Research Article| Volume 58, ISSUE 3, P329-333, April 2020

Evaluation of the bactericidal effect of cold atmospheric pressure plasma on contaminated human bone: an in vitro study

Published:January 19, 2020DOI:


      The use of cold atmospheric pressure plasma (CAPP) as a bacterial decontaminant for chronic wounds has shown good results. The purpose of this in vitro study was to evaluate the bactericidal effects of CAPP on the cancellous area of the bone. Sterile glass slides and processed sterile human bone allografts 1, 2, 3, and 4 mm thick were used for initial contamination and further CAPP treatment. Each block was contaminated with Staphylococcus aureus suspension on one side. Each slide was turned 180° and treated on the reverse side. The bacterial count in colony-forming units (CFU) was then measured and compared with that of a control group, and the bactericidal effects of CAPP in relation to bone density evaluated. A significant reduction in count was measured between treated and untreated groups (groups A-D: p < 0.01 and group E: p = 0.04). A strong positive linear relation was found between bone density and the S aureus count (r = 0.844, p = 0.156). Treatment with CAPP had a bactericidal effect on bone structures with a penetration depth of up to 4 mm. It might be used for all diseases involving infected bone, and so extends the existing range of treatments.


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        • Haeffs T.H.
        • Scott C.A.
        • Campbell T.H.
        • et al.
        Acute and chronic suppurative osteomyelitis of the jaws: a 10-year review and assessment of treatment outcome.
        J Oral Maxillofac Surg. 2018; 76: 2551-2558
        • Lazzarini L.
        • Mader J.T.
        • Calhoun J.H.
        Osteomyelitis in long bones.
        J Bone Joint Surg. 2004; 86-A: 2305-2318
        • Baur D.A.
        • Altay M.A.
        • Flores-Hidalgo A.
        • et al.
        Chronic osteomyelitis of the mandible: diagnosis and management—an institution’s experience over 7 years.
        J Oral Maxillofac Surg. 2015; 73: 655-665
        • Beck-Broichsitter B.E.
        • Smeets R.
        • Heiland M.
        Current concepts in pathogenesis of acute and chronic osteomyelitis.
        Curr Opin Infect Dis. 2015; 28: 240-245
        • Hannan C.M.
        • Attinger C.E.
        Special considerations in the management of osteomyelitis defects (diabetes, the ischemic or dysvascular bed, and irradiation).
        Semin Plast Surg. 2009; 23: 132-140
        • Shuster A.
        • Reiser V.
        • Trejo L.
        • et al.
        Comparison of the histopathological characteristics of osteomyelitis, medication-related osteonecrosis of the jaw, and osteoradionecrosis.
        Int J Oral Maxillofac Surg. 2019; 48: 17-22
        • Hauer L.
        • Jambura J.
        • Hrusak D.
        • et al.
        Surgical therapy for medication-related osteonecrosis of the jaw in osteoporotic patients treated with antiresorptive agents.
        Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2019; ([Epub ahead of print])
        • Gallego L.
        • Junquera L.
        • Pelaz A.
        • et al.
        The use of pedicled buccal fat pad combined with sequestrectomy in bisphosphonate-related osteonecrosis of the maxilla.
        Med Oral Patol Oral Cir Bucal. 2012; 17: e236-41
        • Lopes R.N.
        • Rabelo G.D.
        • Rocha A.C.
        • et al.
        Surgical therapy for bisphosphonate-related osteonecrosis of the jaw: six-year experience of a single institution.
        J Oral Maxillofac Surg. 2015; 73: 1288-1295
        • Poubel V.
        • Silva C.A.B.
        • Mezzomo L.A.M.
        • et al.
        The risk of osteonecrosis on alveolar healing after tooth extraction and systemic administration of antiresorptive drugs in rodents: a systematic review.
        J Craniomaxillofac surg. 2018; 46: 245-246
        • Salvi G.E.
        • Aglietta M.
        • Eick S.
        • et al.
        Reversibility of experimental peri-implant mucositis compared with experimental gingivitis in humans.
        Clin Oral Implants Res. 2012; 23: 182-190
        • Bertrand K.
        • Lamy B.
        • De Boutray M.
        • et al.
        Osteomyelitis of the jaw: time to rethink the bone sampling strategy?.
