In vitro effect of different implant decontamination methods in three intraosseous defect configurations

Combining Glycine Powder Air-Polishing and Ultrasonic Scaling for Bone Regeneration Around Infected Dental Implants

OBJECTIVES

In vitro studies were conducted to evaluate the effectiveness of combining glycine powder air-polishing (AP) and ultrasonic scaling (US) in surgical bone reconstructive therapy for peri-implantitis.

MATERIALS AND METHODS

Twenty clinically failed implants and 60 pristine implants were treated in vitro with AP and/or US by using stainless steel, titanium, or carbon fiber tips. Implant surface topography, contaminant distribution, elemental proportion, and composition were analyzed using scanning electron microscopy and energy-dispersive X-ray spectroscopy.

RESULTS

AP effectively removed bacterial plaques but was unable to eliminate calcified deposits involving calculi and bone fragments. Conversely, US exhibited a high capacity for removing calcified deposits but inevitably altered implant surface topography and the atomic percentages of oxygen (O) and titanium (Ti) regardless of the ultrasonic tip used. AP showed minimal effects on the implant surface and even alleviated the adverse effects of US on the surface topography and the atomic percentages of O, Ti, and even carbon. A sequential protocol involving AP followed by US, with a final AP step, effectively removed contaminants from infected implants while minimally affecting the original surface features.

CONCLUSIONS

The combined application of AP and US in surgical peri-implantitis therapy may be a preferred and effective approach for obtaining bone regeneration around infected dental implants.

Antimicrobial Effect and Cytocompatibility After Using Different Decontamination Methods on Titanium Implant Surfaces: An In Vitro Study

AIM

To evaluate in vitro the antibacterial efficacy and cytocompatibility of different implant-decontamination methods, using both 2D and 3D peri-implant mucosa models.

METHODS

Four decontamination methods [chlorhexidine (CHX), electrolytic treatment (GS), curcumin (CUR), xanthohumol (XN)] were compared in four independent experiments, three with a 2D peri-implant mucosa model on titanium surfaces and another on a 3D peri-implant mucosa model. These decontamination procedures were tested for their antibacterial effect using a multispecies biofilm model with Streptococcus oralis , Actinomyces naeslundii , Veillonella dispar , and Porphyromonas gingivalis for 24 h. Direct cytocompatibility evaluating the impact of the treatments on tissue cells as well as indirect cytocompatibility (colonization of treated implant surfaces by tissue cells) were also tested. Both outcomes were assessed by confocal laser scanning microscopy supported by neural networks.

RESULTS

CHX demonstrated a strong alteration of cytocompatibility and antibacterial effect, but did not remove biofilm biomass. XN and CUR demonstrated antibacterial effect and biofilm removal action, as well as cytocompatibility. GS showed antibacterial capacity with a combination of areas completely clean of biofilm with others in which a non-vital biofilm remained. In the 3D peri-implant mucosa model, XN and CUR showed maintenance of the mucosa integrity after treatment, whereas CHX and GS displayed disruption in the mucosal layers.

CONCLUSIONS

Phytotherapeutics (CUR and XN) were the most cytocompatible substances and showed the largest antimicrobial effect. GS displayed antibiofilm activity with a localized "bubble-shaped effect" and impaired tissue cell morphology and integrity, compromising cytocompatibility, and CHX showed antimicrobial capacity, without reducing biofilm biomass and with altered cytocompatibility.

Efficacy of biofilm decontamination methods of dental implant surfaces: A systematic review of in vitro studies

This systematic review examines the decontamination techniques used to clean titanium (Ti) implant surfaces covered with in vitro bacterial biofilms. The selected studies were gathered from the PubMed and Web of Science databases. These include in vitro studies investigating decontamination methods used to clean Ti implant surfaces coated with bacterial biofilms until January 2024. The determined studies were filtered according to the PRISMA guidelines, and the Science in Risk Assessment and Policy (SciRAP) was used to assess the reporting and methodological quality of the included studies. A total of 634 full-length peer-reviewed articles were identified. After excluding duplicate papers between the databases and screening according to the predefined inclusion and exclusion criteria, 13 studies were included. The decontamination methods investigated included mechanical, chemical, and physical methods, either as a single or in a combined approach. Significant variability was observed among the included studies. Combining the mechanical and physical methods with a chemical yielded the most significant reduction in both single- and multiple-species biofilms. The current results do not indicate that any single decontamination technique is more effective than others in eradicating bacterial biofilm from Ti surfaces; the combined approach was more advantageous than the single ones.

