensitivity as it relates to the presence of S. mutans and the
production of acid therefrom. Hence, it is possible that this
invention may help in the prevention of tooth hypersensitivity by
inhibiting S. mutans in restorations on the root or in the vicinity
of the cemento enamel junction. In accordance with that embodiment,
a curable composition including an antimicrobial agent is inserted
into a desired tooth cavity and allowed to inhibit the growth of S.
mutans in a manner to reduce tooth hypersensitivity.
EXAMPLE II
Physical Properties of the Inventive Compositions--Color
Stability
[0066] The physical properties of the modified composite
restorative materials were evaluated, including color stability,
compressive strength, and bond strength to dentin. Surprisingly,
there was a distinct trend, especially in bond strength to dentin,
towards improved physical properties for composite material
containing increasing levels of triclosan.
[0067] The triclosan and composite restorative material (Kerr,
Herculite XRV.TM.) were obtained commercially. The syringes of the
composite were emptied and the antimicrobial was incorporated into
the composite by kneading as previously described at concentrations
of 0.25%, 0.5% and 1% ww. The composite material was then
re-packaged in the original syringes and coded so that the
investigators were unaware of the contents of the syringes. Prior
to color measurement studies, the syringes were stored at room
temperatures for two weeks. After this period, 3.times.15 mm discs
were prepared for each sample and the material was light cured for
30 seconds using a commercial curing light. The baseline color of
the discs was then measured using a colorimeter with
45-degree/0-degree illumination/observation geometry (Minolta.TM.
CR221) and the color parameters was recorded in the tristimulus L*,
a*, b* color space. For each disc six readings were taken at random
locations.
[0068] The discs were then placed in a Sun Lamp color stability box
as specified in the American Dental Association Specification #27
and exposed to UV light for 24 hours. The color was then determined
by visual examinations and by the CR221 calorimeter. The
calorimeter readings were taken at six random locations. The change
in color was evaluated by averaging the tristimulus L*a*b* color
parameters and comparing the results of the CIELAB color scale
(Commission International de L'Eclairage, Recommendations on
uniform color spaces, color difference equations, and psychometric
color terms, Supplement 2 to CIE publication 15 (E-13.1) 1971
(TC-1.3), 1978, Paris: Beaureau Central de la CIE, 1978).
E=[(L*).sup.2+(a*).sup.2+(b*).sup.2].sup.1/2
[0069] Visual evaluation of the color change according to ADA
specifications showed insignificant color changes indicating that
the antimicrobial can be added to current restorative material
formulation without alteration of color. These results were
confirmed by calorimeter measurements. As shown in Table 3, the
mean color or E(E(Initial)) of the color sample (without the
antimicrobial agent) was calculated to 57.50. The mean E of the
kneaded sample was calculated to be 56.64. The mean color value or
E for the sample containing 0.25% w/w antimicrobial were calculated
to be 55.17. The mean color values for samples containing 0.5% and
1.0% antimicrobial were calculated to be 57.26 and 55.31
respectively. Statistical analysis by the F-test (variance of two
populations of numbers) did not show significant differences
between the groups hence providing further evidence that addition
of the antimicrobial to the restorative material under examination
will not cause a significant alteration in color.
[0070] After exposure to UV light (E(Final)), the color values for
untreated and kneaded controls were calculated to be 57.14 and
56.45 respectively. The E values for 0.25%, 0.5% and 1% were
calculated to be 54.42, 57.27, and 55.26 respectively. Statistical
analysis by the F test showed a maximum significance level of
p=0.011 for the controls (kneaded) versus 1% antimicrobial agent
strongly suggesting that a larger sample size would yield a
significant statistical difference and thus the antimicrobial agent
may enhance color stability and prevent UV induced
discoloration.
[0071] The overall change in color (Change in E) (baseline vs.
exposure to light) was calculated using the Commission
Internationale de L'Eclairage color difference equation. The change
in E for the control, the kneaded samples, the 0.25%, 0.5%, and
1.0% triclosan was calculated and is shown in Table 4 below.
4TABLE 4 Sample E (Initial) E (Final) Change in E Control 57.5
57.14 -0.36 Kneaded Control 56.64 56.45 -0.18 +0.25% w/w triclosan
55.17 54.42 -0.75 +0.50% w/w triclosan 57.26 57.27 0.01 +1.00% w/w
triclosan 55.31 55.26 -0.05
[0072] Collectively, the results shown above indicate that addition
of antimicrobial agent to the restorative material tested will not
cause an alteration in color. In fact, the results suggest that the
antimicrobial agent will cause an improvement in color stability
after exposure to UV light.
