Effects of Titanium Curette, Air Polishing and Titanium Brush on Implant Surface Roughness Using Scanning Probe Microscopy

The clinical condition involving dental implants, characterized by soft tissue inflammation, bleeding, suppuration and rapid bone loss is widely known as peri implantitis. The main objective in the treatment of peri-implantis is to arrest the progression of the disease and at the same time to keep the dental implant in the mouth solving the inflammations signs of bleeding and pain. The aim of this paper is to highlight the effectiveness of the use of titanium brush and antimicrobial photodynamic therapy (aPDT) to decontaminate the implant surface, in association with regenerative procedures by means of autologous bone and demineralized bovine bone mineral (DBBM) in the treatment of peri-implantitis defects.

BackgroundTo evaluate the effect of several representative decontamination methods of oral biofilms on different implant surfaces.Material and methodsEleven participants wore a hard resin splint carrying 6 rough (GC Aadva® implant; 3.3-mm diameter, 8-mm length) or machined (not commercially available) surface implants for 4 days to accumulate dental plaque naturally on the titanium surfaces of the implants. Apart from surface roughness, the morphology of all implants was identical. After detaching the implants from the splints, the ability of the following decontamination methods—gauze soaked in saline (G), ultrasonic scaler (US), air abrasive (Air), rotary stainless steel instrument (Rot), and Er:YAG laser (Las)—to cleanse the contaminated implant surface for 1 min extra-orally was tested. The control (Cont) group did not receive any decontamination. Scanning electron microscopic (SEM) investigation of one participant’s samples was employed to examine the post-instrumented implant surface for qualitative analysis, and bacterial culture of the remaining 10 participants’ samples was performed to count the number of colony-forming units (CFU) for quantitative analysis. The experimental sequence was initially performed for the rough surface implants and then similarly repeated for the machined surface implants. Bacterial CFU counts among the six groups were analyzed using the Steel-Dwass test, and differences between rough and machined surface implants were determined using the Mann-Whitney U test.ResultsG and Rot eliminated most biofilms on machined surface implants according to SEM analysis. G, Air, and Rot removed significantly more of the biofilms on rough and machined surface implants compared with US according to CFU counts. Moreover, G significantly reduced more biofilms than Las on machined surface implants. The analysis between rough and machined surface implants showed that Cont, G, and US were better able to cleanse biofilms on machined surface implants compared with rough surface implants.ConclusionsGauze soaked in saline and rotary stainless steel instruments may be advantageous for cleansing contaminated implant surfaces based on the qualitative and quantitative analyses. In contrast, air abrasives were not shown to be preferable in the qualitative analyses. Additionally, apart from the Er:YAG laser, the reduction of biofilms assessed in both qualitative and quantitative analyses demonstrated that all decontamination methods were better at cleansing machined surface implants compared with rough surface implants.

An essential component of peri-implantitis treatment is the effective decontamination of implant surfaces. The ideal decontamination technique should safely and efficiently remove biofilm without damaging the implant surface. This pilot study aimed to evaluate the cleaning efficacy and surface alterations associated with three mechanical decontamination protocols. Here, 12 implants were stained with indelible red ink and mounted into acrylic blocks to simulate horizontal peri-implant defects. Surface decontamination was performed for 2 min by the same examiner using one of the following devices: titanium brush (TiB), chitosan brush (ChB), or titanium curette (TiC). No chemical decontamination agents were used in combination with the mechanical tools. Standardized photographs were taken before and after the decontamination from buccal and oral frontal views, as well as at 30° and 60° angulations. The uncleaned implant surface area was calculated digitally. Scanning electron microscopy (SEM) was used to assess surface morphology. None of the tested methods achieved complete removal of the ink stain. Although 75.98% ± 2.42% of the stain remained, TiB showed the highest cleaning efficacy at buccal and oral frontal views (p = 0.027), followed by TiC (80.3% ± 0.86% stain remaining) and ChB (90.34% ± 6.07% stain remaining). Significant differences were observed between the ChB and TiB groups (p = 0.022). SEM analysis revealed that the TiC caused the greatest surface damage, whereas the TiB produced minimal alterations. Within the limitations of this pilot study, TiB demonstrated effective cleaning while preserving implant surface morphology. These findings suggest that titanium brushes may represent a safer and more efficient mechanical decontamination option during peri-implantitis treatment. However, further studies are warranted to evaluate combinations of mechanical and chemical techniques to enhance cleaning efficacy.