D-arginine-loaded pH-responsive mesoporous silica nanoparticles enhances the efficacy of water jet therapy in decontaminating biofilm-coated titanium surface

Peri-implantitis, caused by bacterial biofilm on dental implants, leads to bone loss and tissue inflammation, ultimately causing oral health decline. Traditional methods to remove biofilm are ineffective in promoting reosseointegration on implant surfaces. This phenomenon can be attributed to two factors: incomplete removal of biofilm from hard-to-reach areas and alterations in the physicochemical properties of implant surfaces caused by decontamination procedures. To address this problem, we developed D-arginine-loaded chitooligosaccharide-capped pH-responsive mesoporous silica nanoparticles (Dar@MSN-COS) for improving the efficacy of decontamination of Water Jet (WJ). Dar@MSN-COS particles exhibit a targeted approach towards the extracellular polymeric substance (EPS) in order to disrupt the biofilm, and possess the capability to infiltrate confined areas between implant screws. Following this, the WJ treatment effectively removed residual biofilm and demonstrated improved cleaning efficacy. Furthermore, the decontamination of the Dar@MSN-COS combination with WJ promotes effective cell cytocompatibility on the titanium surface. The results of mechanistic experiments indicate that Dar@MSN-COS may act on biofilms by releasing a significant quantity of reactive oxygen species (ROS), suggesting it as a key contributing factor. In summary, our novel therapeutic protocol shows promise as an alternative solution for addressing the clinically complex aspects of peri-implantitis.

The Effect of NiTi Brush, Polishing Brush, and Chemical Agent on the Dental Implant Surface Morphology and Cytocompatibility

OBJECTIVES

To in vitro investigate the effect of different implant surface decontamination methods and treatment storing conditions on implant surface morphology and cell viability.

MATERIALS AND METHODS

Titanium disks with a sand-blasted and acid-etched surface (Promote, PRO) were treated with diamond polishing brushes (BRUSH), nickel-titanium brushes (NITI), or phenol and sulfuric acid-gel (GEL). The disks were stored in saline (-S) or left exposed to air overnight (-A). Untreated (PRO) and machined (MACHINED) disks were used as controls. GEL samples were treated for the 60 s, while the operative time was recorded for BRUSH and NITI. The samples were subjected to scanning electron microscopy (SEM), surface roughness measurements, and cell viability (SaOS-2 cells, 7 days) assessment.

RESULTS

The operative time was shorter for NITI than for BRUSH (p = 0.017). The original surface morphology (PRO) was not altered in the GEL group, in contrast with what was observed for BRUSH and NITI. The type of storage did not influence the surface morphology. No significant differences in Sa and Sz were observed among the groups, except for MACHINED, which presented lower Sa values (p < 0.05). Cells were able to proliferate on all surfaces. NITI-S showed significantly higher cell viability compared to all groups (p ≤ 0.001), except for NITI-A and MACHINED. Among the treated groups, only one additional significant difference was found, as NITI-A performed better than GEL-S.

CONCLUSIONS

None of the investigated protocols compromised the cytocompatibility of the titanium dental implant surface. The best results were registered in the NITI group when the samples were stored in saline. Future studies should confirm the effectiveness of the proposed methods in removing bacterial biofilm from contaminated implant surfaces.

In-vitro simulation methods for mechanical plaque removal: a systematic scoping review of current techniques and future directions

BACKGROUND AND OBJECTIVES

Different methods to simulate plaque in order to test the efficacy of oral cleaning methods have been published. This scoping review aims to provide an overview of the existing models and to highlight their respective benefits and limitations.