EXAMPLE III
Compressive Strength/Bond Strength
[0073] The following example demonstrates that no significant
differences were observed in the compressive strength between
control and antimicrobial composite samples.
[0074] Triclosan was incorporated into Herculite XRV (Kerr) by
emptying the syringes and kneading in the dark at concentrations of
0.25%, 0.5%, and 1% w/w. The composite material was then
re-packaged in the original syringes and coded so that the
investigators were unaware of the contents of the syringes. Freshly
extracted human molars were stored in a thymol solution at
3.degree. C. Prior to use, the enamel was removed by using a slow
speed diamond saw (Isomet, Beuhler) to obtain flat surfaces and all
samples were examined under a light microscope to ensure all the
enamel was removed from the test areas. For compressive strength
measurements a standard cylindrical stainless steel die was used
which allows for curing in 3 mm sections.
[0075] To measure compressive strength, the die was filled and
compressed up to a level of 3 mm. This was cured with a standard
light for 30 seconds. A second 3 mm section was then compressed
onto the cured section and again exposed to a curing light for 30
seconds. This was repeated for the third section to obtain
3.times.9 mm cylindrical specimens. The specimens were then stored
at 37.degree. C. in a humidity chamber to obtain complete curing.
Compressive strength measurements were carried out using a
crosshead-type tensile strength tester (MTS Model 810 Material
Testing System) set at a load of 250 N. For each test sample three
cylinders were prepared.
[0076] Bond strength was measured by compressing the test samples
into a gelatin capsule (4 mm diameter and 9 mm length). The
capsules were placed onto a glass slide to obtain flat surfaces and
cured for 1 minute using a standard dental curing light. After
ensuring all the surfaces were flat, the cylinders were bonded onto
etched dentin surfaces using Prime & Bond.TM. (Caulk) system
according to the manufacturer's instructions. To each tooth, two
samples were bonded for each sample two teeth were used. Prior to
measurements the samples were stored in a humidity chamber for at
37.degree. C. Shear bond strength was measured by using the MTS
system under stroke control at a strain rate of 0.2"/min ensuring
that knife edge was placed at the dentin-restorative material
interface.
[0077] The results of the compressive strength are outlined in
Table 5 and show no significant differences between the control and
antimicrobial composite samples.
5 TABLE 5 Sample Compressive Strength (MPa) Control 50.03 (SD =
9.70) Control (Kneaded) 48.90 (SD = 2.80) 0.25% Triclosan 48.87 (SD
= 2.60) 0.50% Triclosan 48.24 (SD = 2.88) 1.00% Triclosan 52.05 (SD
= 6.42)
[0078] The results of the bond strength to dentin are shown in
Table 6 below.
6 TABLE 6 Sample Compressive Strength (MPa) Control 9.74 (SD .+-.
4.30) Control (Kneaded) 10.43 (SD .+-. 3.30) 0.25% Triclosan 10.53
(SD .+-. 4.16) 0.50% Triclosan 13.13 (SD .+-. 5.94) 1.00% Triclosan
14.13 (SD .+-. 6.22)
[0079] Statistical analysis by ANOVA (analysis of variance) did not
show any differences between the samples. However, examination of
the data showed a directional improvement in the shear bond
strength with an increase in concentration of the antimicrobial
agent, e.g., the dentin-enamel bond strength of control was
determined to be 9.74.+-.4.37 Mpa while the bond strength of the
restorative material containing 1.0% antimicrobial agent was
determined to be 14.13.+-.6.22 Mpa, which translates into a 45%
improvement demonstrating that the antimicrobial composite material
of the present invention may provide for an enhancement in the
shear bond strength when cured in contact with primed dentin.
