Abstract
Titanium particles embedded on peri-implant tissues are associated with a variety of detrimental effects. Given that the characteristics of these detached fragments (size, concentration, etc.) dictate the potential cytotoxicity and biological repercussions exerted, it is of paramount importance to investigate the properties of these debris. This study compares the characteristics of particles released among different implant systems (Group A: Straumann, Group B: BioHorizons and Group C: Zimmer) during implantoplasty. A novel experimental system was utilized for measuring and collecting particles generated from implantoplasty. A scanning mobility particle sizer, aerodynamic particle sizer, nano micro-orifice uniform deposit impactor, and scanning electron microscope were used to collect and analyze the particles by size. The chemical composition of the particles was analyzed by highly sensitive microanalysis, microstructures by scanning electron microscope and the mechanical properties by nanoindentation equipment. Particles released by implantoplasty showed bimodal size distributions, with the majority of particles in the ultrafine size range (<100 nm) for all groups. Statistical analysis indicated a significant difference among all implant systems in terms of the particle number size distribution (p < 0.0001), with the highest concentration in Group B and lowest in Group C, in both fine and ultrafine modes. Significant differences among all groups (p < 0.0001) were also observed for the other two metrics, with the highest concentration of particle mass and surface area in Group B and lowest in Group C, in both fine and ultrafine modes. For coarse particles (>1 µm), no significant difference was detected among groups in terms of particle number or mass, but a significantly smaller surface area was found in Group A as compared to Group B (p = 0.02) and Group C (p = 0.005). The 1 first minute of procedures had a higher number concentration compared to the second and third minutes. SEM-EDS analysis showed different morphologies for various implant systems. These results can be explained by the differences in the chemical composition and microstructures of the different dental implants. Group B is softer than Groups A and C due to the laser treatment in the neck producing an increase of the grain size. The hardest implants were those of Group C due to the cold-strained titanium alloy, and consequently they displayed lower release than Groups A and B. Implantoplasty was associated with debris particle release, with the majority of particles at nanometric dimensions. BioHorizons implants released more particles compared to Straumann and Zimmer. Due to the widespread use of implantoplasty, it is of key importance to understand the characteristics of the generated debris. This is the first study to detect, quantify and analyze the debris/particles released from dental implants during implantoplasty including the full range of particle sizes, including both micro- and nano-scales.
Highlights
Titanium and its alloys perform excellently for implant osseointegration, and have seen widespread use as biomaterials in medical and dental fields [1]
For coarse particles (>1 μm), no significant differences were detected among groups in terms of particle number and mass, but a significantly smaller surface area was found in Group A (Straumann) as compared to Group B (p = 0.02) and Group C (p = 0.005) (Table 2, Figure 3A–C)
The highest particle number concentration was observed in Group B (BioHorizons); the lowest particle number concentration wasniunmGrboeurpcCon(Zciemnmtreart)i,oinn bwotahsfoinbesaenrdveudltrianfiGnermouopdeBs ((1particle number concenμm), the patratitciloe nnuwmabserincoGncreonutrpatCion(sZwimerme emro),reinovbeorltahppfiendeaamnodngugltrroaufipns.e(Bm) oPdaretsicl(e
Summary
Titanium and its alloys perform excellently for implant osseointegration, and have seen widespread use as biomaterials in medical and dental fields [1]. Peri-implantitis, characterized by inflammation of the peri-implant mucosa and subsequent progressive loss of supporting bone, is defined as a plaque-associated pathological condition [9] with multiple local-, systemic-, implant- and host-related factors playing a role in its development and progression. Factors such as poor oral hygiene, history of periodontitis and smoking, among others, have been widely studied in relation to peri-implantitis. These metal debris have been associated with a variety of detrimental effects, including the initiation of an inflammatory process potentially leading to marginal bone loss [14,15], activation of DNA damage in oral epithelial cells [16] and peri-implantitis [12,13,17]
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