Fig. 6. Comparison of cleansability of each decontamination method on the different implant surfaces. Asterisk indicates p < 0.05
Fig. 6. Comparison of cleansability of each decontamination method on the different implant surfaces. Asterisk indicates p < 0.05
Fig. 5. Quantitative analysis of CFU counts on rough and machined surface implants after cleansing by each method. Asterisk represents vs Cont; a, vs G; b, vs US; c, vs Air; d, vs Rot; e, vs Las which indicates p < 0.05
Fig. 5. Quantitative analysis of CFU counts on rough and machined surface implants after cleansing by each method. Asterisk represents vs Cont; a, vs G; b, vs US; c, vs Air; d...
Fig. 4. SEM analysis of 4 areas. 1 Rough surface—microthread area. 2 Rough surface—macrothread area. 3 Machined surface—microthread area. 4 Machined surface—macrothread area
Fig. 4. SEM analysis of 4 areas. 1 Rough surface—microthread area. 2 Rough surface—macrothread area. 3 Machined surface—microthread area. 4 Machined surface—macrothread area
Fig. 3. Decontamination methods. a Gauze soaked in saline applied using a sawing motion. b Ultrasonic scaler (SUPRASSON P-MAX, Satelec-Acteon group, Bordeaux, France, power setting: P5, tip: Implant Protect IP3L/R). c Air abrasives (AIR-FLOW MASTER PIEZON®, EMS, Nyon, Switzerland, power setting: water flow 100%, air pressure 75%, powder: AIR-FLOW® PERIO POWDER, nozzle: PERIO-FLOW® nozzles, di...
Fig. 2. GC Aadva® implant; 3.3-mm diameter, 8-mm length
Fig. 2. GC Aadva® implant; 3.3-mm diameter, 8-mm length
Fig. 1. Hard resin splint model carrying 6 implants
Fig. 1. Hard resin splint model carrying 6 implants
Rough surfaceContGUSAirRotLasMedian137.53.446.513.04.816.3Min73.00.36.80.50.63.0Max785.027.0240.035.537.034.0Machine surfaceContGUSAirRotLasMedian84.50.98.53.23.325.3Min43.00.20.92.01.60.4Max295.04.236.014.05.661.5Table 3 Quantitative analysis of CFU counts (× 105) from rough and machined surface implants after cleansing by each method
Machined surface (microthread)No effectFairGoodExcellentG   +US  + Air  + Rot   +Las +  Machined surface (macrothread)No effectFairGoodExcellentG   +US  + Air  + Rot   +Las  + Table 2 Qualitative evaluation by SEM analysis of micro- and macrothread areas of machined surface implants
Rough surface (microthread)No effectFairGoodExcellentG  + US +  Air +  Rot  + Las+   Rough surface (macrothread)No effectFairGoodExcellentG  + US  + Air  + Rot  + Las+   Table 1 Qualitative evaluation by SEM analysis of micro- and macrothread areas of rough surface implants
Fig. 6. Comparison of cleansability of each decontamination method on the different implant surfaces. Asterisk indicates p < 0.05
Fig. 6. Comparison of cleansability of each decontamination method on the different implant surfaces. Asterisk indicates p < 0.05
Fig. 5. Quantitative analysis of CFU counts on rough and machined surface implants after cleansing by each method. Asterisk represents vs Cont; a, vs G; b, vs US; c, vs Air; d, vs Rot; e, vs Las which indicates p < 0.05
Fig. 5. Quantitative analysis of CFU counts on rough and machined surface implants after cleansing by each method. Asterisk represents vs Cont; a, vs G; b, vs US; c, vs Air; d...
Fig. 4. SEM analysis of 4 areas. 1 Rough surface—microthread area. 2 Rough surface—macrothread area. 3 Machined surface—microthread area. 4 Machined surface—macrothread area
Fig. 4. SEM analysis of 4 areas. 1 Rough surface—microthread area. 2 Rough surface—macrothread area. 3 Machined surface—microthread area. 4 Machined surface—macrothread area
Fig. 3. Decontamination methods. a Gauze soaked in saline applied using a sawing motion. b Ultrasonic scaler (SUPRASSON P-MAX, Satelec-Acteon group, Bordeaux, France, power setting: P5, tip: Implant Protect IP3L/R). c Air abrasives (AIR-FLOW MASTER PIEZON®, EMS, Nyon, Switzerland, power setting: water flow 100%, air pressure 75%, powder: AIR-FLOW® PERIO POWDER, nozzle: PERIO-FLOW® nozzles, di...
