Plastic Curettes Research Articles

In Vitro Comparison of Titanium Disc Surface Roughness and Bacterial Colonization After Ultrasonic Instrumentation With Three Different Tips.

During implant maintenance, preserving a smooth surface on the machined transmucosal abutment is critical to reduce biofilm attachment and colonization. The present study compared the surface roughness and bacterial colonization of machined titanium surfaces after instrumentation with various materials. Forty-four machined grade 23 titanium discs were instrumented with a round polyether ether ketone (PEEK) tip, a plastic curette tip, or a pure titanium curette tip with piezoelectric devices. Before and after instrumentation, the surface roughness (Ra and Rz) values were analyzed with a profilometer and scanning electron microscopy (SEM). Streptococcus sanguinis was cultured and incubated for 24 hours on the instrumented discs, and colony-forming units per milliliter were obtained for each group. Samples instrumented with the metal ultrasonic tip significantly increased surface roughness compared with the other groups. This resulted in greater colonization by S. sanguinis than surfaces instrumented with PEEK tips or the negative control. Samples instrumented with PEEK and plastic tips did not exhibit any statistically significant increase in surface roughness, and SEM analysis revealed a significantly rougher surface of discs instrumented with metal compared with discs instrumented with plastic or PEEK tips despite the possibility of debris from tip dissolution. Our results suggest that instrumentation with metal ultrasonic tips with piezoelectric devices significantly increased machined titanium's surface roughness and elicited higher biofilm formation in vitro. Meanwhile, instrumentation of machined titanium with PEEK or plastic ultrasonic tips did not affect the surface roughness or bacterial adhesion.

Decontamination and Repair Protocol Promotes Positive Outcomes in Implants Affected by Peri-implantitis: A Human Case Series.

This study assessed the effectiveness and predictability of a readily available protocol to treat peri-implantitis utilizing mechanical debridement, chemical antiseptic surface detoxification, and osseous grafting. Nine patients (7 women, 2 men; mean age: 56.5 years) with 15 implants with peri-implantitis were included. Pocket probing depth (PPD), bleeding on probing (BOP), and standardized digital periapical radiographic measurements were taken. Surgical flaps were elevated, and the implant threads were cleaned with a plastic curette. Chemical decontamination was performed by scrubbing solutions of 0.25% sodium hypochlorite (NaClO) and 1.5% hydrogen peroxide (H2O2) around the exposed implant using cotton pellets. Bony defects were filled with a 50/50 mixture of bovine hydroxyapatite and nanocrystalline calcium sulfate (CaSO4). A porcine collagen membrane was placed over the grafted bony defect. Follow-up appointments were scheduled 1 week, 2 weeks, 3 months, 6 months, 9 months, and 1 year posttreatment. Clinical and radiographic parameters were assessed and compared. At baseline, PPD ranged from 5 to 7.5 mm (mean: 6 ± 0.7 mm). At 12 months, PPD ranged from 1.5 to 4.2 mm (mean: 2.5 ± 0.8 mm). The mean PPD reduction of 3.6 mm (59.2%) was statistically significant (P < .001). The number of bleeding sites around each test implant decreased significantly from 4 to 0.4 sites between baseline and 12 months (P < .001). Mean radiographic bone loss decreased from 4.8 ± 1.3 mm to 2.7 ± 1.2 mm (P < .001). The proposed method of mechanical decontamination, chemical detoxification, and bone regeneration is clinically effective and reproducible. Clinical peri-implant parameters and radiographic bone levels were improved and maintained their stability for 1 year using this peri-implantitis treatment protocol.

A Review of Bacterial Colonization on Dental Implants With Various Hygiene Instruments.