        Eur J Clin Microbiol Infect Dis. 2018; 37: 1071-1080
        • Hilker L.
        • von Woedtke T.
        • Weltmann K.D.
        • et al.
        Cold atmospheric plasma: a new tool for the treatment of superficial driveline infections.
        Eur J Cardiothorac Surg. 2017; 51: 186-187
        • Mai-Prochnow A.
        • Clauson M.
        • Hong J.
        • et al.
        Gram positive and Gram negative bacteria differ in their sensitivity to cold plasma.
        Sci Rep. 2016; 6: 38610
        • Luhrmann A.
        • Matthes R.
        • Kramer A.
        Impact of cold atmospheric pressure argon plasma on antibiotic sensitivity of methicillin-resistant Staphylococcus aureus strains in vitro.
        GMS Hyg Infect Control. 2016; 11 (Doc17)
        • Hartwig S.
        • Doll C.
        • Voss J.O.
        • et al.
        Treatment of wound healing disorders of radial forearm free flap donor sites using cold atmospheric plasma: a proof of concept.
        J Oral Maxillofac Surg. 2017; 75: 429-435
        • Ulrich C.
        • Kluschke F.
        • Patzelt A.
        • et al.
        Clinical use of cold atmospheric pressure argon plasma in chronic leg ulcers: A pilot study.
        J Wound Care. 2015; 24 (198–200, 202–193): 196
        • Isbary G.
        • Morfill G.
        • Schmidt H.U.
        • et al.
        A first prospective randomized controlled trial to decrease bacterial load using cold atmospheric argon plasma on chronic wounds in patients.
        Br J Dermatol. 2010; 163: 78-82
        • Hafner S.
        • Ehrenfeld M.
        • Storz E.
        • et al.
        Photodynamic inactivation of Actinomyces naeslundii in comparison with chlorhexidine and polyhexanide—a new approach for antiseptic treatment of medication-related osteonecrosis of the jaw?.
        J Oral Maxillofac Surg. 2016; 74: 516-522
        • Suttapreyasri S.
        • Suapear P.
        • Leepong N.
        The accuracy of cone-beam computed tomography for evaluating bone density and cortical bone thickness at the implant site: micro-computed tomography and histologic analysis.
        J Craniofac Surg. 2018; 29: 2026-2031
        • Gonzalez-Garcia R.
        • Monje F.
        The reliability of cone-beam computed tomography to assess bone density at dental implant recipient sites: a histomorphometric analysis by micro-CT.
        Clin Oral Implants Res. 2013; 24: 871-879
        • Yang Y.
        • Guo J.
        • Zhou X.
        • et al.
        A novel cold atmospheric pressure air plasma jet for peri-implantitis treatment: An in vitro study.
        Dent Mater J. 2018; 37: 157-166
        • Kieft I.E.
        • Broers J.L.
        • Caubet-Hilloutou V.
        • et al.
        Electric discharge plasmas influence attachment of cultured CHO K1 cells.
        Bioelectromagnetics. 2004; 25: 362-368
        • Ulu M.
        • Pekbagriyanik T.
        • Ibis F.
        • et al.
        Antibiofilm efficacies of cold plasma and er: YAG laser on Staphylococcus aureus biofilm on titanium for nonsurgical treatment of peri-implantitis.
        Niger J Clin Pract. 2018; 21: 758-765
        • Haertel B.
        • von Woedtke T.
        • Weltmann K.D.
        • et al.
        Non-thermal atmospheric-pressure plasma possible application in wound healing.
        Biomol Ther (Seoul). 2014; 22: 477-490
        • Dezest M.
        • Chavatte L.
        • Bourdens M.
        • et al.
        Mechanistic insights into the impact of cold atmospheric pressure plasma on human epithelial cell lines.
        Sci Rep. 2017; 7: 41163
        • Hafner S.
        • Ehrenfeld M.
        • Neumann A.C.
        • et al.
        Comparison of the bactericidal effect of cold atmospheric pressure plasma (CAPP), antimicrobial photodynamic therapy (aPDT), and polihexanide (PHX) in a novel wet surface model to mimic oral cavity application.
        J Craniomaxillofac Surg. 2018; 46: 2197-2202
        • Kleineidam B.
        • Nokhbehsaim M.
        • et al.
        Effect of cold plasma on periodontal wound healing-an in vitro study.
        Clin Oral Investig. 2019; 23: 1941-1950
        • Tominami K.
        • Kanetaka H.
        • Sasaki S.
        • et al.
        Cold atmospheric plasma enhances osteoblast differentiation.
        PLoS One. 2017; 12e0180507