Fig. 2. GC Aadva® implant; 3.3-mm diameter, 8-mm length
Fig. 2. GC Aadva® implant; 3.3-mm diameter, 8-mm length
Fig. 1. Hard resin splint model carrying 6 implants
Fig. 1. Hard resin splint model carrying 6 implants
Rough surfaceContGUSAirRotLasMedian137.53.446.513.04.816.3Min73.00.36.80.50.63.0Max785.027.0240.035.537.034.0Machine surfaceContGUSAirRotLasMedian84.50.98.53.23.325.3Min43.00.20.92.01.60.4Max295.04.236.014.05.661.5Table 3 Quantitative analysis of CFU counts (× 105) from rough and machined surface implants after cleansing by each method
Machined surface (microthread)No effectFairGoodExcellentG   +US  + Air  + Rot   +Las +  Machined surface (macrothread)No effectFairGoodExcellentG   +US  + Air  + Rot   +Las  + Table 2 Qualitative evaluation by SEM analysis of micro- and macrothread areas of machined surface implants
Rough surface (microthread)No effectFairGoodExcellentG  + US +  Air +  Rot  + Las+   Rough surface (macrothread)No effectFairGoodExcellentG  + US  + Air  + Rot  + Las+   Table 1 Qualitative evaluation by SEM analysis of micro- and macrothread areas of rough surface implants
Otsuki, M., Wada, M., Yamaguchi, M. et al. Evaluation of decontamination methods of oral biofilms formed on screw-shaped, rough and machined surface implants: an ex vivo study.
Int J Implant Dent 6, 18 (2020). https://doi.org/10.1186/s40729-020-00212-y
Download citation
Received: 06 February 2020
Accepted: 17 March 2020
Published: 22 April 2020
DOI: https://doi.org/10.118...
Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material...
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
All participants provided informed consent verbally. Study information was disseminated to participants both verbally and in written form. This study protocol was approved by the ethical committee of Osaka University (H26.E-36).
All participants consented to the publication of their data through a written consent form obtained from the ethical committee of Osaka University.
Motohiro Otsuki, Masa...
Department of Prosthodontics, Gerodontology and Oral Rehabilitation, Osaka University Graduate School of Dentistry, 1-8 Yamadaoka, Suita, Osaka, 565-0871, Japan
Motohiro Otsuki, Masahiro Wada, Yoshinobu Maeda & Kazunori Ikebe
Department of Oral and Molecular Microbiology, Osaka University Graduate School of Dentistry, Osaka, Japan
Masaya Yamaguchi & Shigetada Kawabata
You can also search...
GC Corporation provided the implants to this research.
The authors thank Tomoaki Mameno for his work on data analysis.
Romeo E, Ghisolfi M, Murgolo N, Chiapasco M, Lops D, Vogel G. Therapy of peri-implantitis with resective surgery. A 3-year clinical trial on rough screw-shaped oral implants. Part I: clinical outcome. Clin Oral Implants Res. 2007;16(1):9–18.
Aoki A, Mizutani K, Schwarz F, Sculean A, Yukna RA, Takasaki AA, et al. Periodontal and peri-implant wound healing following laser therapy. Periodontol 200...
Berglundh T, Armitage G, Araujo MG, Avila-Ortiz G, Blanco J, Camargo PM, et al. Peri-implant diseases and conditions: consensus report of workgroup 4 of the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions. J Periodontol. 2018;89(Suppl 1):S313–8.
Sousa V, Mardas N, Spratt D, Boniface D, Dard M, Donos N. Experimental models for contamination of ti...
Schwarz F, Ferrari D, Popovski K, Hartig B, Becker J. Influence of different air-abrasive powders on cell viability at biologically contaminated titanium dental implants surfaces. J Biomed Mater Res B Appl Biomater. 2009;88(1):83–91.
Widodo A, Spratt D, Sousa V, Petrie A, Donos N. An in vitro study on disinfection of titanium surfaces. Clin Oral Implants Res. 2016;27(10):1227–32.
Sahrmann P,...
Derks J, Schaller D, Hakansson J, Wennstrom JL, Tomasi C, Berglundh T. Effectiveness of implant therapy analyzed in a Swedish population: prevalence of peri-implantitis. J Dent Res. 2016;95(1):43–9.
Fransson C, Lekholm U, Jemt T, Berglundh T. Prevalence of subjects with progressive bone loss at implants. Clin Oral Implants Res. 2005;16(4):440–6.
Wada M, Mameno T, Onodera Y, Matsuda H, Daimon...
Control (no decontamination)
Gauze soaked in saline
Ultrasonic scaler (SUPRASSON P-MAX, Satelec-Acteon Group, Bordeaux, France; power setting: P5, tip: Implant Protect IP3L/R)
Air abrasive (AIR-FLOW MASTER PIEZON®, EMS, Nyon, Switzerland; power setting: water flow 100%, air pressure 75%, powder: AIR-FLOW® PERIO POWDER, nozzle: PERIO-FLOW® nozzles, distance from the nozzle to the implant 2 ...
The datasets used during the current study are available from the corresponding author on reasonable request.
In the present ex vivo experimental study, none of the tested decontamination methods thoroughly eliminated biofilms formed on rough/machined surface implants intraorally. Gauze soaked in saline and the rotary stainless steel instrument showed better cleansability than the ultrasonic scaler in qualitative and quantitative analyses and may be advantageous for cleansing contaminated implant surfaces...