Peri-implant diseases can still develop despite oral hygiene practices being maintained. Consequently, regular debridement must be carried out to ensure the implant is sustained. This review evaluated bacterial colonization on implants following the use of different hygiene instruments. A literature search was conducted in PubMed, ScienceDirect, and Scopus databases for articles published from 2012 to 2022. A total of 19 full-text papers were selected. The number of bacteria colonized was most commonly evaluated with a scanning electron microscope (SEM) or by colony-forming unit (CFU) counts, crystal violet assays, plaque index, probing depth, bleeding on probing, turbidity test, and live-dead assays. Rubber cup polishing with an abrasive paste showed a significantly greater reduction in biofilm formation compared with air abrasion with glycine powder, while the air abrasion treatment was found to be more efficient than piezoelectric, carbon, and stainless steel scalers. Surface treatment with Er, Cr: YSGG laser, and Er: YAG laser resulted in statistically significant superior dental biofilm removal compared with titanium curettes and photodynamic therapy. Air abrasion, plastic curette, titanium curette, and ultrasonic scaler showed no significant differences in bacterial colonization, but air abrasion and plastic curette were safer for zirconia implant decontamination. Furthermore, the titanium brush showed better results in decontaminating the implant surface than the Er: YAG laser. Although no single instrument or method could be considered as offering a gold standard in treating peri-implant diseases, the use of air abrasion with glycine powder, laser therapies, rubber cup polishing with an abrasive paste, and a titanium brush had high levels of cleaning efficacy and acceptance by patients.

Amino acid buffered hypochlorite facilitates debridement of porcine infected burn wounds

IntroductionRemoval of necrotic tissue is a vital step in the treatment of full-thickness burn wounds, with surgical debridement being the most effective method. Since minor burn wounds are typically treated on an outpatient basis where surgical capabilities can be limited there is a need for alternative treatment options. In this study we aim to evaluate the use of amino acid buffered hypochlorite (AABH) as a chemical enhancement for wound debridement in a porcine infected burn wound model. MethodA total of 60 full-thickness burn wounds, 3 cm in diameter, were created on four pigs using a standardized burn device. The wounds were inoculated with 107 colony-forming units (CFU) of S. aureus. The experimental groups included wounds debrided with a plastic curette, wounds debrided after pretreatment with AABH, and control wounds wiped with gauze. Wounds were treated twice per week for three weeks. Debridement, healing, and infection parameters were evaluated over time. ResultsAfter one week, but not after two and three weeks, the curette and AABH groups had higher debrided weights compared to control (p < 0.05). Percentage of wound area adequately cleared from necrotic tissue was higher in the AABH-group compared to the curette-group and control, after one week. The earliest healing was measured in the AABH group after two weeks (5 % of wounds), which also had the most healed wounds after three weeks (55 %). In both the AABH and the curette groups, bacterial load had fallen below 105 CFU/g after two weeks. No CFU were detectable in the AABH group after three weeks. The AABH-group was also the easiest to debride. ConclusionOur results indicate that AABH facilitates wound debridement and could be a helpful addition to an effective treatment modality for removal of necrotic tissue in full-thickness burns.

Effects on the Titanium Implant Surface by Different Hygiene Instrumentations: A Narrative Review.

Peri-implant disease is usually caused by the accumulation of dental biofilm around the implant, and this biofilm can irradiate the gingiva tissue, which leads to inflammation and, more severely, to a deterioration of the bone structure. There is a concern regarding the removal of biofilm from the implant surface by using different hygiene instruments. Some hygiene instruments may have some effect on the dental implant surface, resulting in roughening or damage to the implant surfaces. This study reviewed the effects of titanium implant surfaces on different hygiene instruments. A literature search was conducted from PubMed, ScienceDirect, and Scopus databases for articles published from 1992 to 2021. A total of 19 full-text papers with keywords of interest that met all the eligibility criteria were selected. Surface roughness was evaluated with a scanning electron microscope and also using a profilometer, laser scanning, scanning probe, and atomic force microscopes. A metal curette produced a roughened surface on the titanium implant, but a plastic curette did not alter the surface. Instrumentation with rubber cups left the surface unchanged and appeared to smoothen the surface, whereas the air-powder abrasive instrumentation altered the surface with the presence of micro pits and pores. A conventional metal ultrasonic scaler showed significant surface topographical changes and scratches on both titanium surfaces, as a diode laser, light-emitting diode (LED), and laser treatment did not show any alteration on the rough and smooth titanium surfaces. Thus, a non-metallic instrument such as a plastic curette, rubber cups, and novel technology including diode laser, LED, and laser treatment is appropriate and can be used for debridement on smooth and machined titanium implant surfaces as well as sandblasted and acid-etched (SLA), titanium plasma-sprayed (TPS), and resorbable blasted media (RBM) surfaces. The use of metallic instruments should be avoided, and it is not recommended.

