Titanium particles generated during ultrasonic scaling of implants

Assessing the Impact of Various Decontamination Instruments on Titanium and Zirconia Dental Implants: An In Vitro Study

This study investigates the impact of various instrumentation techniques on material removal and surface changes in titanium (Ti)- and zirconia (Zr) implant discs. Ti- and Zr discs were subjected to standardized experiments using various instruments including airflow, ultrasound, carbide, and diamond burs. Instrumentation was performed for 60 s with continuous automatic motion. Abrasion and changes in surface roughness were assessed using profilometry, while scanning electron microscopy was used to examine morphological changes and particle size. Carbide burs predominantly caused abrasion on Ti discs, while diamond burs caused more abrasion on Zr discs. The Ti discs were more susceptible to surface changes. However, among the materials tested, machined Zr discs treated with diamond burs produced the largest particle. In certain cases, a statistical significance (p < 0.05) was observed between the groups, while in others, there was no considerable difference among the means (p > 0.05). These results highlighted the statistical significance of our findings. These results found diverse alterations in surface characteristics of Ti- and Zr discs due to different instruments, with carbide and diamond burs causing notable effects. The findings highlight the need for a careful balance between promoting healing and minimizing harm during implantoplasty.

Quantity and Size of Titanium Particles Released from Different Mechanical Decontamination Procedures on Titanium Discs: An In Vitro Study

Complications such as peri-implantitis could ultimately affect the survival of a dental implant. The prevention and treatment of peri-implant diseases require managing bacterial biofilm and controlling environmental risks, including the presence of pro-inflammatory titanium (Ti) particles in the peri-implant niche. Objectives included the evaluation of the size and quantity of Ti particles released from moderately roughened Ti surfaces during common mechanical surface decontamination methods. One hundred and forty moderately roughened Ti discs were divided into seven groups (n = 20 per group); six groups received mechanical decontamination procedures (ultrasonic scaling (US) with a metal tip and poly-ether-ketone (PEEK) under low and medium power settings, air-polishing with erythritol powder, and Ti brush), and the control group underwent air-water spray using a dental triplex. The rinsing solution was collected for Ti mass analysis using inductively coupled plasma mass spectrometry (ICPMS), as well as for Ti particle size and count analysis under scanning electron microscopy (SEM) with energy-dispersive spectroscopy (EDS). US metal tip instrumentation generated 34.00 ± 12.54 μg and 34.44 ± 6.08 μg of Ti under low and medium power settings, respectively. This amount of Ti generation was significantly higher than other instrumentation methods. The mean Ti particle size of the US groups ranged from 0.89 ± 0.27 μm to 1.25 ± 0.24 μm. No statistically significant difference was found in the particle size among US groups and Ti brush group (1.05 ± 0.11 μm), except for US with the PEEK tip, where a significantly smaller mean particle diameter was found at the low power setting (0.89 ± 0.27 μm). Mechanical instrumentation can produce Ti particulates and modify the implant surfaces. US using a metal tip generated the highest amount of Ti with smaller Ti size particles compared to all other commonly used mechanical surface instrumentations. The EDS analysis confirmed Ti in PEEK US tips. It can be suggested that deterioration from the PEEK US tip and Ti brush, as observed under SEM, is an additional source of Ti release during Ti surface decontamination.

Evaluation of different debridement strategies for implant-abutment connections: An in vitro study

STATEMENT OF PROBLEM

Technical complications, including abutment fracture, are a clinical reality. After retrieving failed components, re-establishing a reliable implant-abutment connection is essential, but recommendations on how to clean the interface are lacking.

PURPOSE

The purpose of this in vitro study was to evaluate different clinical debridement strategies for removing titanium powder from an implant-abutment interface with regard to their efficacy and associated risk of damaging the interface.

MATERIAL AND METHODS

Specimens (n=5) were assembled from previously cut implant halves, which were then contaminated by placing titanium powder inside the implant-abutment connection. Activated rinsing, airflow, and an ultrasound scaler, as well as combinations thereof, were then used to clean the implant-abutment connections. Both parts of each specimen were rated under a light microscope with respect to contamination and damage. In addition, abutments were placed in intact implants (n=10), which had previously been contaminated and cleaned, to record torque curves and abutment stability. Statistical analysis of ratings was based on Kruskal-Wallis tests and the Nemenyi All Pairs test with single-step P value correction, while abutment stability and torque were analyzed using analysis of variance and Tukey HSD tests (α=.05).