Through SEM analysis and CFU counts, it was demonstrated that, except for the Er:YAG laser, decontamination of the machined surface implant was easier than that of the rough surface implant regardless of decontamination method. Gauze soaked in saline and the ultrasonic scaler demonstrated a statistically significant difference in CFU counts between the two surfaces. In this context, a machined sur...
Sahrmann et al. [15] tested three instruments (ultrasonic scaler, Gracey curette, and air abrasive device with glycine powder) on rough surface implants stained with indelible ink used as artificial plaque. There was a statistically significant difference in terms of stain removal rate. The air abrasive device showed the best result among the tested instruments. The result of this study is in line...
It has been previously stated that the alteration of the implant surface during cleansing may attenuate biocompatibility [29]. However, several clinical studies revealed the considerable treatment effect even though there was certain expected damage on the implant surface [7, 34]. Therefore, it is assumed that the most important consideration for treating peri-implantitis in the clinical setting s...
Regarding the air abrasives, the cleansing effect in the SEM analysis was also as considerable as that achieved by the ultrasonic scaler in the present study, in contrast to the results of the aforementioned study. Louropoulou et al. [29] also stated in their systematic review that an air-powder abrasive system with sodium bicarbonate powder could cleanse contaminated rough/smooth implant surfaces...
Based on the results of the SEM qualitative analysis, gauze soaked in saline and the rotary stainless steel instrument consistently showed good cleansability on rough and machined surface implants compared with the other methods. Conversely, the Er:YAG laser showed inferior cleansability to all other methods especially on rough surface implants. The ultrasonic scaler and air abrasive exhibited fai...
This study was performed following an ex vivo design to overcome the drawbacks of previous studies. One particular difference in this study was the use of a commercially available screw-shaped implant. As the implant shape and design have rather complicated macro- and microstructures compared with titanium disks or different forms of titanium commonly used in experimental studies, previous results...
During the experiment, three participants experienced small ulcers caused by the implants carried on the splints; however, it did not affect their daily life. Additionally, there were no signs of gingival inflammation in any participant.
G and Rot achieved relatively clean implant surfaces compared with Las in micro- and macrothread areas. US and Air demonstrated fair cleansability in microthread...
The SEM analysis was performed as previously described [16,17,18]. The decontaminated implant samples were fixed with 2% glutaraldehyde-RPMI 1640 immediately for 1 h at room temperature and washed with distilled water. Then, the samples were dehydrated with 100% t-butyl alcohol and freeze-dried. Finally, the samples were coated with platinum and examined using an emission-scanning electron micro...
Eleven participants, nine men and two women between 28 and 42 years of age (mean age 31.3 ± 4.6), were recruited as the study subjects. All participants provided informed consent verbally. Study information was disseminated to participants both verbally and in written form. The inclusion criteria were as follows:
Generally healthy subjects
Dentate subjects without ill-fitting restorations (...
Dental implants are now used broadly for recovering loss of masticatory function and esthetics. Although it has been revealed that dental implants can often survive long term, biological and mechanical complications may arise. Recent cross-sectional and retrospective studies noted a higher prevalence of peri-implantitis at the implant and subject level than previously considered [1,2,3,4]. Additio...
To evaluate the effect of several representative decontamination methods of oral biofilms on different implant surfaces.
Eleven 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 sur...
Fig. 1. Flow diagram
Fig. 1. Flow diagram
Outcome variable
Crude modela
β (95% CI)
p value
Adjusted modelb
β (95% CI)
p-value
% Sites BoP
...
Â
Control
Test
T0 (n = 22)
T3 (n = 20)
T0 (n = 31)
T3 (n = 30)
...
N = 47a
Total anaerobic bacterial load
Log-transformed mean (SD)
Â
T0
T3
Difference
β (95% CI)b
p value
Control
...
N = 40a
Total anaerobic bacterial load
Log-transformed mean (SD)
Â
Tpre
Tpost
Difference
β (95% CI)b
p value
...
Characteristics
Control
Test
Number of patients
14
14
...
Hentenaar, D.F.M., De Waal, Y.C.M., Strooker, H. et al. Implant decontamination with phosphoric acid during surgical peri-implantitis treatment: a RCT.
Int J Implant Dent 3, 33 (2017). https://doi.org/10.1186/s40729-017-0091-5
Download citation
Received: 28 March 2017
Accepted: 22 June 2017
Published: 17 July 2017
DOI: https://doi.org/10.1186/s40729-017-0091-5
Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were...
Diederik F. M. Hentenaar, Yvonne C. M. de Waal, Hans Strooker, Henny J. A. Meijer, Arie-Jan van Winkelhoff, and Gerry M. Raghoe declare that they have no competing interests.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Correspondence to
Gerry M. Raghoebar.
Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, PO Box 30.001, 9700 RB, Groningen, The Netherlands
Diederik F. M. Hentenaar, Henny J. A. Meijer & Gerry M. Raghoebar
Center for Dentistry and Oral Hygiene, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
Yvonne C. M. De Waal, Hans Strooker, He...