Comparison of antimicrobial effect of several decontaminating methods on contaminated Titanium discs

Decontaminating the implant surface, exposed to bacterial biofilm, is a concern in the treatment of peri-implant inflammatory disease. The aim of this study was to compare the effect of several methods on reduction of the bacterial load, colonized on the surfaces of titanium discs.In this in vivo study, seven titanium discs with Sandblasted, Large-grit, acid-etched (SLA) surface were placed in the mouth of each of ten patients with chronic periodontitis by an intra-oral maxillary splint for 24 h. In each patient, the contaminated discs, except for the negative control ones, were randomly treated by one of the six antiseptic methods including sterile normal saline, plastic curette, air polisher, hydrogen peroxide, 980 nm diode laser, and Er-YAG laser. A spectrophotometer was used to measure Optical Density (OD) in case of aerobic microorganisms. Colony-Forming Units (CFUs) were used for anaerobic bacteria. Data were analyzed through Kruskal-Wallis and Mann-Whitney Tests at a significance level of α =0.05 by SPSS software.Statistical analysis showed a significant decrease in OD of aerobic bacteria among the seven groups during a 0-24 h time interval (P < 0.001). Furthermore, these tests showed a significant difference in the CFU (P < 0.001) for anaerobic bacteria after 48 h.The results of this study showed that all of the adopted methods significantly reduced microbial colonies on the surfaces of titanium discs with SLA surface. Er: YAG laser and normal saline had the highest and the lowest effects, respectively.

Qualitative Evaluation of the Effects of Professional Oral Hygiene Instruments on Prosthetic Ceramic Surfaces

During professional hygiene procedures, different instruments used may cause various damage to dental prostheses. Deplaquing and scaling with curettes and ultrasonic instruments may inadvertently increase the surface roughness of the material and the risk of future bacterial adhesion and/or also compromise the marginal seal of the prosthesis. Hence, the aim of this study was to assess the qualitative effects of two types of curettes and one piezoelectric instrument with a stainless-steel tip on three types of metal-free samples. After treating the samples with different instrumentations, they were analyzed using the scanning electron microscope and then underwent a qualitative microanalysis by using a spectroscopy machine. All the materials tested in this study have undergone significant changes of their superficial structure after instrumentation both with mechanical and manual instruments. Plastic curettes appeared to be less aggressive than the other instruments. Disilicate samples show a significantly lower degree of surface glazing erosion compared to the zirconia sample with all the instruments used.

Impact of physical decontamination methods on zirconia implant surface and subsequent bacterial adhesion: An in-vitro study.

ObjectiveTo evaluate the effect of routinely used physical decontamination methods on the surface characteristics of zirconia implants and subsequent ability of bacteria to adhere in vitro.BackgroundPhysical decontamination methods commonly used in peri‐implantitis therapy and routine implant maintenance can potentially alter zirconia implant surfaces.MethodsAcid‐etched zirconia discs were instrumented with titanium curette (TC), plastic curette, air abrasive device, ultrasonic scaler (US) with stainless steel tip. Following instrumentation, surface topography, and surface elemental composition was analyzed using 3D‐laser scanning microscopy and energy‐dispersive X‐ray spectroscopy, respectively. Subsequently, plaque biofilm was cultured on zirconia discs for 48 h and bacterial adhesion assessed using a turbidity test and scanning electron microscopy.ResultsA significant difference in surface roughness was observed between the US and control group (p < 0.05). The US and TC caused gray surface discolouration on zirconia discs due to deposition of metallic residue as confirmed by X‐ray spectroscopy. No significant difference in bacterial adhesion was noted among all treatment groups (p > 0.05).ConclusionTC and US with stainless steel tips should be used with caution due to deposition of metallic residue on the surface. Air abrasive devices and plastic curettes caused minimal surface alterations and are, therefore, safer for zirconia implant decontamination.

Dentists' preferences in implant maintenance and hygiene instruction.

This study investigated the preferences of dentists in Australia in providing professional implant maintenance and implant-specific oral hygiene instructions (OHI). General dentists were surveyed online about their preferences in peri-implant diagnostics, maintenance provision, armamentarium used, and implant OHI techniques and frequency. Most of the 303 respondents (96%) provided maintenance services; 87.6% reviewed implants regularly while 10.7% only performed diagnostics after detecting clinical signs/symptoms. Supragingival prosthesis cleaning was performed by 77.9% of respondents, 35.0% performed subgingival debridement, 41.9% treated peri-implant mucositis and 18.2% treated peri-implantitis. About 15% did not treat nor refer peri-implant disease, including significantly more non-implant providers and dentists without implant training. Maintenance armamentarium commonly included floss (76.3%), prophylaxis (73.9%), plastic curettes (43.3%) and stainless-steel ultrasonics (38.0%). Brushing (86.5%), flossing (73.9%) and interdental brush use (68.3%) were most commonly recommended. Implant OHI was repeated routinely by 57.4% of dentists who provided it. Dentists with greater implant training and experience were more likely to perform reviews and complex maintenance procedures. Peri-implant diagnostics performed, treatments provided and armamentarium varied among dentists. Implant providers and those with higher levels of training had more preventative approaches to implant OHI. Possible shortcomings in disease management and OHI reinforcement were identified.

