Abstract
To compare the dental implant surface properties such as mean surface roughness, roughness depth, and the surface loss produced by different prophylactic instrument types. Twenty-four surfaces of twelve dental implants were treated using titanium curettes, titanium-coated curettes, an air abrasion unit, and titanium brushes. The dental implants were inserted partially into a Styrofoam base, exposing one-third to simulate cases of peri-implantitis. The exposed surface was coated with artificial dental calculus (ADC) and divided into four groups for treatment. The arithmetic mean surface roughness (Ra) and the mean roughness depth (Rz) were assessed using the confocal microscope, and the surface loss (SL) area was calculated from the scanning electron microscopic images using an image analysis software. The Ra value varied between 1.08 to 0.29 µm, the Rz value between 10.3 to 70.5 µm, and the mean surface loss area between 154 to 9410 µm2. The One-way ANOVA analysis showed a statistically significant difference between the four groups (P < 0.05). The air abrasion unit showed the highest mean roughness value of 1.08 ± 0.14 µm, mean roughness depth of 70.5 ± 2.21 µm, and a minor surface area loss of 154 ± 132 µm2. In comparison, the titanium brushes showed the least Ra and Rz of 0.29 ± 0.05 µm and 10.3 ± 2.32 µm, respectively, whereas the titanium-coated curettes showed the highest loss of surface area 9410 ± 91.6 µm2. The air abrasion unit was shown to have the least detrimental effect on the implant surface when removing the artificial dental calculus compared to the other three methods.
Similar content being viewed by others
Avoid common mistakes on your manuscript.
1 Introduction
Nonsurgical surface debridement is the gold standard in managing periodontal disease [1]. Unfortunately, there is no gold standard in the decontamination of dental implants. Still, mechanical debridement might have to be combined with surface decontamination treatment to improve the hygiene in the deeper groove of the implants [2, 3]. In patients with periodontitis, the most commonly used method for root surface debridement is using the curettes to remove the calculus and dental plaque. However, when used inadvertently, these stainless-steel curettes produce implant surface irregularities [4, 5] and produce plaque retention and causes initiation or progression of the disease.
In a study by Polizzi and co-workers the complex calculus formed on the surface of the dental implants is shown to be adherent and penetrate the micro irregularities and the grooves of the acid-etched surface of the implant. Removing this residual calculus is a challenge and can result in refractory periodontal disease even after the treatment of the surface of the dental implant [6]. A study [7] on the presence of plaque/calculus and peri-implant health showed that plaque/calculus results more often in patients with an unhealthy peri-implantitis state than in the absence of it. Prophylaxis should aim at controlling persistent hard residue, such as calculus that converts the tooth to a foreign object hampering the attachment of the soft and hard tissues to the surface of the dental implants [6].
One of the most critical problems that can result from the removal of plaque from the surface of the dental implant is the damage to its surface. The loss of the surface oxide layer can result in the corrosion of the metal and impaired attachment of the fibroblasts to the dental implant surface. Hence, a more conducive approach is to treat the implant surface using an instrument that seldom results in surface roughness loss and eradicates the surface biofilm [8]. The survival rate of a moderately rough implant is about 98.4% compared to highly rough and minimally rough that were 96.4% and 97.6%, respectively [9]. In an another review the peri-implant bone loss in minimally rough was less (0.86 mm) in comparison to the moderately rough (1.01 mm) and highly rough surface (1.04 mm) [10].
The primary treatment modalities are surgical or nonsurgical treatment combined with mechanical debridement. Several instruments are used for mechanical debridement such as plastic, metal or ultrasonic scalers, rubber polishers, air-powder abrasive devices, and rotating titanium brushes [11, 12]. A study comparing a plastic curette, implantoplasty using the titanium brushes, and an air-abrasive system showed that these were valid approaches that eliminate the plaque and improves the implant’s biocompatibility [13]. As a commercialized medical instrument, titanium brushes have been used in treating peri-implantitis and have achieved satisfactory results in previous investigations. The advantage of these brushes during decontamination is the access and in turn being effective in smaller thread pitch and thread depth improving their effectiveness. In one of the studies it was notice that Implants with smaller thread pitch and thread depth values appeared to have less residual staining compared to deeper thread pitch. But, these brushes can lead to wearing of the implant with deeper thread depth. On the other hand, the most followed methods for treating peri-implantitis that have shown favorable results as assessed by systematic reviews are air abrasion and the titanium brush [8].