The present study aimed to evaluate the effectiveness of three decontamination methods on the surface alterations of dental implants and the removal of bacterial plaque from their surfaces. In this experimental in vitro study, 24 titanium cylinders with sandblasted, large-grit, acid-etched (SLA) surfaces were contaminated with Staphylococcus aureus to simulate biofilm formation. Samples were randomly assigned to four groups (n=6): titanium curette, diode laser, titanium brush, and saline flush control. Surface roughness (Ra and Rz) was measured using scanning electron microscopy (SEM) before and after cleaning. Colony-forming units (CFUs) were quantified post-treatment to assess bacterial removal. Statistical analyses included Kruskal-Wallis tests, Mann-Whitney pairwise comparisons, and one-way ANOVA with post hoc LSD tests (α=0.05). Surface roughness differed significantly among groups after cleaning (Ra, P=.002; Rz, P=.002). Titanium curette and titanium brush produced smoother surfaces than diode laser and control, with the curette achieving the greatest reduction in roughness. CFU analysis revealed significant differences among groups (F=3.26, P=.043). Contrary to expectations, the saline flush control showed the lowest CFU counts, whereas titanium curette and titanium brush exhibited higher bacterial counts than control (P.05), and diode laser did not differ significantly from control (P=.151). The titanium curette and titanium brush caused the samples' most significant surface roughness changes. However, the effectiveness of these methods for bacterial plaque removal was lower than that of the control group and the Diode laser group.

This in vitro investigation attempts to assess how air polishing with various abrasive powders affects implant abutment surface roughness. Thirty titanium implant abutments, split into three groups of ten each, were used in this in vitro investigation. Powdered glycine was given to Group A, powdered sodium bicarbonate to Group B and powdered erythritol to Group C. For 20 seconds, all abutments were air polished at a pressure of 60 psi and a nozzle distance of 5 mm. A profilometer assessed the surface roughness (Ra values) before and after treatment. Implant abutments' surface roughness changed very little after air polishing with erythritol and glycine powders. Therefore, implant care is possible. Sodium bicarbonate powder, on the other hand, dramatically increased surface roughness, which would raise the possibility of biofilm formation. Consequently, it is advised to regularly clean implant abutments using glycine and erythritol.

A Commentary onEsati J, Amran T, Weiger R, Alsulaimani L, Blatz M B, Eggmann F.Adverse effects of ultrasonic instrumentation and air polishing on dental restorations: a systematic review of laboratory studies. J Esthet Restor Dent 2025; 10.1111/jerd.13428.ObjectiveA systematic review of the literature was conducted, assessing the potential for adverse effects on surface roughness and marginal integrity with use of ultrasonic instrumentation and air polishing on variety of dental restorations. With the aim to guide clinical practice to aid mitigation of adverse effects.Data sourcesFive databases: Cochrane Library, OpenGrey through DANS, PubMed, Scopus, and Web of Science, and supplemental manual searches were used to identify relevant literature. The review adhered to the PRISMA guidelines.Study selectionPublications were included between 1978 and 2022. Population: dental restorations or restorative biomaterials in vitro. Intervention: ultrasonic instrumentation and/or air polishing. Comparison: no debridement procedure or paste polishing. Outcome: surface roughness and/or marginal quality. Forty-two laboratory studies were included in the final analysis. The studies evaluated data to answer the following research question: In specimens made of or featuring dental restorations or restorative biomaterials, how does the use of ultrasonic instrumentation and/or air polishing, compared with no debridement procedure or paste polishing, affect the surface roughness and/or marginal quality?Data extraction and synthesisData extracted included: author(s) and year, laboratory studies, biomaterials evaluated, specimen quantity, specimen geometry, grouping methodology, types of ultrasonic and/or air polishing devices used, air polishing powders, device operational settings, application type and duration of ultrasonic and/or air polishing, assessments of surface roughness and marginal quality, and the observed effects on both surface roughness and marginal quality. Biomaterial assessed included: porcelain fused to metal (PFM), zirconia (ZrO2), lithium disilicate (LDS), polymer-infiltrated ceramic network material (PICN), fine-structure felspathic ceramic (FSFC), gold alloy, amalgam, resin-modified glass ionomer cements (RMGIC), conventional and flowable resin-based composite (RBC), and silorane-based RBCs restorations. Studies measured surface roughness via contact profilometry, scanning electron microscopy, and atomic force microscopy. Ra was used as a parameter for surface roughness. Stereomicroscopy and confocal laser microscopy were used to assess marginal quality. Risk of bias was assessed using the RoBDEMAT tool.ResultsUltrasonic instrumentation and air polishing both negatively impacted surface roughness. Air polishing with sodium bicarbonate and calcium carbonate powders had a significantly greater effect on surface roughness, compared with erythritol and glycine powders. The surface roughness for RBCs and RMGICs were the most affected by ultrasonic instrumentation. In comparison, ZrO2 and LDS restorations were found to have the highest level of resistance compared to other restorations. Three studies observed that an increase in surface roughness could be mitigated using rubber cups and polishing paste after instrumentation. Ultrasonic instrumentation and air polishing methods both led to an adverse marginal quality outcome. Crowns with a narrow ceramic shoulder margin (0.7 mm) were particularly susceptible. RMGIC and amalgam restorations had a greater adverse impact on the marginal quality compared with RBC restorations.ConclusionsIt is advised to use air polishing with less abrasive powders, including erythritol and glycine, to mitigate surface damage and changes at the marginal interface. Another important clinical consideration is the type of restorative material. High strength ceramic restorations, such as LDS and ZrO2, are much more resistant to surface roughening compared with all other materials.

