Abstract
ObjectivesBiofilm removal is the decisive factor for the control of peri-implantitis. Cold atmospheric pressure plasma (CAP) can become an effective aid due to its ability to destroy and to inactivate bacterial biofilm residues. This study evaluated the cleaning efficiency of CAP, and air-polishing with glycine (APG) or erythritol (APE) containing powders alone or in combination with CAP (APG + CAP, APE + CAP) on sandblasted/acid etched, and anodised titanium implant surface.Materials and methodsOn respective titanium discs, a 7-day ex vivo human biofilm was grown. Afterwards, the samples were treated with CAP, APG, APE, APG + CAP, and APE + CAP. Sterile and untreated biofilm discs were used for verification. Directly after treatment and after 5 days of incubation in medium at 37 °C, samples were prepared for examination by fluorescence microscopy. The relative biofilm fluorescence was measured for quantitative analyses.ResultsAir-polishing with or without CAP removed biofilms effectively. The combination of air-polishing with CAP showed the best cleaning results compared to single treatments, even on day 5. Immediately after treatment, APE + CAP showed insignificant higher cleansing efficiency than APG + CAP.ConclusionsCAP supports mechanical cleansing and disinfection to remove and inactivate microbial biofilm on implant surfaces significantly. Here, the type of the powder was not important. The highest cleansing results were obtained on sandblasted/etched surfaces.Clinical relevance.Microbial residuals impede wound healing and re-osseointegration after peri-implantitis treatment. Air-polishing treatment removes biofilms very effectively, but not completely. In combination with CAP, microbial free surfaces can be achieved. The tested treatment regime offers an advantage during treatment of peri-implantitis.
Highlights
Dental implant installation is a very common and accepted treatment method to replace hopeless or missing teeth
Since the aetiology of peri-implantitis is similar to periodontitis [1], the removal of the dysbiotic microbial biofilm from the exposed implant surface [2] is the cornerstone of peri-implantitis therapy
We showed that the combination of a powerdriven, nylon brush with subsequent cold atmospheric pressure plasma (CAP) treatment led to a complete biofilm removal from titanium discs and enhanced osteoblastic cell spreading comparable to the sterile control discs [15]
Summary
Dental implant installation is a very common and accepted treatment method to replace hopeless or missing teeth. Since the aetiology of peri-implantitis is similar to periodontitis [1], the removal of the dysbiotic microbial biofilm from the exposed implant surface [2] is the cornerstone of peri-implantitis therapy. Clinical Oral Investigations gauze pellets soaked in saline and/or chlorhexidine, with air-powder devices, rotating or oscillating brushes or treatment with carbon dioxide or diode laser [3, 4]. Air powder devices exhibited the best cleansing capability of all mechanical methods. 20 to 60% of the exposed surface still remains untreated, depending on the treatment angle, even during optimal access, especially in the undercuts of the implant threads [5]. The microrough implant surface (roughness below 50 microns) and the implant threads provide “protected areas” for the microorganisms, inaccessible to conventional mechanical removal. A literature review did not find any debridement method superior to any other in removing the biofilm and no method was able to achieve a stable result over time [6]
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