Hence the study aimed to evaluate the efficiency of artificial dental calculus (ADC) removal of four different types of scaling instruments from the surface of dental implants. The objectives of the present study were to compare the complete removal of the artificial dental calculus (ADC) from the surface of a dental implant by different prophylactic methods and to compare and evaluate the surface roughness of the new dental implants created by various types of surface treatment methods.
2 Material and Method
2.1 Materials
Twenty-four surfaces on twelve sandblasted and acid-etched dental implants (MIS narrow-diameter implants) were chosen for this study. Four instruments included were the titanium curette, titanium-coated curette, air abrasion unit (Pyrax®), and Titanium thread Cleaning Brush (Rotobrush—Salvin®). In addition, a styrofoam mandible model base was used for implant stabilization. The model helped provide a firm base during the implant placement.
Before the commencement of the study, SLA-coated implants were inserted into the Styrofoam base up to half of its length, maintaining adequate primary stability and simulated peri-implant disease (Fig. 1a).
2.2 Artificial Dental Calculus (ADC) Application
Each of the exposed surfaces of the dental implant was coated with artificial dental calculus (ADC). The coating was done to submerge the implant threads (Fig. 1a). Artificial dental calculus (ADC) (Nakagyoku, Kyoto 604-0847 Japan) consisting of light grey and dark grey colored powders and a self-curing liquid resin was applied in two coats on the surface of the implant. The amount of ADC was comparable in all the implants, as it covered only the threads.
2.3 Grouping the Dental Implant Surfaces
Twenty-four surfaces of the twelve dental implants were divided into four groups. Surfaces in Group 1 were treated by titanium curettes (Ti), group 2 was treated by titanium nitride coated universal curettes (TiC), group 3 was treated by Air abrasion unit (Ap), and the group 4 was treated by titanium brushes (Tib) (Fig. 2) [14].
2.4 Titanium Curettes (Ti) and Titanium-Coated Curettes (TiC)
The titanium curette was made out of titanium alloy (Medical grade – Ti6-Al4-V) and was designed identical to the universal curette (Columbia 2R-2L). The titanium-coated curette was a coated curette designed out of stainless-steel metal and the coating of 1 – micron thickness of titanium nitride using the cathode arc evaporation PVD technique.
In the titanium curette (Fig. 1b) treatment group, the root surface covered with the artificial calculus was removed using the titanium curettes following the principles of instrumentation as applied to an invitro situation. The strokes were vertical and traversed from the apical to the coronal part of the implant. A single examiner performing the procedure was calibrated such that the force was within (3-4N). In the titanium-coated instruments group, the ADC-covered titanium surface was treated using the titanium-coated curettes (Fig. 1c).
2.5 Air Abrasion Unit (Ap)
In the Air abrasion (Fig. 1d) group, the treatment was done using the air prophy unit. The unit was filled with sodium bicarbonate (particle size of 40–65 µm), the air abrasion unit was held close to the titanium implant surface, and the treatment was done in a zigzag manner in a mesiodistal direction from the apical to the coronal end of the implant.
2.6 Titanium Brush (Tib)
The titanium brush (Rotobrush®) comprises titanium bristles with a central stainless-steel shaft. The brush was fitted to a slow-speed contra-angled handpiece (NSK), which oscillates in a clockwise/counter-clockwise direction. The handpiece was connected to a portable Coreless Micromotor System. The Tib shaft was placed parallel to the implant surface to give the brush adequate contact. It was moved until the required implant surface was free of the artificial calculus. The procedure was performed by a single examiner (Fig. 1e).
2.7 Determination of the Endpoint of the Treatment
All the procedures were done by a single examiner (SK) to minimize the bias. Other examiners visually explored the residual calculus remnants on the surface of the dental implants, and the instrumentation time was kept constant for all the groups. The procedure was followed by applying H2O2 (3% by Vol) using sterile cotton gauze. The surface roughness and the change in the morphology of the dental implants were determined and calculated.