[0080] The various adhesion promoters in primers and bonding agents
used to increase the bond strength of restorative materials to
dentin are typically surface-active molecules which are applied to
the tooth structure after etching or conditioning. These agents are
believed to provide adhesion by bridging the gap between the
hydrophilic dentin surface and the hydrophobic composite matrix
resin. Although not wishing to be bound by any particular theory,
it is speculated that triclosan and other antimicrobial agents with
similar molecular properties may in some way alter the interfacial
surface tension between the primed dentin surface and the composite
restorative material. In addition, the above data suggest that
triclosan may increase the color stability of a composite
restorative material; the increase in bond strength may be a result
of free-radical quenching abilities of triclosan. Free-radical
quenchers have been shown to reduce branching of the growing
polymer during addition polymerization reactions, an effect which
could result in the presence of an interfacial polymer more linear
in structure. The reduced branching and high linearity of polymers
can result in lower glass transition temperatures and increased
tensile strength.
EXAMPLE IV
[0081] As the results above suggest that the inclusion of triclosan
in a resin-based composite restorative material may increase the
overall bond strength to primed dentin, an adhesion-promoting
composition was prepared as shown in Table 6 below that would serve
as bonding agents between the natural tooth surface (dentin and/or
enamel) and a resin-based restorative material. Other priming or
bonding agents that would benefit from the inclusion of the
water-insoluble antimicrobial compounds described in the present
invention are described in, amount other prior art compositions,
U.S. Pat. Nos. 4,514,527; 4,659,751; 5,270,351; 5,276,068, and
4,966,934 each of which are hereby incorporated by reference in
their entireties.
7 TABLE Ingredient Percent (w/w) Bis-GMA 70.00 Triethylene glycol
dimethacrylate 29.55 Camphorquinone 0.20 Dimethylaminoethyl
methacrylate 0.15 Triclosan 0.10 TOTAL 100.00
[0082] The example shown in Table 6 is an unfilled light-cured
resin that is used to bond resin-based composite restorative
materials to etched enamel surfaces. The porosity created in the
enamel allows for the penetration of low viscosity resin into the
enamel substructure. After curing by exposure to light energy in
the range of 400 to 500 nm, the resulting bond is primarily
mechanical in nature through the formation of hard resin "tags"
that cure within the enamel substructure.
EXAMPLE V
[0083] According to another embodiment of the present invention, a
solvent-based adhesion promoter containing two different levels of
triclosan and useful for bonding the compositions of the present
invention to the natural fingernail surface was prepared and tested
for adhesion durability, compared to a control adhesion promoter
without triclosan. Triclosan was included in the compositions of
Table 7 below at the level of 0.3 and 1.0% by weight of the
non-volatile solids (i.e., exclusive of the ethyl acetate solvent
carrier, which rapidly evaporates upon the priming composition's
contact with the fingernail surface).
8 TABLE 7 Percent (w/w) Ingredient A B C Ethyl acetate 88.24 88.2
88.13 Methacryloyloxyethyl maleate 8.75 8.75 8.75 Hydroxyethyl
methacrylate 2.92 2.92 2.92 Fluorad FC-430 0.08 0.08 0.08 Triclosan
0 0.03 0.12 TOTAL 100 100 100
[0084] Each of the above compositions was evaluated for its
adhesion-promoting properties on 40 individuals. None of the
evaluators participating in the study were informed of product
compositions, and each product in Table 7 was coded in order to
blind the study.
[0085] A single coat of each priming agent was applied to the
natural fingernail surface following a mild abrasion of the nail
plate with a nail file. All priming agents were allowed to
evaporate until the surface appeared to be dry. In each case, there
was residual gloss on the treated fingernail surface following the
evaporation of the ethyl acetate.
[0086] Following the application of the priming agent, an
artificial fingernail excluding triclosan was "sculpted."
Observations as to the artificial fingernails' color, adhesion to
the nailplate, and general performance properties were accumulated
over a 30-day period.
[0087] At the end of the evaluation period, there was a slight
preference (although probably not significant) for the priming
agent corresponding to Table 7 composition B. Overall, the
performance of all the artificial fingernail priming agents was
relatively equal, indicating that the presence of triclosan in the
composition does not affect the performance properties of this type
of adhesion promoter when present at the artificial
fingernail/natural fingernail interface.
EXAMPLE VI
[0088] A number of artificial fingernail liquid binder compositions
were prepared (similar to those described in U.S. Pat. No.
5,738,843 hereby incorporated by reference in its entirety) that
contained varying levels of triclosan. Disks were prepared by
combining 1 part of each liquid binder, by weight with 2 parts of a
finely divided polymer consisting of a 70/30 molar ratio
poly(ethyl-co-methyl methacrylate) copolymer containing
approximately 1.2% by weight of benzoyl peroxide. The benzoyl
peroxide in the powder, when combined with the liquid binder (which
contains dimethyl-p-toluidine), initiates a free-radical addition
polymerization process that renders the liquid binder/powder
mixture into a hard, fused mass in approximately 5 minutes.
