However, the rotary stainless steel instrument created numerous shallow scratches, especially on machined surface implants. John et al. compared the supragingival plaque cleansability of a rotary titanium instrument to that of a stainless metal curette on contaminated titanium disks. The residual biofilm area left on implant treated with the rotary titanium instrument was significantly lower than in the stainless metal curette, and the surface alteration of the titanium disks could not be shown in SEM analysis. Although the cleansability of the rotary stainless steel instrument in the present study is superior and advantageous, the downside of the surface alteration is an issue to consider.

It has been previously stated that the alteration of the implant surface during cleansing may attenuate biocompatibility. However, several clinical studies revealed the considerable treatment effect even though there was certain expected damage on the implant surface. Therefore, it is assumed that the most important consideration for treating peri-implantitis in the clinical setting should be to improve the cleansability of any instrumentation to effectively remove biofilms irrespective of implant surface alteration.