2.8 Measurement of the Surface Roughness and Statistical Analysis
The roughness of the dental implant surface and complete removal of the artificial calculus was assessed using the Scanning electron microscope and surface roughness was evaluated using a Confocal laser scanning microscope (Olympus LEXT OLS4100 Confocal microscope) (Fig. 3). It achieves a 0.12-micron lateral resolution the accuracy of the measurement value is ± 2% all the measurement values were repeatable.
The images of the dental implant surface were checked using the image analysis software (Mountainslab software®) to measure the islands of surface loss.
3 Results
3.1 Determination of the Cleaning Efficacy of the Instruments
The calibrated examiner (SK, MY) determined the complete removal of ADC using visual examination. Examiners considered complete absence of the ADC on the implant surface as effective to maintain the treatment uniformity in all the groups.
3.2 Gross Morphology
The gross morphology under the low magnification of 27× to 30× showed the surface of the implants treated with all four methods. Ti and TiC curettes had residues in the grooves of the threads. The Ap had lesser residue than the other groups (Fig. 4).
3.3 Ultrastructure View
The ultrastructure view at 1000× had regions of surface changes due to the instrumentation. The ultrastructural view shows (Fig. 5) the surface of implants treated with Ti, TiC, and Tib to have more significant regions of loss of the implant surface roughness.
3.4 The Mean Surface Roughness (Ra), the Roughness Depth (Rz), and the Surface Area Loss (SL)
The descriptive group table (Table 1) shows the Ra value to vary between 0.29 to 1.08 µm and the Rz value between 10.3 to 70.5 µm. The mean surface loss area showed variation between 154 and 9410µm2. The homogeneity of variance was checked using Levene’s test (Table 2), and it showed a p > 0.05 for the mean surface roughness and the roughness depth values. Hence, the one-way ANOVA analysis (Fisher’s) was carried out to measure the Mean surface roughness (Ra) and roughness depth (Rz).
3.5 ANOVA Analysis
For the surface area loss (SL), one-way ANOVA (Welch’s) was carried out. The results showed a statistically significant difference between the four groups (P < 0.05) for all three parameters (Table 3).
The air abrasion unit showed the highest mean roughness value of 1.08 ± 0.14 µm (Table 4), a mean roughness depth of 70.5 ± 2.21 µm (Table 5), and a minor surface area loss of 154 ± 132 µm2 (Table 6) (Figs. 6 and 7).
In comparison, the titanium brushes showed the least Ra and Rz of 0.29 ± 0.05 µm and 10.3 ± 2.32 µm, respectively, whereas the titanium-coated curettes showed the highest loss of surface area (SL) 9410 ± 91.6 µm2 (Fig. 8).
3.6 Energy Dispersive X-ray Spectroscopy (EDS)
The elements on the surface of the treated titanium implants were analyzed for the weight percentage of oxygen and titanium elements using energy-dispersive X-ray spectroscopy (EDS). It revealed that the concentration ranged from 54.63% to 11.45% (Fig. 9), and the surface of new implants revealed the weight percentage of Oxygen to be 54.3% (Fig. 10) (Table 7).
But when the titanium element was check on the surface of the treated implant that had the debris/ impurities (in cases of failed implant surface), artificial dental calculus or the material that was left on the surface after air-polishing it was noticed that there was minimal to complete absence of titanium element. On the specified surface of treated implants, the maximum weight percentage of titanium was 2.15%. The weight concentration decreased to even as low as zero percentage (Fig. 11) (Table 7).
4 Discussion
Non-surgical periodontal therapy is aimed at removing dental plaque and calculus from the surfaces of dental structures. Several studies have shown the significance of the rotary, hand, and air abrasives to be significantly effective in treating the surface of the implants and rendering them biocompatible [15]. Dental plaque adhered to the implant surface accounts for the progression of peri-implant mucositis to peri-implantitis [16]. The plaque mineralization occurs and forms the dental calculus. Dental calculus formed on dental implant surfaces presents a challenge for complete removal. The thorough removal of hard & soft deposits from implant surfaces represents the basis for treating peri-implantitis [17]. Many cleaning instruments are available and recommended for personal oral hygiene and professional recall; they include air-polishing abrasive systems, rubber prophy cups with or without abrasives, toothbrushes with soft bristles, interproximal brushes, gauze strips, and plastic or metal scalers [18]. However, during implant surface treatment, the instruments may leave the implant surface more irregular and rougher [19].