RESULTS

Erythritol as an abrasive medium led to significantly greater contamination than the scaler (P=.002), activated rinsing (P=.021), and airflow with sodium bicarbonate combined with either conventional (P=.002) or activated rinsing (P=.007). Greater damage was also observed with erythritol because of accumulations of the abrasive media, while scratches were seen after scaler application. Airflow using sodium bicarbonate in combination with activated rinsing showed the lowest level of damage (versus scaler P=.030). Using conventional (P=.010) or activated (P=.029) rinsing, airflow treatment led to a significant reduction in contamination. The scaler led to a significant decrease in abutment stability (P=.048), while activated rinsing and the combination of airflow and activated rinsing did not significantly affect abutment stability. Abutments placed in implants previously contaminated and cleaned required greater torque as compared with original implants (versus activated rinsing, P=.009).

CONCLUSIONS

Activated rinsing constituted the best technique for cleaning implant-abutment connections. Cleaning efficiency can be enhanced with airflow using sodium bicarbonate as an abrasive medium.

Impact of Metal Particles Released during Ultrasonic Scaling of Titanium Surfaces on Human Gingival Fibroblasts

PURPOSE

Metal particles found in tissues around dental implants have been proposed to play a pathogenic role in peri-implantitis. Ultrasonic scaling has been suggested as a mechanism by which these particles can be inadvertently released into surrounding tissues. Furthermore, risk factors like diabetes can result in exacerbation of this inflammatory condition. The current study aimed to analyze metal particles released from titanium surfaces during ultrasonic scaling and their impact on pro-inflammatory cytokine production by human gingival fibroblasts.

METHODS

Metal particles generated from ultrasonic scaling of titanium discs using two different tips (metal and poly-etheretherketone tips) were characterized using scanning electron microscopy and elemental analysis. Endotoxin levels and Human gingival fibroblast viability, in the presence commercial and ultrasonically generated particles were determined. Fibroblasts, cultured in high or low glucose growth medium, were incubated with commercial titanium particles or ultrasonically generated particles in the presence or absence of interluekin-1β. Interleukin 6 and interleukin 8 production were then quantified using Enzyme linked immunosorbent assay.

RESULTS

Analysis of particles after scaling of titanium discs showed significant levels of titanium particles. Commercial titanium particles and generated particles had no effect of fibroblast viability. Endotoxin levels of all particles were too low to stimulate HGF cells. IL-1β significantly stimulated IL-6 and IL-8 production. However, commercial, and generated particles generally had no significant effect on IL- 6 and IL-8 production.

CONCLUSION

Our study concluded that particles generated during ultrasonic scaling had no significant effect on viability of HGF cells and cytokine production.

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

Objective

To 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.

Background

Physical decontamination methods commonly used in peri‐implantitis therapy and routine implant maintenance can potentially alter zirconia implant surfaces.

Methods

Acid‐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.

Results

A 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).

Conclusion

TC 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.

Evaluation of Surface Change and Roughness in Implants Lost Due to Peri-Implantitis Using Erbium Laser and Various Methods: An In Vitro Study

The aim of our study was to obtain similar surface properties and elemental composition to virgin implants after debridement of contaminated titanium implant surfaces covered with debris. Erbium-doped:yttrium, aluminum, and garnet (Er:YAG) laser, erbium, chromium-doped:yttrium, scandium, gallium, and garnet (Er,Cr:YSGG) laser, curette, and ultrasonic device were applied to contaminated implant surfaces. Scanning electron microscopy (SEM) images were taken, the elemental profile of the surfaces was evaluated with energy dispersive X-ray spectroscopy (EDX), and the surface roughness was analyzed with profilometry. Twenty-eight failed implants and two virgin implants as control were included in the study. The groups were designed accordingly; titanium curette group, ultrasonic scaler with polyetheretherketone (PEEK) tip, Er: YAG very short pulse laser group (100 μs, 120 mJ/pulse 10 Hz), Er: YAG short-pulse laser group (300 μs, 120 mJ/pulse, 10 Hz), Er: YAG long-pulse laser group (600 μs, 120 mJ/pulse, 10 Hz), Er, Cr: YSGG1 laser group (1 W 10 Hz), Er, Cr: YSGG2 laser group (1.5 W, 30 Hz). In each group, four failed implants were debrided for 120 s. When SEM images and EDX findings and profilometry results were evaluated together, Er: YAG long pulse and ultrasonic groups were found to be the most effective for debridement. Furthermore, the two interventions have shown the closest topography of the sandblasted, large grit, acid-etched implant surface (SLA) as seen on virgin implants.

A micromorphological/microbiological pilot study assessing three methods for the maintenance of the implant patient

OBJECTIVE

The aim of this study was to evaluate and compare the effectiveness of the ultrasonic piezoelectric inserts of EMS Steel Tip A, EMS Peek, and IS-TiP-STS-3E© in reducing peri-implant bacterial load without compromising the surface of implants during professional oral hygiene in the follow-up.