Background: Peri-implantitis is the leading cause of implant failure, with a reported prevalence of 22–45%. Effective removal of bacterial biofilm from the implant surface is critical to non-surgical therapy. This study aimed to assess the efficacy of different implant surface cleaning methods across various bone defect configurations, considering operator experience. Methods: Thirty-six dental implants were coated to simulate biofilm, mounted in resin blocks with bone defects of varying geometries, and covered with silicone to simulate soft tissue. Three operators with differing levels of experience treated the implant surfaces using four instruments: a titanium curette (TiCu), ultrasonic scaler (US), titanium brush (TiBr), and air abrasion with erythritol (AirPo). Each combination was tested in triplicate. Implants were photographed and analyzed with dedicated software to quantify cleaning efficacy. Results: The expert dentist achieved the highest average cleaning efficacy (36.6%). The most effective tools were the titanium brush (37.2%) and ultrasonic scaler (35.0%), followed by the titanium curette (28.1%) and air-abrasion (22.9%). The first two instruments were the least operator-dependent. Among the defect types, the 60° defect was the easiest to clean. Complete implant surface decontamination was not achieved in any scenario. Conclusions: Ultrasonic scalers and titanium brushes demonstrated the highest and most consistent cleaning efficacy, independent of operator skill level. Sixty-degree defects were the most amenable to cleaning. These findings underscore the need to tailor decontamination approaches based on defect geometry and to consider combining non-surgical methods with adjunctive or surgical interventions, which may ultimately enhance clinical decision-making and improve treatment outcomes.

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To evaluate the effect of air abrasion and polishing on primary molar fissures under light microscopy. 15 exfoliated primary second molars were longitudinally sectioned and photographed under a stereomicroscope (40×; baseline evaluation). Sections were then randomly allocated into one of the two groups (n=15) and treated by either air abrasion (aluminium oxide jet) or air polishing (sodium bicarbonate jet) for 30s. After treatment, sections were washed with an air/water spray, dried with absorbent paper, and photographed as previously described (final evaluation). Baseline and final morphology were compared by two blinded examiners who evaluated changes in the width and depth of fissures. The percentage of changed fissures was analysed, and the two treatments were compared using the Mann-Whitney test (α=0.01). Both air systems resulted in fissure changes in most (93.3%) of the sections. No significant differences in fissure width changes were found between treatments, but when changes in fissure depth were evaluated, air polishing was found to be less damaging than air abrasion (p<0.01). Air abrasion and polishing cause changes to the anatomical configuration of occlusal fissures of primary molars.