Regarding implant roughness, previous in vivo studies have shown that ultrasonic or metallic instruments leave a rough surface and can harbor plaque. In a study by [20], the procedure that increased the roughness of the Ra values was 0.68 to 2.08 Rz 4.68 to 11.92; the unaltered surface had Ra of 0.44–0.57 and Rz 0.42 to 3.46; methods that smoothened the implant surface had Ra of 0.36 to Rz of 2.15 in our study the air-polishing showed a surface roughness (Ra) of 1.08 ± 0.14 µm and Rz of 70.5 ± 2.21 µm similar to the increased roughness value of the surface. The titanium brush used titanium surface had a Ra of 0.29 ± 0.05 µm and Rz 10.3 ± 2.32 µm, identical to the smoothened implant surface. The roughness value following the air abrasion was similar to a study [21] where it showed the value to be 1.31 ± 0.14 µm, and in our research, it was 1.08 ± 0.14 µm. However, the Ti-Brush Ra value was 1.22 ± 0.31, but in our study, the surface was smoother with a Ra value of 0.29 ± 0.05. The air abrasion and the Tib fulfilled the intended objective, and both removed the ADS from the implant surface. Nevertheless, air abrasion provides a biologically acceptable rough surface as it does not interfere much with the implant surface; hence, the surface oxide layer critical for Osseo integration and implant success could be retained [22].
The different material compositions and differing methods for using the cleaning instruments may adversely affect the surface quality of the implant. They could increase plaque and calculus retention and accumulation. They may also contaminate the surface of the titanium implant and could alter the oxide layer, thus increasing the possibility of implant surface corrosion [8]. The oxide layer on the surface of the titanium trans mucosal abutment is thought to be critical for the success of implant restoration. Studies shows that the surface oxygen content of > 5% [23] is biocompatible and can cause migration of the cells that make the surface conducive for Osseo integration. We have noted that the surface showed an oxygen content > 20% in our study. However, the surface of the failed and the surface treated with titanium brush showed similar oxygen content. We have seen the absence of titanium element on the EDS analysis of the surface of the foreign object, indicating a deterrent to the migrating osteoblast seeking a biocompatible titanium element to house itself. There are several studies done [11, 19, 24,25,26] to show that the air-powder polishing caused lesser surface loss compared to other instruments and was similar to our research but the biocompatible appearance of the implant surface after treatment with titanium brush was not identical to the one after air-polishing but resembled that of a failed implant. Hence, removing the implant surface impurities [27, 28] such as debris or calculus, is necessary, but it should be done without compromising the rough surface [23]. Further, there is a need to assess the limit value for the biological contaminants that can cause adverse reaction [29].
In a systematic review [30], the titanium rotary brushes show improvement in the decontamination of titanium implant surfaces. However, the studies only show efficiency by removing plaque-simulated ink but do not describe the detrimental effect on the surface caused by the instruments. Hence, the present study attempted to check the influence of various instruments on the implant surface during the removal of the artificial dental calculus (ADC).
Several limitations must be considered during the interpretation of the presented data of the study. First, the amount of artificial dental calculus deposited could not be quantified. Second, the attachment dynamics of the calculus on the implant surface could not be established which could affect the amount of force required to remove the ADS using different instruments. Third, the access to the site of treatment, since in clinical situation there can be variations in the access to the site where the usage of abutments could hinder the cleaning procedure. These could be overcome by measuring the amount of ADC used, use of atomic force microscopy to determine the attachment dynamics and using a subgingival invitro model. In the present study, more emphasis was given on the amount of calculus that could be removed even though plaque is the etiology and calculus is a predisposing factor. The surface roughness of the dental implants is an essential factor to determine the biocompatibility and osseointegration. If this portion of the dental implant is exposed due to bone loss and gets contaminated by plaque and calculus then it must be treated. The methods used in this study include curettes, rotary, and air abrasion devices; the air abrasion device has been shown to have a minor surface irregularity compared to other treatment methods. Maximum surface loss was observed after using the titanium brush.