Van Winkelhoff AJ, van Steenbergen TJ, Kippuw N, De Graaff J. Further characterization of Bacteroides endodontalis, an asaccharolytic black-pigmented Bacteroides species from the oral cavity. J Clin Microbiol. 1985;22:75–9.
Zambon JJ. Periodontal diseases: microbial factors. Ann Periodontol. 1996;1:879–925.
Héritier M. Effects of phosphoric acid on root dentin surface. A scanning and transm...
Htet M, Madi M, Zakaria O, Miyahara T, Xin W, Lin Z, Aoki K, Kasugai S. Decontamination of anodized implant surface with different modalities for peri-implantitis treatment: lasers and mechanical debridement with citric acid. J Periodontol. 2016;87:953–61.
Mouhyi J, Sennerby L, Van Reck J. The soft tissue response to contaminated and cleaned titanium surfaces using CO2 laser, citric acid and hy...
Esposito M, Grusovin MG, Worthington HV. Treatment of peri-implantitis: what interventions are effective? A Cochrane systematic review. Eur J Oral Implantol. 2012;5:21–41.
Louropoulou A, Slot DE, Van der Weijden F. The effects of mechanical instruments on contaminated titanium dental implant surfaces: a systematic review. Clin Oral Implants Res. 2014;25:1149–60.
Ramanauskaite A, Daugela P, F...
Lang NP, Berglundh T, Working Group 4 of Seventh European Workshop on Periodontology. Periimplant diseases: where are we now?—Consensus of the Seventh European Workshop on Periodontology. J Clin Periodontol. 2011;38(Suppl):11,178–181.
Derks J, Tomasi C. Peri-implant health and disease. A systematic review of current epidemiology. J Clin Periodontol. 2015;42:158–71.
Derks J, Schaller D, HÃ¥...
Gerry Raghoebar
Diederik Hentenaar
Yvonne de Waal
Implant surface decontamination is considered a highly susceptible step in the treatment of peri-implantitis. The application of 35% phosphoric acid after mechanical debridement is superior to mechanical debridement combined with sterile saline rinsing for decontamination of the implant surface during surgical peri-implantitis treatment. However, phosphoric acid as implant surface decontaminant do...
Recent studies that zoom in on titanium surface physico-chemistry reveal interesting results [38, 39]. Kotsakis et al. [38] hypothesized that chemical residues alter the titanium surface physicochemistry and subsequently compromise cellular response to these decontaminated surfaces. However, they report on effective restoring of biocompatibility when sterile saline, citric acid, and EDTA/sodium hy...
Phosphoric acid gel as agent for implant surface decontamination has only been investigated in two other clinical studies [26, 27]. Strooker et al. [26] used phosphoric acid 35% for peri-implant supportive therapy and found greater reductions in bacterial load, but no significant clinical differences compared to conventional mechanical supportive therapy. They concluded that local application of 3...
This randomized controlled trial aimed to determine the effect of 35% phosphoric etching gel on decontamination of the implant surface during resective surgical treatment of peri-implantitis. Both decontamination procedures (mechanical debridement with curettes and gauzes combined with phosphoric acid 35% and mechanical debridement combined with sterile saline) resulted in a significant immediate ...
The progress of patients throughout the different phases of the study is illustrated in Fig. 1. Table 1 depicts the baseline demographic patient and implant characteristics. The included patients had a total of 128 implants of which 53 implants showed signs of peri-implantitis. Different implant brands and types with different implant surfaces were present, including Straumann (Straumann AG, Bas...
Angular bony defects were eliminated, and bone was recontoured using a rotating round bur under saline irrigation. Mucosal flaps were apically positioned and firmly sutured (Vicryl Plus® 3-0; Ethicon Inc., Somerville, NJ, USA), and suprastructures were re-positioned. For both control and test group, surgery was followed by 2 weeks of mouth rinsing with 0.12% CHX + 0.05% CPC without alcohol t...
Implant mobility;
Implants at which no position could be identified where proper probing measurements could be performed;
Previous surgical treatment of the peri-implantitis lesions.
The study protocol was based on the study protocols of two previous studies evaluating the decontaminating effect of chlorhexidine during surgical peri-implantitis treatment [10, 32] and is briefly described below....
The present study is a double-blind randomized controlled trial evaluating the effect of 35% phosphoric etching gel (test group) compared to the effect of saline (control group) for implant surface decontamination combined with mechanical debridement during surgical peri-implantitis treatment. Patients were randomly assigned to the test or control group using a one-to-one allocation ratio. The stu...
Thus far, the use of phosphoric acid etching gel as decontaminating agent has not been evaluated in a randomized controlled trial. The aim of the present randomized controlled trial is to evaluate the short-term microbiological and clinical effectiveness of 35% phosphoric etching gel as a decontaminating agent of the implant surface during resective surgical treatment of peri-implantitis.
Triggered host defense responses initiate inflammation of the peri-implant soft tissue (peri-implant mucositis), which can lead to loss of peri-implant supporting bone (peri-implantitis), and eventually, result in implant failure [1]. An increasing prevalence of peri-implantitis has been described in recent literature [2], with current incidence ranging from 1 to 47%. A non-linear, accelerating pa...