MATERIALS AND METHODS

Thirteen implants were examined (Winsix, Biosafin, Ancona, Italy). The implants were divided into five groups and analyzed with a SEM microscope and microbiological analysis to evaluate the possible modification of structure and the bacterial load reduction.

RESULTS

The control and A, B, and C test groups were initially contaminated in vitro with Streptococcus mutans. Subsequently, the A, B, and C test groups were treated by an only expert operator in standard conditions. Test groups A, B, and C were inoculated for 3 hr and, furthermore, microbiologically analyzed.

CONCLUSION

The gold standard of an implant maintenance is a significant reduction of the bacterial load without becoming aggressive. According to our results, despite the limitations of the study, the authors recommend the least aggressive IS-TiP-STS-3E© , but combined with an antimicrobial agent to reduce the bacterial load, because the IS-TiP-STS-3E© did not show appreciable results versus the EMS Peek in reducing the bacterial load.

Titanium Wear of Dental Implants from Placement, under Loading and Maintenance Protocols

The objective of this review was to analyze the process of wear of implants leading to the shedding of titanium particles into the peri-implant hard and soft tissues. Titanium is considered highly biocompatible with low corrosion and toxicity, but recent studies indicate that this understanding may be misleading as the properties of the material change drastically when titanium nanoparticles (NPs) are shed from implant surfaces. These NPs are immunogenic and are associated with a macrophage-mediated inflammatory response by the host. The literature discussed in this review indicates that titanium NPs may be shed from implant surfaces at the time of implant placement, under loading conditions, and during implant maintenance procedures. We also discuss the significance of the micro-gap at the implant-abutment interface and the effect of size of the titanium particles on their toxicology. These findings are significant as the titanium particles can have adverse effects on local soft and hard tissues surrounding implants, implant health and prognosis, and even the health of systemic tissues and organs.

Changes in the surface topography and element proportion of clinically failed SLA implants after in vitro debridement by different methods

OBJECTIVE

To evaluate the surface topography and element proportion changes in clinically failed implants after different modalities in vitro debridement and to compare the cleaning effect of different method combinations.

MATERIAL AND METHODS

Thirty clinical failed implants were treated by different debridement methods in vitro as follows: Group 1: physiologic saline irrigation; Group 2: glycine powder air polishing; Group 3: glycine powder air polishing + ethylenediaminetetraacetic acid (EDTA); Group 4: polyetheretherketone (PEEK) tip ultrasonic scaling; and Group 5: PEEK tip ultrasonic scaling + EDTA. The relative contaminated area reduction (RCAR), visual analogue scale (VAS, the higher value means, the better cleaning effect) and surface roughness were assessed using scanning electron microscopy (SEM), stereoscopic microscopy (SM) and white light interferometry (WLI). Surface chemistry was determined by energy dispersive spectroscopy (EDS).

RESULTS

Group 4 and Group 5 showed higher RCARs (82.90%, 82.89%), VAS scores (2.61, 2.33) and roughness reductions (-0.85 μm, -1.80 μm). Group 3 attained the highest decrease of C% (carbon, -26.67%), O% (oxygen, -13.71%) and N% (nitrogen, -5.66%), and the highest increase of Ti% (titanium, 49.67%). PEEK remnants were detected on the implant surface of Groups 4 and 5.

CONCLUSION

Within the limitation of the present in vitro design, PEEK tip ultrasonic scaling was more effective in eliminating visible contamination, while glycine powder air polishing combined with EDTA treatment was more conducive to expose the original surface element distribution. Both methods have their own advantages in decontamination, but none of them could reconstruct the surface as the pristine implant.

Assessment of implant surface and instrument insert changes due to instrumentation with different tips for ultrasonic-driven debridement

Background

To assess the changes of implant surfaces of different roughness after instrumentation with ultrasonic-driven scaler tips of different materials.

Methods

Experiments were performed on two moderately rough surfaces (I—Inicell® and II—SLA®), one surface without pre-treatment (III) and one smooth machined surface (IV). Scaler tips made of steel (A), PEEK (B), titanium (C), carbon (D) and resin (E) were used for instrumentation with a standardized pressure of 100 g for ten seconds and under continuous automatic motion. Each combination of scaler tip and implant surface was performed three times on 8 titanium discs. After instrumentation roughness was assessed by profilometry, morphological changes were assessed by scanning electron microscopy, and element distribution on the utmost surface by energy dispersive X-ray spectroscopy.

Results

The surface roughness of discs I and II were significantly reduced by instrumentation with all tips except E. For disc III and IV roughness was enhanced by tip A and C and, only for IV, by tip D. Instrumentation with tips B, D and E left extensive residuals on surface I, II and III. The element analysis of these deposits proved consistent with the elemental composition of the respective tip materials.