Various mechanical methods have been proposed for decontaminating dental implant surfaces with varying success. This in vitro study evaluated the decontamination efficiency of an air abrasion (AA) system with erythritol powder, a polyether-ether-ketone (PEEK) ultrasonic tip, and titanium curettes (TIT) and their effects on implant surface topography using scanning electron microscopy (SEM). A total of 60 implants were stained with permanent red ink and placed in 3D-printed Class 1A and Class 1B peri-implantitis defects, forming six groups (n=10 per group) based on defect type and treatment protocol. Additionally, one positive and one negative control implant was used. Erythritol powder, PEEK ultrasonic tips, and titanium curettes were applied for 2 min in Class 1A defects and 3 minutes in Class 1B defects. Residual red ink areas were quantified with digital software, and implant surface changes were analyzed using SEM and EDS. None of the methods achieved complete decontamination. However, erythritol powder was significantly the most effective, leaving a residual ink rate of 24% ± 6% (p < 0.001). PEEK ultrasonic tips resulted in 41% ± 4% residual ink, while titanium curettes left 55% ± 3%. Significant differences were observed among all methods. No significant difference in decontamination efficacy was found between Class 1A and Class 1B defects. SEM analysis showed minimal surface damage with erythritol powder and PEEK tips, whereas titanium curettes caused moderate to severe damage. Based on both decontamination efficiency and surface preservation, erythritol powder and PEEK tips are safe and effective options for peri-implantitis treatment, while titanium curettes are less effective and cause considerable surface damage. These findings may assist clinicians in peri-implantitis treatment planning.

The aim of this study was to evaluate the surface characteristics and gingival fibroblast adhesion of disks composed of implant and abutment materials following brief and repeated instrumentation with instruments commonly used in procedures for implant maintenance, stage-two implant surgery, and periimplantitis treatment. One hundred twenty disks (40 titanium, 40 titaniumzirconium, 40 zirconia) were grouped into treatment categories of instrumentation by plastic curette, titanium curette, diode microlaser, rotary titanium brush, and no treatment. Twenty strokes were applied to half of the disks in the plastic and titanium curette treatment categories, while half of the disks received 100 strokes each to simulate implant maintenance occurring on a repetitive basis. Following analysis of the disks by optical laser profilometry, disks were cultured with human gingival fibroblasts. Cell counts were conducted from scanning electron microscopy (SEM) images. Differences in surface roughness across all instruments tested for zirconia disks were negligible, while both titanium disks and titaniumzirconium disks showed large differences in surface roughness across the spectrum of instruments tested. The rotary titanium brush and the titanium curette yielded the greatest overall mean surface roughness, while the plastic curette yielded the lowest mean surface roughness. The greatest mean cell counts for each disk type were as follows: titanium disks with plastic curettes, titanium-zirconium disks with titanium curettes, and zirconia disks with the diode microlaser. Repeated instrumentation did not result in cumulative changes in surface roughness of implant materials made of titanium, titanium-zirconium, or zirconia. Instrumentation with plastic implant curettes on titanium and zirconia surfaces appeared to be more favorable than titanium implant curettes in terms of gingival fibroblast attachment on these surfaces.

The aim of this ex vivo study was to assess the ability to remove oral biofilm by different combinations of mechanical and chemical treatments on smooth and rough titanium surfaces, as well as their impact on osteoconduction. Forty-eight sandblasted acid-etched (SLA) and 48 machined titanium disks were contaminated with oral bacterial biofilm and exposed to the following treatments: (1) titanium brush (TB), (2) TB + 40% citric acid (CA), (3) TB + 5.25% sodium hypochlorite (NaOCl), (4) air polishing with glycine powder (AP), (5) AP + 40% CA, and (6) AP + 5.25% NaOCl. Residual bacteria and chemical contamination were assessed using viable bacterial count assay, scanning electron microscopy (SEM), and x-ray spectroscopy (XPS). Human primary osteoblast (hOB) adhesion and osteocalcin (OC) release were also evaluated. The microbiologic, SEM, and XPS analysis indicate a higher biofilm removal efficiency of combined mechanical-chemical treatments compared with exclusively mechanical approaches, especially on SLA surfaces. SEM analysis revealed significant alterations of surface microtopography on the disks treated with TB, while no changes were observed after AP treatment. OC release by hOBs was mainly decreased on disks treated with CA and NaOCl. The combination of mechanical and chemical treatments provides effective oral biofilm removal on both SLA and machined implant surfaces. NaOCl and CA may have a negative effect on osteoblasts cultured on SLA samples.