Peri-implantitis is known as an infectious disease that affects the peri-implant soft and hard tissue. Today, scientific literature provides very little evidence for an effective intervention protocol for treatment of peri-implantitis. The aim of the present randomized controlled trial is to evaluate the microbiological and clinical effectiveness of phosphoric acid as a decontaminating agent of th...
Figure 1. Flow diagram
Figure 1. Flow diagram
Table 5 Average differences in BoP, SoP, and PPD between the control and test group at 3-month follow-up
Outcome variable
Crude modelaβ (95% CI)
p value
Adjusted modelbβ (95% CI)
p-value
% Sites BoP% Sites SoPMean PPD
16.2 (−7.9 to 40.3)0.0 (−10.9 to 10.9)0.6 (−0.6 to 1.8)
0.7431.0000.205
7.9 (−16.4 to 32.3)0.7 (−10.1 to 11.4)0.2 (−1.0 to 1.3)
0.8210.882...
Table 4 Descriptive statistics of clinical parameters
Â
Â
Control
Test
T0 (n = 22)
T3 (n = 20)
T0 (n = 31)
T3 (n = 30)
Plaque
% of sites (SD)% of implants (n)
4.5 (12.5)13.6 (3)
10.0 (18.8)25.0 (5)
4.0 (9.3)16.1 (5)
2.5 (7.6)9.7 (3)
BoP
% of sites (SD)% of implants (n)
86.4 (18.5)100 (22)
28.8 (35.6)50 (10)
66.1 (29.3)96.8 (30)
39.2 (31.3...
Table 3 Log-transformed mean bacterial anaerobic counts (SD) for the control and test group before (T0) and 3Â months after (T3) the surgical treatment (paperpoint samples)
N = 47a
Total anaerobic bacterial loadLog-transformed mean (SD)
Â
T0
T3
Difference
β (95% CI)b
p value
Control
6.69 (1.32)
6.31 (1.30)
0.38 (1.36)
−0.26 (−0.84–0.33)
0.377
...
Table 2 Log-transformed mean bacterial anaerobic counts (SD) of culture-positive implants for the control and test group before (Tpre) and after (Tpost) debridement and decontamination of the implant surface (intra-operative microbrush samples)
N = 40a
Total anaerobic bacterial loadLog-transformed mean (SD)
Â
Tpre
Tpost
Difference
β (95% CI)b
p value
Control
5.57 ...
Table 1 Characteristics of included patients/implants
Characteristics
Control
Test
Number of patients
14
14
Age (years; mean [SD])
57.0 (13.7)
60.9 (7.2)
Gender; M (male), F (female)
M5, F9
M7, F7
Smoking; n subjects (%)
1 (7%)
3 (21%)
History of periodontitis; n subjects (%)
4 (29%)
5 (36%)
Dental status; n subjects (%)
- Partially edentul...
References
Lang NP, Berglundh T, Working Group 4 of Seventh European Workshop on Periodontology. Periimplant diseases: where are we now?—Consensus of the Seventh European Workshop on Periodontology. J Clin Periodontol. 2011;38(Suppl):11,178–181.
Derks J, Tomasi C. Peri-implant health and disease. A systematic review of current epidemiology. J Clin Periodontol. 2015;42:158–71.
Derks ...
The residual biofilm area was significantly greater after treatment with phosphoric acid compared to air abrasive treatment with powder or even control treatment without powder. Apparently, only water and air might be effective in reducing the biofilm. Nonetheless, when the titanium surface was viewed under a scanning electron microscopy (SEM), no visible titanium surface change was seen aft...
A gel as application mode has the great advantage of being precisely applicable with minimal touching of the surrounding bone or connective tissue. A disadvantage of a gel might be the limited flow in deeper areas of the rough implant surface. To overcome this problem, it was decided to continuously rub the etching gel onto the implant surface with a small brush during the decontamination pe...
Discussion
This randomized controlled trial aimed to determine the effect of 35% phosphoric etching gel on decontamination of the implant surface during resective surgical treatment of peri-implantitis. Both decontamination procedures (mechanical debridement with curettes and gauzes combined with phosphoric acid 35% and mechanical debridement combined with sterile saline) resulted in a sign...
Clinical outcomes
Descriptive statistics of the clinical outcomes at baseline and follow-up are depicted in Table 4. At 3-month follow-up, 75% of the implants (66.7% of the patients) in the control group and 63.3% of the implants (53.8% of the patients) in the test group showed no clinical signs of inflammation (PPD ≤4 mm without bleeding and/or suppuration on probing) (Table 4). The results...
Results
The progress of patients throughout the different phases of the study is illustrated in Fig. 1. Table 1 depicts the baseline demographic patient and implant characteristics. The included patients had a total of 128 implants of which 53 implants showed signs of peri-implantitis. Different implant brands and types with different implant surfaces were present, including Straumann (Strauman...