Conclusion

All ultrasonic instruments led to microscopic alterations of all types of implants surfaces assessed in the present study. The least change of implant surfaces might result from resin or carbon tips on machined surfaces.

Comparison between four different implant surface debridement methods: an in-vitro experimental study

BACKGROUND

Peri-implantitis treatment is a very challenging topic to discuss. What is certain is that preventive/supportive therapy plays a key-role in peri-implant tissues' health maintenance and non-surgical implant surface mechanical debridement remains one of the solid pillars in the therapeutic pathway. In this perspective, many surface decontaminating methods have been proposed and tested to remove hard and soft bacterial deposits. The aim of this study was to compare four different commonly used non-surgical implant debridement methods in terms of cleaning potential in vitro, using a peri-implant pocket-simulating model.

METHODS

Sixty-four dental implants were ink-stained and placed into a simulated peri-implant pocket. Samples were then divided into four groups and treated with different debridement methods: stainless-steel ultrasonic tip (PS), peek-coated ultrasonic tip (PI), sub-gingival air-polishing with erythritol powder (EHX) and sub-gingival air-polishing with glycine powder (GLY). For each treatment group, half of the samples were treated for 5 seconds and the other half for 45 seconds. High-resolution images were taken using a digital microscope and later analyzed with a light processing software for measuring the cleaned area percentage (ink-free). Two different images were captured for every sample: a first image with the implant positioned perpendicular to the microscope lenses (90°) and a second one with the implant placed with a 45° vertical angulation, with the smooth neck towards the ground. Percentage of removed ink was statistically modelled using a generalized linear mixed model with the implant as a random (clustering) factor.

RESULTS

A paired comparison between all treatments in terms of debridement potential (cleaned area percentage) was performed. In 5s and with 90° sample angulation EHX/PS comparison showed an odds ratio of 2.75 (P<0.001), PI/EHX an OR of 0.20 (P<0.001), GLY/PS an OR of 2.90 (P<0.001), PI/GLY an OR of 0.19 (P<0.001) and PI/PS an OR of 0.56 (P=0.105). With the same sample angulation and 45s treatment time, the OR was 6.97 (P<0.001) for EHX/PS comparison, 0.14 (P<0.001) for PI/EHX comparison, 4.99 (P<0.001) for GLY/PS, 0.19 (P<0.001) for PI/GLY and 0.95 for PI/PS (P =0.989). With 5s of treatment time and 45° sample angulation, EHX/PS comparison shows a 3.19 odds ratio (P<0.001), PI/EHX a 0.14 odds ratio (P<0.001), GLY/PS a 3.06 odds ratio (P<0.001), PI/GLY a 0.15 odds ratio (P<0.001) and PI/PS a 0.46 odds ratio (P=0.017). With the same sample angulation but 45s treatment time, EHX/PS comparison produced an odds ratio of 4.90 (P<0.001), PI/EHX an OR of 0.20 (P<0.001), GLY/PS an OR of 8.74 (P<0.001), PI/GLY an OR of 0.11 (P<0.001) and PI/PS an OR 0.96 of (P =0.996).

CONCLUSIONS

Among the four treatments considered, air-polishing therapy represents the best one in terms of ink removal from the implant surface. Furthermore, increasing the treatment time to 45 seconds, air-polishing resulted considerably more efficient.

Annual review of selected scientific literature: A report of the Committee on Scientific Investigation of the American Academy of Restorative Dentistry

This comprehensive review of the 2019 restorative dental literature is offered to inform busy dentists regarding remarkable publications and noteworthy progress made in the profession. Developed by the Scientific Investigation Committee of the American Academy of Restorative Dentistry, each author brings discipline-specific expertise to 1 of 8 sections of the report: (1) prosthodontics; (2) periodontics, alveolar bone, and peri-implant tissues; (3) implant dentistry; (4) dental materials and therapeutics; (5) occlusion and temporomandibular disorders; (6) sleep-related breathing disorders; (7) oral medicine and oral and maxillofacial surgery; and (8) dental caries and cariology. The report targets important information likely to influence day-to-day dental treatment decisions. Each review is not intended to stand alone but to update interested readers so that they may visit source material when greater detail is desired. As the profession moves toward evidence-based clinical decision-making, an incredible volume of potentially valuable dental literature continues to increase. It is the intention of this review and its authors to provide assistance in negotiating the extensive dental literature published in 2019. It is our hope that readers find this work useful in the clinical management of dental patients.

Zeolite-based catalytic micromotors for enhanced biological and chemical water remediation

The novel zeolite-based micromotors showed rapid and safe elimination of bacteria in a very short time and removed heavy metals efficiently.