Assessment of soft and hard tissue dimensions following different treatment approaches of ligature‐induced peri‐implantitis defects

To evaluate peri-implant tissue dimensions following nonsurgical (NS) and surgical therapy (S) employing different decontamination protocols of advanced ligature-induced peri-implantitis in dogs. Peri-implantitis defects (n=5 dogs, n=30 implants) were randomly and equally allocated in a split-mouth design to NS or S treatment using either an Er:YAG laser (ERL), an ultrasonic device (VUS), or plastic curettes+local application of metronidazole gel (PCM), respectively. Horizontal bone thickness (hBT) and soft tissue thickness (hMT) were measured at different reference points: (v0) at the marginal portion of the peri-implant mucosa (PM); (v1) at 50% of the distance from PM to bone crest (BC); (v2) at the BC; (v3) at the most coronal extension of the bone-to-implant contact. Vertical peri-implant tissue height was calculated from PM to BC. All of the treatment groups showed a gradual hMT increase from v0 to the v2 reference point, followed by a reduction from v2 to the v3 region. The S-VUS subgroup tended to be associated with higher hMT values at the v0 region than the NS-VUS subgroup (0.44mm versus 0.31mm). PM-BC distance varied from 2.22 to 2.83mm in the NS group, and from 2.07 to 2.38 in the S group. Vertical and horizontal peri-implant tissue dimensions were similar in different treatment groups.

A importância da higienização de próteses tipo protocolo inferior

INTRODUÇÃO: Um correto planejamento e execução de cada caso, os ajustes da prótese em momentos oportunos e também a manutenção de uma boa higiene contribuem para longevidade de próteses totais implantossuportadas. OBJETIVO: Discorrer sobre a importância da orientação ao paciente quanto à higienização das próteses tipo protocolo inferior, para aumentar o percentual de sucesso do trabalho reabilitador. METODOLOGIA: Foram realizadas buscas nas bases de dados como BVS, Google acadêmico, entre 2003 e 2019, com as palavras chave: “higienização de próteses totais implantossuportadas”, “mucosite”, “periimplantite” selecionando artigos com textos completos, publicados em português e inglês. DISCUSSÃO: Escovas convencionais ou elétricas, interdentais, fio dental agulhado ou com passa fio, dentifrícios com pouca abrasividade, enxaguatório bucal e aparelhos hidropropulsores são os instrumentos de eleição para a limpeza feita pelo paciente. O cirurgião dentista pode realizar a manutenção com curetas plástica ou teflon, com taças de borracha e pasta profilática sem abrasividade ou pontas de ultrassom banhadas a ouro e, se necessário, pode remover a prótese para que a higienização seja feita fora da boca. CONCLUSÃO: É de suma importância que exista um bom relacionamento entre paciente e dentista para que o paciente tenha liberdade para relatar problemas ou dificuldades na higienização.

Pilot Study on the Use of a Laser-Structured Double Diamond Electrode (DDE) for Biofilm Removal from Dental Implant Surfaces.

No proper treatment option for peri-implantitis exists yet. Based on previous studies showing the in vitro effectiveness of electrochemical disinfection using boron-doped diamond electrodes, novel double diamond electrodes (DDE) were tested here. Using a ceramic carrier and a laser structuring process, a clinically applicable electrode array was manufactured. Roughened metal discs (n = 24) made from Ti-Zr alloy were exposed to the oral cavities of six volunteers for 24 h in order to generate biofilm. Then, biofilm removal was carried out either using plastic curettes and chlorhexidine digluconate or electrochemical disinfection. In addition, dental implants were contaminated with ex vivo multispecies biofilm and disinfected using DDE treatment. Bacterial growth and the formation of biofilm polymer were determined as outcome measures. Chemo-mechanical treatment could not eliminate bacteria from roughened surfaces, while in most cases, a massive reduction of bacteria and biofilm polymer was observed following DDE treatment. Electrochemical disinfection was charge- and time-dependent and could also not reach complete disinfection in all instances. Implant threads had no negative effect on DDE treatment. Bacteria exhibit varying resistance to electrochemical disinfection with Bacillus subtilis, Neisseria sp., Rothia mucilaginosa, Staphylococcus haemolyticus, and Streptococcus mitis surviving 5 min of DDE application at 6 V. Electrochemical disinfection is promising but requires further optimization with respect to charge quantity and application time in order to achieve disinfection without harming host tissue.