Peri-implant diseases have become one of the notable biological complications of postrehabilitation with implant-supported restorations. Effective modalities for decontamination of biofilm deposits around implant surfaces are critical for resolution of the inflammation. Air polishing is one of the recommended clinical methods for treating peri-implant diseases. This systematic review assessed clinical evidence on efficacy of using air polishing technology for the management of peri-implant diseases, including peri-implant mucositis and peri-implantitis. Four electronic databases from January 1990 to December 2022 were searched to identify the relative human randomized clinical trials that applied air polishing for nonsurgical and surgical treatment of peri-implant mucositis and peri-implantitis. Twelve articles were selected. For treating peri-implant mucositis, air polishing showed a comparable effect to ultrasonic scaling in the reduction of bleeding on probing (BOP) and probing pocket depth (PPD). The nonsurgical approach of air polishing in treating peri-implantitis varied in the reduction of BOP, PPD, and clinical attachment level (CAL) in evaluated studies. Air polishing in the surgical treatment of peri-implantitis was comparable to mechanical cleaning, implantoplasty, and the use of Ti-brush, in regards to the significant reduction of BOP, PPD, and CAL, as well as the improvement of the bone level between baseline and follow-ups. The standardized mean difference with a 95% confidence interval of the studied parameters was estimated using the random effect model; however, statistical differences were not detected between air polishing and comparative modalities in the treatment of peri-implantitis. Within the limitations of this review, the application of air polishing did not result in more favorable outcomes in the treatment of peri-implant diseases compared to other modalities.

The purpose of this study was to evaluate the effects of air polishing with sodium bicarbonate and erythritol powders on surface roughness and morphological changes in titanium abutments. A total of 45 grade V titanium discs were divided in three groups: Group A (Control) air polished with air/water; Group B, air polished with sodium bicarbonate powder; and Group C, air polished with erythritol powder. After air polishing, the samples' roughness (Sa) in micrometres were analysed with an optical profilometer. The samples' surface morphology study was conducted via scanning electronic microscope (SEM). Data were described using mean and standard deviation of roughness values (Sa). Inferential analysis was performed using the ANOVA multiple comparison test followed by Tukey's post hoc test. Both tests used a 5% level of significance. After air polishing, average roughness of group A, B and C were 0.036, 0.046 and 0.037 μm, respectively, with statistically significant differences between groups A and B (p < 0.05). No statistically significant differences were found between group A and group C, as well as between group B and C (p > 0.05). As for the morphology analysis, damages to the titanium surface were only observed in group B. The study indicates that air polishing with erythritol powder maintains titanium abutment integrity better than sodium bicarbonate, which increased surface roughness and caused damage. Erythritol is preferable for minimizing surface alterations and maintaining morphological stability.

The aim of this systematic review was to evaluate the effects of ultrasonic instrumentation and air polishing on surface roughness and marginal integrity of dental restorations, addressing their potential adverse impacts on various biomaterials. A search of five databases, supplemented by manual searches, identified relevant laboratory studies. Forty-two studies met the inclusion criteria, with data on surface roughness and marginal quality extracted for analysis. The RoBDEMAT tool was used to assess risk of bias. Ultrasonic instrumentation significantly increased roughness, particularly in resin-modified glass ionomer cements and resin-based composites, whereas zirconia and lithium disilicate were less affected. Air polishing, especially with sodium bicarbonate and calcium carbonate powders, also increased roughness. Erythritol and glycine powders were the least abrasive. Both ultrasonic scaling and air polishing negatively impacted marginal quality. The RoBDEMAT assessments revealed shortcomings in randomization, sample size justification, and blinding. Ultrasonic instrumentation and air polishing can adversely affect dental restorations, with the degree of impact varying by biomaterial and debridement method. Low-abrasive powders, such as erythritol and glycine, are recommended. Methodological refinements and clinical studies are needed to enhance the applicability of these findings to patient care. This review highlights the critical need to choose appropriate debridement methods to minimize iatrogenic damage to dental restorations. Low-abrasive air polishing powders, such as erythritol and glycine, are recommended for the removal of soft deposits and stains to preserve surface smoothness and marginal integrity.