Assuming a two-sided two sample t test with a significance level (α) of 0.05 and a power (β) of 80% required a sample size of 34 implants. A 20% compensation for dropouts was taken into account (34/0.8 = 42.5 implants). Based on a previous study [10], it was expected that not all baseline microbiological samples would yield a detectable number of cultivable bacteria ([10], 19 out of 79 =...
Peri-implant pocket depth was measured at four sites per implant (mesial, buccal, distal, and lingual) using a pressure sensitive probe (KerrHawe Click Probe®, Bioggo, Switzerland) (probe force of 0.25 N). Bleeding and suppuration were scored up to 30s after pocket probing. Microbiological peri-implant sulcus samples were collected from each implant with peri-implantitis using four sterile paper...
Angular bony defects were eliminated, and bone was recontoured using a rotating round bur under saline irrigation. Mucosal flaps were apically positioned and firmly sutured (Vicryl Plus® 3-0; Ethicon Inc., Somerville, NJ, USA), and suprastructures were re-positioned. For both control and test group, surgery was followed by 2 weeks of mouth rinsing with 0.12% CHX + 0.05% CPC without alcohol t...
Interventions
The study protocol was based on the study protocols of two previous studies evaluating the decontaminating effect of chlorhexidine during surgical peri-implantitis treatment [10, 32] and is briefly described below.
Within 1Â month before surgical treatment, all patients received extensive oral hygiene instructions and mechanical non-surgical debridement of implants and remaining de...
Methods
Trial design
The present study is a double-blind randomized controlled trial evaluating the effect of 35% phosphoric etching gel (test group) compared to the effect of saline (control group) for implant surface decontamination combined with mechanical debridement during surgical peri-implantitis treatment. Patients were randomly assigned to the test or control group using a one-to-one al...
Background
Triggered host defense responses initiate inflammation of the peri-implant soft tissue (peri-implant mucositis), which can lead to loss of peri-implant supporting bone (peri-implantitis), and eventually, result in implant failure [1]. An increasing prevalence of peri-implantitis has been described in recent literature [2], with current incidence ranging from 1 to 47%. A non-linear, acc...
Implant decontamination with phosphoric acid during surgical peri-implantitis treatment: a RCT
Abstract
Background
Peri-implantitis is known as an infectious disease that affects the peri-implant soft and hard tissue. Today, scientific literature provides very little evidence for an effective intervention protocol for treatment of peri-implantitis. The aim of the present randomized controlled t...
Table 3 Quantitative analysis of CFU counts (× 105) from rough and machined surface implants after cleansing by each method
Â
Rough surface
Cont
G
US
Air
Rot
Las
Median
137.5
3.4
46.5
13.0
4.8
16.3
Min
73.0
0.3
6.8
0.5
0.6
3.0
Max
785.0
27.0
240.0
35.5
37.0
34.0
Machine surface
Cont
G
US
Air
Rot
Las
Median
84.5
0.9
8.5
3.2
3.3
...
Table 2 Qualitative evaluation by SEM analysis of micro- and macrothread areas of machined surface implants
Â
Machined surface (microthread)
No effect
Fair
Good
Excellent
G
Â
Â
Â
+
US
Â
Â
+
Â
Air
Â
Â
+
Â
Rot
Â
Â
Â
+
Las
Â
+
Â
Â
Machined surface (macrothread)
No effect
Fair
Good
Excellent
G
Â
Â
Â
+
US...
Table 1 Qualitative evaluation by SEM analysis of micro- and macrothread areas of rough surface implants
Â
Rough surface (microthread)
No effect
Fair
Good
Excellent
G
Â
Â
+
Â
US
Â
+
Â
Â
Air
Â
+
Â
Â
Rot
Â
Â
+
Â
Las
+
Â
Â
Â
Rough surface (macrothread)
No effect
Fair
Good
Excellent
G
Â
Â
+
Â
US
Â
Â
...
Â
Figure 6. Comparison of cleansability of each decontamination method on the different implant surfaces. Asterisk indicates p < 0.05
Â
Figure 5. Quantitative analysis of CFU counts on rough and machined surface implants after cleansing by each method. Asterisk represents vs Cont; a, vs G; b, vs US; c, vs Air; d, vs Rot; e, vs Las which indicates p < 0.05
Figure 4. SEM analysis of 4 areas. 1 Rough surface—microthread area. 2 Rough surface—macrothread area. 3 Machined surface—microthread area. 4 Machined surface—macrothread area
Â
Figure 3. Decontamination methods. a Gauze soaked in saline applied using a sawing motion. b Ultrasonic scaler (SUPRASSON P-MAX, Satelec-Acteon group, Bordeaux, France, power setting: P5, tip: Implant Protect IP3L/R). c Air abrasives (AIR-FLOW MASTER PIEZON®, EMS, Nyon, Switzerland, power setting: water flow 100%, air pressure 75%, powder: AIR-FLOW® PERIO POWDER, nozzle: PERIO-FLOW®...
