Cleaning potential of five different methods for peri-implantitis treatment – An in-vitro study

Background

Peri-implant diseases are related to an inflammatory state, caused by dental biofilm. With the increase of dental replacement with implants, peri-implantitis are an emerging failure to face. Nowadays, even after recent recommendations, there are still no consensus on the protocol to adopt. However, it is recognized that cleaning the peri-implant tissues leads to the healing of such pathology. Also, studies have shown that preserving implant surface pattern can be benefit for cells reattachment.

Aim/Hypothesis

To assess cleaning potential of five mostly used techniques in peri-implantitis treatments and to control titanium surface modifications after instrumentation. Hypothesis is that laser is the most effective, and less damaging technique. Air abrasion is supposed to leave powder particles after use.

Material and Methods

Eleven dental implants have been used (Bone Level SLA®, Straumann, AG, CH)- ten have been ink-stained and one has been kept natural for surface control. Each instrument (Er-yag laser, air abrasion with glycine powder, titanium brush, ultra-sonic scale with titanium tip and manual carbon curette) has been tested on two ink-stained implants for 60 seconds, by the same operator, on two sites. For each instrumented zone, three pictures have been taken (before after staining and after instrumentation). Those images were used for colorimetrical analysis in order to estimate removed ink amount. Also, each implant has been analyzed with EDS in order to confirm measures and to explore implant surface's composition. Ink residual amount results were turned into cleaning potential percentage with a rule of three. To evaluate stained titanium surface integrity, and presence of glycine particles, implants have been observed with SEM at 1,500× 3,000× magnification. Finally, roughness profile was done.

Results

The percentage of removed ink, calculated with colorimetrical analysis, is- 82% for Er-yag laser, 65% air abrasion device, 52% titanium brush, 43% ultra-sonic scale, 33% manual carbon curette. This outcome was double checked with EDS analyses. Percentages found are respectively- 86%, 69%, 44%, 31%, 8%. After decontamination and the analysis of both SEM and roughness profile, dental implant surface does not seem to be altered with laser instrumentation and is very few damaged with air abrasion. But it's hardly damaged with titanium brush and ultra-sonic scale. The carbon curette inefficiency in ink removing does not allow to see the titanium surface to control it. No glycine powder particle has been found with air abrasion decontamination.

Conclusion and Clinical Implications

In terms of cleaning potential, air abrasion device is the most efficient but it shows small modifications of the surface. No glycine's powder residue has been found. Laser instrumentation is quite efficient and surface remains unchanged after treatment. Titanium brush and ultra-sonic device are not so efficient and altered implant surface. Carbon curette instrumentation seems to be inefficient. Therefore, air-abrasion and laser are the most suitable methods to use for peri-implantitis.