Effect of a Er, Cr:YSGG laser and a Er:YAG laser treatment on oral biofilm-contaminated titanium.

Implant surface decontamination is a challenging procedure for therapy of peri-implant disease.Objective:This study aimed to compare the effectiveness of decontamination on oral biofilm-contaminated titanium surfaces in Er:YAG laser, Er, Cr:YSGG laser, and plastic curette.Methodology:For oral biofilms formation, six participants wore an acrylic splint with eight titanium discs in the maxillary arch for 72 hours. A total of 48 contaminated discs were distributed among four groups: untreated control; decontamination with plastic curettes; Er, Cr:YSGG laser; and Er:YAG laser irradiation. Complete plaque removal was estimated using naked-eye and the time taken was recorded; the residual plaque area was measured and the morphological alteration of the specimen surface was observed by scanning electron microscopy. The total bacterial load and the viability of adherent bacteria were quantified by live or dead cell labeling with fluorescence microscopy.Results:The mean treatment time significantly decreased based on the treatment used in the following order: Er:YAG, Er, Cr:YSGG laser, and plastic curettes (234.9±25.4 sec, 156.1±12.7 sec, and 126.4±18.6 sec, P=0.000). The mean RPA in the Er, Cr:YSGG laser group (7.0±2.5%) was lower than Er:YAG and plastic curettes groups (10.3±2.4%, 12.3±3.6%, p=0.023). The viable bacteria on the titanium surface after Er, Cr:YSGG laser irradiation was significantly lower compared to the decontamination with plastic curette (P=0.05) but it was not significantly different from the Er:YAG laser irradiation.Conclusion:We found that Er:YAG laser and Er, Cr:YSGG laser irradiation were effective methods for decontaminations without surface alterations.

Temperature Changes and SEM Effects of Three Different Implants-Abutment Connection during Debridement with Er:YAG Laser: An Ex Vivo Study.

The study aimed to evaluate a temperature increase in, and damage to, titanium implants during flapless laser debridement. The study analyzed 15 implants with various implant–abutment connections: a two-piece implant (n = 4) with a screw abutment (IA—Implant–Abutment) and a one-piece implant with a ball type fixture (BTF, n = 4) or fix type fixture (FTF, n = 4). The implants were placed in porcine mandibles 2 mm over a bone crest to imitate a peri-implantitis. The implants were debrided in contact mode for 60 s with a Er:YAG laser at fluence of 9.95 J/cm2 (G1 group: 50 mJ/30 Hz); 19.89 J/cm2 (G2 group: 100 mJ/30 Hz); 39.79 J/cm2 (G3 group: 200 mJ/30 Hz), or a scaler with a ceramic tip (G4 control group: 4 W/20 Hz). The temperature was measured with thermocouples at implant and abutment levels. The damage in the titanium surface (n = 3, non-irradiated implants from each type) was assessed using SEM (Scanning Electron Microscopy). The temperature increase at the implant level for the laser was higher at IA in contrast with FTF and BTF. (p < 0.05) The temperature change at the abutment level was lower for the scaler in contrast to Er:YAG laser at FTF. (p < 0.0002) Er:YAG laser didn’t increase the temperature by 10 °C at 100 mJ/30 Hz and 50 mJ/30 Hz. Based on SEM analysis, cracks occurred on the surface of two-piece implants and were more pronounced. Cracks and the melting of the titanium surface of two-piece implants cleaned with Er:YAG laser at 100 or 200 mJ were observed. The specimens treated with the ultrasonic scaler with a plastic curette showed the remaining dark debris on the titanium surface. We recommend using Er:YAG laser at 50 mJ/30 Hz during flapless implants debridement.

Adjunctive effect of modifying the implant-supported prosthesis in the treatment of peri-implant mucositis.