Figure 2. GC Aadva® implant; 3.3-mm diameter, 8-mm length
Surface characteristics
Through SEM analysis and CFU counts, it was demonstrated that, except for the Er:YAG laser, decontamination of the machined surface implant was easier than that of the rough surface implant regardless of decontamination method. Gauze soaked in saline and the ultrasonic scaler demonstrated a statistically significant difference in CFU counts between the two surfaces. ...
Our results are also in accordance with their results in terms of the high cleansability of the rotary metal instrument. In addition, the cotton pellet showed moderate cleansability among the tested methods, but the cleansing time for the cotton pellet (60 s) was shorter than that of the titanium brush with (120 s + 60 s)/without (120 s) photodynamic therapy. If adjusting the d...
Charalampakis et al. examined the effectiveness of mechanical and chemical decontamination methods using titanium disks contaminated intraorally. They employed four decontamination methods: gauze in saline, chlorhexidine, delmopinol, and an essential oil mixture. The authors discovered there was no significant difference in CFU counts among the four methods. In the present study, our findin...
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 significantl...
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 significantl...
Regarding the air abrasives, the cleansing effect in the SEM analysis was also as considerable as that achieved by the ultrasonic scaler in the present study, in contrast to the results of the aforementioned study. Louropoulou et al. also stated in their systematic review that an air-powder abrasive system with sodium bicarbonate powder could cleanse contaminated rough/smooth implant surface...
The SEM analysis demonstrated that three different rough surface disks harbored complex and firmly attached biofilms after gauze scrubbing irrespective of which antiseptic or saline was used.
However, the disks with a turned surface hosted fewer biofilm clusters after scrubbing. This finding is in line with our result showing the better cleansability of gauze soaked in saline on the m...
Augthun et al. examined the cultivability of mouse fibroblasts after cleansing machined or plasma-splayed surface implants carried on acrylic plates that had been contaminated with supragingival plaque from individuals. A plastic hand scaler and an air-abrasive system with sodium bicarbonate powder were employed in their study. A similar number of viable fibroblasts were observed after clean...
Discussion
Study design
This study was performed following an ex vivo design to overcome the drawbacks of previous studies. One particular difference in this study was the use of a commercially available screw-shaped implant. As the implant shape and design have rather complicated macro- and microstructures compared with titanium disks or different forms of titanium commonly used in experi...
Results
Complications
During the experiment, three participants experienced small ulcers caused by the implants carried on the splints; however, it did not affect their daily life. Additionally, there were no signs of gingival inflammation in any participant.
SEM analysis (Fig 4, Tables 1 and 2)
Rough surface implants
G and Rot achieved relatively clean implant surfaces compared with Las in...
This study protocol was approved by the ethical committee of Osaka University (H26.E-36).
SEM analysis
The SEM analysis was performed as previously described. The decontaminated implant samples were fixed with 2% glutaraldehyde-RPMI 1640 immediately for 1 h at room temperature and washed with distilled water. Then, the samples were dehydrated with 100% t-butyl alcohol and freeze-dried. Finall...
At the end of the 4-day experimental period, the implants were carefully removed from the splints by breaking the resin caps that held them in place. Each implant was randomly assigned to a treatment method (Cont, control (no decontamination); G, gauze soaked in saline; US, ultrasonic scaler (SUPRASSON P-MAX, Satelec-Acteon Group, Bordeaux, France; power setting: P5, tip: Implant Protect IP3L/R); ...
Materials and methods
Study subjects
Eleven participants, nine men and two women between 28 and 42 years of age (mean age 31.3 ± 4.6), were recruited as the study subjects. All participants provided informed consent verbally. Study information was disseminated to participants both verbally and in written form. The inclusion criteria were as follows:
Generally healthy subjects
Dent...
Background
Dental implants are now used broadly for recovering loss of masticatory function and esthetics. Although it has been revealed that dental implants can often survive long term, biological and mechanical complications may arise. Recent cross-sectional and retrospective studies noted a higher prevalence of peri-implantitis at the implant and subject level than previously considered. Add...
Abstract
Background
To evaluate the effect of several representative decontamination methods of oral biofilms on different implant surfaces.
Material and methods
Eleven 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 ti...
Figure 3. Representative SEM images of healing abutments after electrolysis of different charges and currents for 10 V and 5 min (all images × 1000 magnification)
Â
Figure 3. Representative SEM images of healing abutments after electrolysis of different charges and currents for 10 V and 5 min (all images × 1000 magnification)
Figure 2. Microscopical images of the healing abutments after the electrochemical treatments under different currents at constant 10 V with different electrodes. The healing abutments were stained with phloxine B after electrolysis. Images from side (a, c, e, g, i, k) and from top (b, d, f, h, j, l). a, b 1 A group I. c, d 1.5 A group I. e, f 1 A group II. g, h 1.5 A group II. i, j 1 A...