Data Availability
This manuscript does not report data generation or analysis.
References
Lindhe J, Westfelt E, Nyman S et al (1984) Long-term effect of surgical/non-surgical treatment of periodontal disease. J Clin Periodontol 11:448–458. https://doi.org/10.1111/j.1600-051X.1984.tb01344.x
Prathapachandran J, Suresh N (2012) Management of peri-implantitis. Dent Res J (Isfahan) 9:516. https://doi.org/10.4103/1735-3327.104867
Machtei EE (2014) Treatment alternatives to negotiate peri-implantitis. Adv Med 2014:1–13. https://doi.org/10.1155/2014/487903
Fox SC, Moriarty JD, Kusy RP (1990) The effects of scaling a titanium implant surface with metal and plastic instruments: an in vitro study. J Periodontol 61:485–490. https://doi.org/10.1902/jop.1990.61.8.485
Mengel R, Buns CE, Mengel C, Flores-de-Jacoby L (1998) An in vitro study of the treatment of implant surfaces with different instruments. Int J Oral Maxillofac Implants 13:91–6
Mombelli A (2019) Maintenance therapy for teeth and implants. Periodontol 2000 79:190–199. https://doi.org/10.1111/prd.12255
Cheung MC, Hopcraft MS, Darby IB (2021) Patient-reported oral hygiene and implant outcomes in general dental practice. Aust Dent J 66:49–60. https://doi.org/10.1111/adj.12806
Louropoulou A, Slot DE, Van der Weijden FA (2012) Titanium surface alterations following the use of different mechanical instruments: a systematic review. Clin Oral Implants Res 23:643–658. https://doi.org/10.1111/j.1600-0501.2011.02208.x
Deporter D, Pharoah M, Yeh S et al (2014) Performance of titanium alloy sintered porous-surfaced (SPS) implants supporting mandibular overdentures during a 20-year prospective study. Clin Oral Implants Res. https://doi.org/10.1111/clr.12043
Doornewaard R, Christiaens V, De Bruyn H et al (2017) Long-term effect of surface roughness and patients’ factors on crestal bone loss at dental implants. A systematic review and meta-analysis. Clin Implant Dent Relat Res 19:372–399. https://doi.org/10.1111/cid.12457
MatsubaRa Leong VHBW, Leong MJL et al (2020) Cleaning potential of different air abrasive powders and their impact on implant surface roughness. Clin Implant Dent Relat Res 22:96–104. https://doi.org/10.1111/cid.12875
Sanz-Martín I, Paeng K, Park H et al (2021) Significance of implant design on the efficacy of different peri-implantitis decontamination protocols. Clin Oral Investig 25:3589–3597. https://doi.org/10.1007/s00784-020-03681-y
Toma S, Lasserre J, Brecx MC, Nyssen-Behets C (2016) In vitro evaluation of peri-implantitis treatment modalities on Saos-2osteoblasts. Clin Oral Implants Res 27:1085–1092. https://doi.org/10.1111/clr.12686
Ramaglia L, di Lauro AE, Morgese F, Squillace A (2006) Profilometric and standard error of the mean analysis of rough implant surfaces treated with different instrumentations. Implant Dent 15:77–82. https://doi.org/10.1097/01.id.0000202425.35072.4e
Madi M, Htet M, Zakaria O et al (2018) Re-osseointegration of dental implants after periimplantitis treatments. Implant Dent 27:101–110. https://doi.org/10.1097/ID.0000000000000712
Orton GS, Steele DL, Wolinsky LE (1989) Dental professional’s role in monitoring and maintenance of tissue-integrated prostheses. Int J Oral Maxillofac Implants 4:305–310
Tonetti MS, Eickholz P, Loos BG et al (2015) Principles in prevention of periodontal diseases. J Clin Periodontol 42:S5–S11. https://doi.org/10.1111/jcpe.12368
Todescan S, Lavigne S, Kelekis-Cholakis A (2012) Guidance for the maintenance care of dental implants: clinical review. J Can Dent Assoc 78:c107
Ronay V, Merlini A, Attin T et al (2017) In vitro cleaning potential of three implant debridement methods. Simulation of the non-surgical approach. Clin Oral Implants Res 28:151–155. https://doi.org/10.1111/clr.12773