To evaluate the adjunctive effect of modifying the implant-supported prosthesis to facilitate access to oral hygiene when treating peri-implant mucositis. A 6-month randomized clinical trial was designed. Patients with peri-implant mucositis were treated by implant surface debridement with plastic curettes and a plastic tipped ultrasonic device. Then, they were randomly assigned to either modifying their prosthesis to allow for better oral hygiene (test group) or not (control group). Subsequently in both groups, individualized oral hygiene instructions were provided. Clinical and radiographical outcomes were evaluated at baseline and 1, 3 and 6months after treatment. 48 patients were included, and 45 completed the clinical trial (24 test and 21 control patients). After 6months, changes in the modified bleeding index between the control and test groups were 0.50 (standard deviation -SD=0.70) and 1.14 (SD=0.96), respectively (p=0.01). The changes in implant probing pocket depth at 6months were -0.02 (SD=0.61) and 0.31 (SD=1.20) mm, respectively (p=0.04). Modifying the contour of the prostheses to improve access for oral hygiene significantly improved the clinical outcomes after standard mechanical treatment of peri-implant mucositis.

Surface changes and bacterial adhesion on implant abutment materials after various clinical cleaning procedures.

Supportive treatments are essential to long-term dental implant success; however, professional cleaning procedures may alter the surfaces of implant abutments and lead to adverse biological responses. This study aimed to evaluate four clinically used cleaning procedures by examining surface changes and subsequent bacterial adhesion on abutment materials. Discs of titanium and zirconia were polished and divided into five groups: titanium curette treatment, carbon fiber reinforced plastic curette treatment, ultrasonic scaling with carbon fiber tip treatment, air polishing with glycine powder, and control group without any treatment. After instrumentation, the arithmetical mean roughness (Ra), hydrophilicity, and surface free energy were recorded. The bacterial adhesion was evaluated after 1 h of Streptococcus mitis incubation by optical microscope and quantified by turbidity test. Among the titanium samples, titanium curette treatment group showed significant surface morphology changes, increased Ra, hydrophilicity, surface free energy, and higher optical density of adhered bacteria. As for the zirconia samples, the differences in surface morphology, Ra, and bacterial adhesion between groups were nonsignificant. Comparing to titanium, zirconia was less susceptible to surface changes after tested cleaning procedures. Titanium curette should be used with care on titanium abutments.

Clinical Evaluation of Three Surgical Modalities in the Treatment of Peri-Implantitis: A Randomized Controlled Clinical Trial.

Objectives: To compare the efficacy of three mechanical procedures for surgically treating peri-implantitis. Materials and Methods: In a randomized, prospective, parallel-group study, 47 patients with peri-implantitis were treated with (a) plastic curettes (n = 15 patients, 25 implants), (b) an air-abrasive device (Perio-Flow®, n = 16 patients,22 implants), or (c) a titanium brush (Ti-Brush®, n = 16 patients, 23 implants). Patients were assessed for the following measures at three timepoints (baseline, and three and six months after surgery): plaque index, bleeding on probing, gingival index, probing pocket depth (PPD), relative attachment level, and bone loss. Treatment outcome was considered successful when the implant was still present with PPD ≤ 5 mm, no bleeding on probing, and no further mean bone loss ≥ 0.5 mm. Results: A greater reduction of gingival index and PPD was observed in the titanium brush group than in the other groups at six months (P < 0.001). Relative attachment level decreased from baseline in each group at three months but was more marked in the titanium brush group (P < 0.001). At six months, there was less bone loss in the titanium brush group than in the plastic curette group (P < 0.001; linear mixed model and Kruskal–Wallis). A successful outcome was observed in 22% of implants in the plastic curette group, 27% in the Perio-Flow® group, and 33% in the Ti-Brush® group. Conclusions: The titanium brush and glycine air-polishing device were more effective than the other methods, but treatment success remained low. Combining mechanical procedures with antimicrobials and/or antibiotics might be a more effective strategy and warrants careful investigation.

Effects of air abrasive decontamination on titanium surfaces: A systematic review of in vitro studies.