Figure 1. The amount of residual contamination after electrochemical treatments under different charges and currents at constant 10 V. Mean ± SD (n = 5). *P < 0.05, **P < 0.01, ***P < 0.005
Figure 1. The amount of residual contamination after electrochemical treatments under different charges and currents at constant 10 V. Mean ± SD (n = 5). *P < 0.05, **P < 0.01, ***P < 0.005
Table 3. Composition (%wt) of the surface of the healing abutment analyzed with EDS. Mean of 5 samples was presented
Groups
Charges and currents
Titanium
Carbon
Others
I
+ 0.5 A
24.77
75.23
-
− 0.5 A
35.13
64.87
-
+ 1 A
62.82
37.18
-
− 1 A
84.10
15.90
-
+ 1.5 A
63.86
36.14
-
− 1.5 A
81.71
18.29
-
II
...
Â
Mean roughness score of 4 SEM images per electrolysis of different charges and currents
Mean all examiners
P value compared to Control
Ex 1
Ex 2
Ex 3
Control
2.00 ± 0.00
2.00 ± 0.00
2.00 ± 0.00
2.00 ± 0.00
-
− 1 A, group I
4.00 ± 0.00
3.00 ± 0.00
3.25 ± 0.50
3.42 ± 0.17
*
− 1.5 A, group I
4.00 ± 0.00
3.75 ± 0.50
4.00 ± 0.00
...
Table 1 pH after electrolysis. pH was measured after electrolysis for 5 min under different charges and current at constant 10 V. pH of original electrolyte, 7.5% NaHCO3, before electrolysis was 7.8
Charges and currents
Group I
Group II
Group III
−, 0.5 A
7.91
7.92
7.94
+, 0.5 A
7.02
7.03
7.02
−, 1 A
7.94
8.02
8.01
+, 1 A
6.6
6.2
7.72
...
Although EDS analysis was performed in three areas on each sample, the atomic percentage of carbon on the contaminated area was higher than that on the clean area and the atomic percentage of titanium was lower on the contaminated areas than on the clean area except cathodic potential 1 A and 1.5 A in group III. The possible sources of carbon conta...
According to the previous studies, complete killing of bacteria was seen at anode with low current. However, in this study, complete removal of contaminant was seen in electrolysis after cathodic potential 1 A and 1.5 A in group III. This complete removing action can be attributed to the alkaline environment generated at cathodic potential. Moreover, decrease in electro...
However, copper deposition was formed on the sample after electrolysis of anodic potential in group II. It is believed that anodic current was preferentially supplied by the electrolysis of water, which occurred on the surface of the sample because deposition attained electroconductivity. Thus, it was confirmed that copper could be incorporated into the titanium surface sample, t...
Previous studies also pointed out that low direct current can kill oral bacteria forming in biofilm. Although charging the implant surface with current can kill the bacteria, organic residues still remain adhering on the surface. Infected implants present carbon-based contaminants and considerable changes in titanium surfaces composition even after sterilization. This could be the reas...
Therefore, in this study, phloxine B staining was used to detect residual contamination on the surface of the healing abutments.
Previous studies also pointed out that low direct current can kill oral bacteria forming in biofilm. Although charging the implant surface with current can kill the bacteria, organic residues still remain adhering on the surface. Infected implants present carbon-based c...
Discussion
The current study showed that electrolysis could be an effective means to decontaminate the healing abutment surfaces with complete removal of contaminants without any surface changes at 10 V, 1 A into 5 min, cathodic potential in group III. A minimally invasive approach to remove and disinfect dental implants utilizes the fact that titanium is an electrically conducting me...
Analysis of healing abutment surface roughness after electrolysis
Representative SEM images after electrolysis of two different charges (cathodic and anodic) and two different currents (1 A and 1.5 A) are presented in Fig. 3. The SEM images showed surface modification ranging from smoothening to roughening. The surfaces were between the electrolytic healing abutments and control unused healin...
Results
Analysis of the electrolytes’ pH before and after electrolysis
As shown in Table 1, pH of electrolyte (catholyte) was not changed after electrolysis of different currents. However, the pH decreased after electrolysis of anodic potential of 1 A and 1.5 A in group I and II.
Evaluation of the amount of stained area (contamination) of the healing abutments
The perce...
Ninety healing abutments removed from patients at the Dental Implant Clinic, Dental Hospital, Tokyo Medical and Dental University, were used. As this clinical study is an in vitro experimental study, the university ethical committee decided that ethical approval was not necessary.
These healing abutments were at least for 4 weeks up to 6 weeks in patients’ oral cavities. All the healing abu...
Background
A healing abutment is a small metal cap placed on the dental implant. In dental implant treatment, a healing abutment is first placed on the implant. The top of the healing abutment is exposed in the oral cavity, while its body penetrates the soft mucosal tissue. During the implant treatment, the healing abutment is temporarily removed and replaced into several times until the prosth...
Abstract
Background
To evaluate the effects of electrolysis on cleaning the contaminated healing abutment surface and to detect the optimal condition for cleaning the contaminated healing abutment.
Methods
Ninety healing abutments removed from patients were placed in 1% sodium dodecyl sulfate solution and randomly divided for electrolysis with 7.5% sodium bicarbonate in the following three d...