Matarasso S, Quaremba G, Coraggio F et al (1996) Maintenance of implants: an in vitro study of titanium implant surface modifications subsequent to the application of different prophylaxis procedures. Clin Oral Implants Res 7:64–72. https://doi.org/10.1034/j.1600-0501.1996.070108.x
Toma S, Behets C, Brecx MC, Lasserre JF (2018) In Vitro Comparison of the efficacy of peri-implantitis treatments on the removal and recolonization of Streptococcus gordonii biofilm on titanium disks. Materials 11:2484. https://doi.org/10.3390/ma11122484
Wennerberg A, Albrektsson T, Chrcanovic B (2018) Long-term clinical outcome of implants with different surface modifications. Eur J Oral Implantol 11(Suppl 1):S123–S136
Huang C-L, Huang K-T, Lee T-M (2023) The biological responses of osteoblasts on titanium: effect of oxygen level and surface roughness. J Formos Med Assoc 122:584–592. https://doi.org/10.1016/j.jfma.2023.01.009
Sahrmann P, Ronay V, Hofer D et al (2015) In vitro cleaning potential of three different implant debridement methods. Clin Oral Implants Res 26:314–319. https://doi.org/10.1111/clr.12322
Moharrami M, Perrotti V, Iaculli F et al (2019) Effects of air abrasive decontamination on titanium surfaces: a systematic review of in vitro studies. Clin Implant Dent Relat Res 21:398–421. https://doi.org/10.1111/cid.12747
Ichioka Y, Derks J, Dahlén G et al (2022) Mechanical removal of biofilm on titanium discs: an in vitro study. J Biomed Mater Res B Appl Biomater 110:1044–1055. https://doi.org/10.1002/jbm.b.34978
Wilson TG, Valderrama P, Burbano M et al (2015) Foreign bodies associated with peri-implantitis human biopsies. J Periodontol 86:9–15. https://doi.org/10.1902/jop.2014.140363
Korsch M, Obst U, Walther W (2014) Cement-associated peri-implantitis: a retrospective clinical observational study of fixed implant-supported restorations using a methacrylate cement. Clin Oral Implants Res 25:797–802. https://doi.org/10.1111/clr.12173
Stricker A, Bergfeldt T, Fretwurst T et al (2022) Impurities in commercial titanium dental implants—a mass and optical emission spectrometry elemental analysis. Dent Mater 38:1395–1403. https://doi.org/10.1016/j.dental.2022.06.028
González FJ, Requena E, Miralles L et al (2021) Adjuvant effect of titanium brushes in peri-implant surgical treatment: a systematic review. Dent J (Basel) 9:84. https://doi.org/10.3390/dj9080084
Funding
Open access funding provided by Manipal Academy of Higher Education, Manipal. Seed Money for Faculty Research: Grant/Award number: 00000074 provided by Manipal Academy of Higher Education, Manipal.
Author information
Authors and Affiliations
Contributions
SK contributed to the conceptualization, project administration and preparation of methodology of this research; Investigations and formal analysis were provided by RB, NLP and SK; Original draft was written by SK, MY, PG and SGB; Review, editing and final approval were done by all the authors.
Corresponding author
Ethics declarations
Competing Interests
The authors have no competing interest.
Ethical Approval
Ethical approval was obtained from the institutional ethics committee (IEC 104–2019).
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
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 in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
About this article
Cite this article
Kumar, S., Yewale, M., Parthasarathi, N.L. et al. Evaluation of the Loss of Surface Roughness Following the Use of Four Different Instruments for Mechanical Debridement of Dental Implants: An In-vitro Pilot Study. J Bio Tribo Corros 10, 77 (2024). https://doi.org/10.1007/s40735-024-00881-x
Received:
Revised:
Accepted:
Published:
DOI: https://doi.org/10.1007/s40735-024-00881-x