MATERIAL AND METHODS

Following the recommended scoping review methodology the scientific literature was systematically searched electronically (PubMed and Scopus) and by hand search up to July 2024, using combinations of search items related to oral plaque simulation, periodontitis or peri-implantitis. Retrieved study titles and abstracts were screened for possible inclusion. Finally, data from included fulltexts was extracted by two independent reviewers. Nine different characteristics for proper plaque simulation method were defined and each existing method evaluated and rated accordingly, and an overall rating was calculated for each method.

RESULTS

Initially, 1787 records were identified. After abstract and title screening and fulltext revision, 25 fulltexts describing 7 different simulation methods, were included. The assessed methods of simulation were ink (12), varnish (5), calcium phosphate (1), calcium carbonate (1), occlusal spray (3), aluminum (1), commercially distributed and prepared artificial plaque (2). Even though some materials achieved good results in the assessment for individual criteria like water solubility, big differences could be found concerning practicability and production time, no simulation method was rated "very good" or even "good" in the overall evaluation. While ink and varnish were considered simulation materials of moderate quality for oral plaque simulation, all other techniques were assessed as weak simulation materials.

CONCLUSION

Among the different published methods for the simulation of mechanical plaque removal, none seems to sufficiently simulate the essential characteristics of oral plaque, while some simulation methods may be useful to feature single properties of plaque in in-vitro studies sufficiently. Nevertheless, advanced models reflecting the diverse features of dental plaque more comprehensively are needed.

Periodontal Endoscopy for Mechanical Debridement in the Non-Surgical Management of Peri-Implantitis: A Narrative Review

Background: The aim of the present narrative review is to synthesize the available scientific evidence on the effects of submarginal instrumentation with periodontal endoscopy and evaluate its' potential efficacy in terms of the non-surgical therapy of peri-implantitis. Methods: The literature search was performed via electronic databases, including PubMed, Web of Science, Cochrane, and Scopus, and was supplemented by manual searching. A literature review was conducted addressing the following PICOS questions: (1) What is the efficacy of non-surgical submarginal instrumentation of the implant surface with the aid of a periodontal endoscope in patients with peri-implantitis? (2) What is the efficacy of non-surgical subgingival instrumentation performed with the aid of a periodontal endoscope compared with conventional subgingival instrumentation in patients with periodontitis, in terms of clinical parameters and patient-reported outcomes? Mechanical decontamination of the implant surface is crucial for resolving inflammation and arresting further bone loss. However, there is no consensus on the most effective treatment. Non-surgical therapy remains the initial intervention, focused on biofilm removal to control the disease, although with limited capability to achieve complete disease resolution as the presence of threads and the complex-structured implant surface hinder effective biofilm removal. This evokes the need for providing supporting technologies such as periodontal endoscopy, which enables direct visualization and precision, potentially enhancing the outcomes and reducing the necessity for surgical procedures and their associated risks. Within the limitations of this narrative review, periodontal endoscopy may offer a less tissue-invasive approach. Larger prospective studies and RCTs are needed to confirm these findings and guide clinicians in determining periodontal endoscopy's suitability based on specific case characteristics.

The Decontamination Effect of an Oscillating Chitosan Brush Compared With an Ultrasonic PEEK-Tip: An In Vitro Study Using a Dynamic Biofilm Model

OBJECTIVES

This study aimed to assess the effect of an oscillating chitosan brush (OCB) compared with an ultrasonic device with PEEK tip (US-PEEK) for mechanical implant surface decontamination using an in vitro model combining 3D models and a validated dynamic multispecies biofilm.

MATERIALS AND METHODS

A multispecies biofilm using six bacterial strains (Streptococcus oralis, Veillonella parvula, Actinomyces naeslundii, Fusobacterium nucleatum, Porphyromonas gingivalis, and Aggregatibacter actinomycetemcomitans) was seeded on dental implants with machined and sandblasted, large-grit and acid-etched (SLA) surfaces. These were installed in 3D models depicting peri-implant defect. Mechanical decontamination was performed for 120 s using either an OCB or a US-PEEK. A negative control group received no treatment. Scanning electron microscopy (SEM) was used to evaluate the bacterial composition and quantitative PCR (qPCR) analyzed the number of each bacterial species [colony-forming units per milliliter (CFU/mL)].