[0089] Very little, if any, difference in the polymerization time
was noted between the various mixtures prepared from the liquid
binders in Table 8 below, indicating that the inclusion of
triclosan did not inhibit the addition polymerization reaction in
any significant way. This was somewhat unexpected, due to the
sensitivity of most acrylic free-radical polymerization reactions
to the presence of aromatic alcohols, such as BHT (butylated
hydroxytoluene).
9 TABLE 8 Percent (w/w) Ingredient A B C D Ethyl methacrylate 83.2
82.7 82.2 81.2 Ethylene glycol dimethacrylate 6 6 6 6 Isopropyl
alcohol 10 10 10 10 Dimethyl-p-toluidine 0.8 0.8 0.8 0.8 Triclosan
0 0.5 1 2 TOTAL 100 100 100 100
EXAMPLE VII
[0090] Denture adhesives are typically composed high molecular
weight water-soluble polymers dispersed in a hydrophobic carrier,
such as petrolatum. When placed in the oral cavity at the interface
between a denture and the soft tissue of the mouth, water is
absorbed by the dispersed polymer, which gives rise to a sharp
increase in the cohesion and the viscosity of the composition. By
reaching a high viscosity and highly cohesive state can a denture
adhesive be described as cured. An example of a useful
antimicrobial denture adhesive composition is provided in Table 9
as follows:
10 TABLE 9 Ingredient Percent (w/w) Petrolatum 32.540 Mineral Oil
14.271 D&C Red #27 Lake 0.019 Hydrated Silica 1.833 Gantrez
MS-955 32.285 Cellulose Gum 18.752 Sodium Saccharin 0.100 Triclosan
0.200 TOTAL 100.000
[0091] The above composition was prepared by dissolving the
triclosan in the petrolatum and mineral oil (to which D&C Red
#27 Lake and Sodium saccharin had been added and thoroughly
dispersed), which was heated to 150.degree. F. to liquefy the
mixture. A dispersion mixer was used to sequentially blend the
Hydrated Silica, the Gantrez MS-955 (IS), Wayne, N.J.), and finally
the Cellulose Gum into the above mixture. Mixing was continued
until a smooth dispersion was obtained the finished composition was
immediately filled into in foil-plastic laminate tubes and
sealed.
[0092] Similar types of formulations, without the added inventive
steps of including a substantially water-insoluble, non-cationic
antimicrobial agent, are found throughout the prior art (see, for
example, U.S. Pat. No. 5,424,058 incorporated herein by reference
in its entirety). In general, such compositions, consist of (1) a
water-insoluble carrier, (2) one or more water-swellable polymers
in a finely-divided form, dispersed homogeneously throughout the
carrier, and (3) various adjuvants, including pigments, dyes,
flavorants and preservatives. The water-insoluble carrier portion
of the denture adhesive may be hydrophobic organic materials such
as petrolatum, mineral oil, waxes, and vegetable oils.
Water-swellable polymers finding utility in denture adhesives
include poly(ethylene oxide), salts of carboxymethyl cellulose,
methyl cellulose, hydroxypropylcellulose, acrylamide polymers, poly
(vinylpyrrolidone), and mixed partial salts of poly(methyl vinyl
ether-co-maleic and increase inviscosity and cohesion as a result
of the absorption of water from the growth medium. Zone of
inhibition studies were carried out as previously described in
Example I. After 48 hours, the triclosan-containing denture
adhesive above exhibited a zone of inhibition of approximately 3-4
mm, while a commercial available denture adhesive did not exhibit a
zone of inhibition. In fact, the surface of the commercial denture
adhesive was colonized by S. mutans after the 48-hour test period.
The addition of triclosan to the denture adhesive formulation above
resulted in a composition capable of inhibiting microorganisms in
the volume surrounding the swollen or cured mass.
[0093] It is to be understood that the embodiments of the present
invention which have been described are merely illustrative of some
of the applications of the principles of the invention. Numerous
modifications may be made by those skilled in the art based upon
the teachings presented herein without departing from the true
spirit and scope of the invention.
* * * * *