Air abrasion (AA) is one of the decontamination methods that have demonstrated promising results in treating peri-implant diseases. This systematic review aimed at evaluating the in vitro effect of AA on surface change, cleaning efficacy, and biocompatibility of titanium surfaces and at comparing it with other decontamination methods. A comprehensive search was conducted up to April 2018 using PubMed, Scopus, and Google Scholar databases to identify studies on the decontamination effect of AA. All types of titanium surfaces, abrasive powders, contaminated surfaces, and measuring methods were included. Overall, 1502 articles were identified. After screening the titles and abstracts, and carefully reading the full-texts, 48 articles published between 1989 and 2018 were selected. AA was considered almost safe, particularly for the nonmodified surfaces. Nevertheless, harder powders such as sodium bicarbonate tended to damage the surface more than glycine. AA resulted in surface change similar to plastic curettes and Er: YAG lasers. Regarding the cleaning efficacy, there was no significant difference between glycine and sodium bicarbonate, but different mixtures of calcium phosphate, hydroxyapatite, and erythritol were superior to glycine. AA was superior or equal to all other decontamination methods in cleaning. Regarding biocompatibility, AA was more successful in preserving biocompatibility for noncontaminated surfaces compared with contaminated surfaces and when used with erythritol and osteoinductive powders. AA can efficiently remove contamination without serious damage to the surface. The main drawback of the AA method seems to be its limitation in restoring the biocompatibility of the surface.

Investigation of the antibacterial effect of laser irradiation and chemical agent on human oral biofilms contaminated titanium discs.

A main challenge in treatment of peri-implant disease is the effective decontamination of the implant surface. This challenge has always been a problem, associated with the treatment of these diseases with regard to the difficulty in removing and eliminating bacterial biofilm from the surface of dental implants, especially rough surfaces. The aim of this in-vivo study was to evaluate the effect of five different antimicrobial methods in reducing bacteria adhering to titanium surfaces. In the present in-vivo study, the contaminated discs, except for the negative control group, randomly underwent one of five treatments: Erbium: Yattrium Aluminum Garnet (Er-YAG) laser, plastic curette, 0.12% chlorhexidine, aPDT, and 810 nm diode laser. A pectrophotometer was used to measure Optical Density (OD) in case of aerobic microorganisms. Colony-Forming Units (CFUs) were used for anaerobic bacteria. Then, all the analyses were carried out at a significance level of α = 0.05 through SPSS software. One-way analysis of variance (ANOVA) of aerobic bacteria showed a significant difference among 6 groups in terms of OD variations during a 0-24 h time interval (P < 0.001). The results of Kruskal-Wallis test were used to investigate the effect of study methods on anaerobic bacteria after 48 h, and the results showed a significant difference among 6 groups in terms of CFUs (P < 0.001). The results of the present study showed that all five mechanicals (plastic curette), chemical (CHX), laser (810 nm diode and Er: YAG), and aPDT methods could reduce oral biofilms from roughed surfaces of titanium discs. Er: YAG laser and plastic curette had the highest and the lowest effects respectively.

In Vitro Comparison of the Efficacy of Peri-Implantitis Treatments on the Removal and Recolonization of Streptococcus gordonii Biofilm on Titanium Disks.

Objective: To compare the efficacy of four commonly used clinical procedures in removing Streptococcus gordonii biofilms from titanium disks, and the recolonization of the treated surfaces. Background: Successful peri-implantitis treatment depends on the removal of the dental biofilm. Biofilm that forms after implant debridement may threaten the success of the treatment and the long-term stability of the implants. Methods: S. gordonii biofilms were grown on titanium disks for 48 h and removed using a plastic curette, air-abrasive device (Perio-Flow®), titanium brush (TiBrush®), or implantoplasty. The remaining biofilm and the recolonization of the treated disks were observed using scanning electron microscopy and quantified after staining with crystal violet. Surface roughness (Ra and Rz) was measured using a profilometer. Results: S. gordonii biofilm biomass was reduced after treatment with Perio-Flow®, TiBrush®, and implantoplasty (all p < 0.05), but not plastic curette (p > 0.05), compared to the control group. Recolonization of S. gordonii after treatment was lowest after Perio-Flow®, TiBrush®, and implantoplasty (all p < 0.05 vs. control), but there was no difference between the plastic curette and the control group (p > 0.05). Ra and Rz values ranged from 1–6 µm to 1–2 µm and did not differ statistically between the control, plastic curette, Perio-Flow, and TiBrush groups. However, the implantoplasty group showed a Ra value below 1 µm (p < 0.01, ANOVA, Tukey). Conclusions: Perio-Flow®, TiBrush®, and implantoplasty were more effective than the plastic curette at removing the S. gordonii biofilm and preventing recolonization. These results should influence the surgical management of peri-implantitis.