RESULTS

Well-structured biofilms with a dense microbial distribution were observed on the negative control implants after 72 h. qPCR following mechanical decontamination showed a scarce bacterial reduction in the OCB group. The US-PEEK group exhibited a significant decrease in bacterial species compared to both OCB and control groups (p < 0.05). A biofilm removal effect was also observed in the OCB group for the machined implant surfaces.

CONCLUSION

In vitro assessment using an anatomical 3D model showed that mechanical decontamination effectively reduced biofilm. The US-PEEK group demonstrated biofilm reduction on the SLA surface, while the OCB group showed a reduction on the machined implant surface. Additionally, the US-PEEK group demonstrated greater efficacy in reducing bacterial numbers.

Residual bone level as a prognostic factor in the surgical treatment of peri-implantitis

Peri-implantitis is a progressive inflammatory disease affecting the tissues surrounding dental implants and leading to bone loss. The severity of this disease is typically classified based on the depth of the bone defect or the percentage of bone loss around the implant. Marginal bone loss is a critical factor in the surgical management of peri-implantitis, as it can complicate access for implant decontamination and hinder efforts to stabilize the condition. In cases where bone loss exceeds 50% of the implant length, explantation is often recommended due to significantly reduced success rates after treatment. This narrative review seeks to examine the scientific evidence on marginal bone loss as a prognostic factor in the surgical treatment of peri-implantitis.

Comprehensive treatment protocol for peri-implantitis: an up-to date narrative review of the literature

This narrative review describes up-to-date treatment options for peri-implantitis and proposes a treatment protocol and flowchart based on the current scientific evidence. Peri-implantitis treatment should be based on the phased treatment protocol for periodontitis, which is a continuous flow of decisions for extraction, nonsurgical and surgical treatments with step-by-step re-evaluation. The protocol's goals are to fulfill the success criteria for peri-implantitis treatment (probing depth of ≤5 mm, and absence of bleeding on probing, suppuration, and progressive bone loss) and to halt disease progression. Fixtures with peri-implantitis can initially be classified as failed or failing. A failed implant needs to be removed. In contrast, nonsurgical and surgical treatments can be applied to a failing implant. Nonsurgical treatment should be the initial treatment for failing implants; however, sole nonsurgical treatment was regarded as inefficient for peri-implantitis. Recent studies have found that the adjunctive use of antibiotics to nonsurgical debridement increased the success of nonsurgical treatment for peri-implantitis. Surgical treatments can be classified into resective, access, and reconstructive surgeries. The technique should be selected according to the patient's bone defect configuration, which relate to regenerative potential. Various combinations of decontamination methods (e.g., mechanical, chemical, and pharmacological approaches) are required to achieve absolute surface decontamination. Clinicians should select an appropriate surface decontamination strategy according to the purpose of surgery. After signs of disease disappear and its progression is halted through active peri-implantitis treatment, it is necessary to enroll patients into maintenance programs. Compliance of patients with the maintenance program reduces the recurrence of peri-implantitis and sustains clinical success after treatment. Maintenance visits should include professional plaque control and hygiene care reinforcement for patients, and their interval should be set according to individual peri-implantitis risk. Clinicians should remind that peri-implantitis treatment is not a single procedure, but rather a continuing cycle of treatment and re-evaluation.

Surgical regenerative methods for peri-implantitis treatment: A systematic review and meta-analysis

Background

The purpose of this study was to review the literature on the efficacy of different surgical regenerative methods for peri-implantitis treatment.

Methods

A preliminary search was conducted in seven electronic databases. The studies included in the analysis implemented surgical regenerative treatment in at least one study group. Baseline and follow-up values for bleeding on probing (BoP), pocket depth (PD), plaque index (PI), bone level (BL), and bone gain (BG) were extracted. The standardized mean difference (SMD) was calculated using Cohen's d or Hedges' g, and a random-effects-restricted maximum likelihood (REML) method was applied for the meta-analysis.

Results

Fifteen studies were included in the qualitative synthesis. The meta-analysis was performed on six studies comparing regenerative techniques that involved bone grafts with those that did not. The overall effect size for using bone grafts at the one-year follow-up was 0.04 (95% CI: -0.26‒0.35; P=0.78) for BoP, -0.08 (95% CI: -0.42‒0.27; P=0.66) for PD, 0.37 (95% CI: 0.08‒0.65; P=0.01) for PI, -0.44 (95% CI: -0.84 to -0.03; P=0.03) for BL, and 0.16 (95% CI: -0.68‒1.01; P=0.70) for BG.

Conclusion

Various materials have been employed for peri-implant defect filling and coverage. A bone substitute did not significantly improve BoP, PD, and BG values, while PI and BL were significantly ameliorated at one-year follow-up. However, recommending a single unified protocol as the most effective for surgical regenerative treatment of peri-implantitis was not feasible.

Efficacy of a novel three-step decontamination protocol for titanium-based dental implants: An in vitro and in vivo study

AIM

The aim of the study was to evaluate several mechanical and chemical decontamination methods associated with a newly introduced biofilm matrix disruption strategy for biofilm cleaning and preservation of implant surface features.

MATERIALS AND METHODS

Titanium (Ti) discs were obtained by additive manufacturing. Polymicrobial biofilm-covered Ti disc surfaces were decontaminated with mechanical [Ti curette, Teflon curette, Ti brush, water-air jet device, and Er:YAG laser] or chemical [iodopovidone (PVPI) 0.2% to disrupt the extracellular matrix, along with amoxicillin; minocycline; tetracycline; H2 O2 3%; chlorhexidine 0.2%; NaOCl 0.95%; hydrocarbon-oxo-borate-based antiseptic] protocols. The optimal in vitro mechanical/chemical protocol was then tested in combination using an in vivo biofilm model with intra-oral devices.

RESULTS

Er:YAG laser treatment displayed optimum surface cleaning by biofilm removal with minimal deleterious damage to the surface, smaller Ti release, good corrosion stability, and improved fibroblast readhesion. NaOCl 0.95% was the most promising agent to reduce in vitro and in vivo biofilms and was even more effective when associated with PVPI 0.2% as a pre-treatment to disrupt the biofilm matrix. The combination of Er:YAG laser followed by PVPI 0.2% plus NaOCl 0.95% promoted efficient decontamination of rough Ti surfaces by disrupting the biofilm matrix and killing remnants of in vivo biofilms formed in the mouth (the only protocol to lead to ~99% biofilm eradication).

CONCLUSION

Er:YAG laser + PVPI 0.2% + NaOCl 0.95% can be a reliable decontamination protocol for Ti surfaces, eliminating microbial biofilms without damaging the implant surface.

Anatomical three-dimensional model with peri-implant defect for in vitro assessment of dental implant decontamination

OBJECTIVES

Access to the implant surface plays a significant role in effective mechanical biofilm removal in peri-implantitis treatment. Mechanical decontamination may also alter the surface topography of the implant, potentially increasing susceptibility to bacterial recolonization. This in vitro study aimed to evaluate a newly developed, anatomically realistic, and adaptable three-dimensional (3D)printed model with a peri-implant bone defect to evaluate the accessibility and changes of dental implant surfaces after mechanical decontamination treatment.

MATERIAL AND METHODS

A split model of an advanced peri-implant bone defect was prepared using 3D printing. The function of the model was tested by mechanical decontamination of the exposed surface of dental implants (Standard Implant Straumann AG) coated with a thin layer of colored occlusion spray. Two different instruments for mechanical decontamination were used. Following decontamination, the implants were removed from the split model and photographed. Image analysis and fluorescence spectroscopy were used to quantify the remaining occlusion spray both in terms of area and total amount, while scanning electron microscopy and optical profilometry were used to analyze alteration in the implant surface morphology.

RESULTS

The 3D model allowed easy placement and removal of the dental implants without disturbing the implant surfaces. Qualitative and quantitative assessment of removal of the occlusion spray revealed differences in the mechanism of action and access to the implant surface between tested instruments. The model permitted surface topography analysis following the decontamination procedure.

CONCLUSION

The developed 3D model allowed a realistic simulation of decontamination of implant surfaces with colored occlusion spray in an advanced peri-implant defect. 3D printing allows easy adaptation of the model in terms of the shape and location of the defect. The model presents a valuable tool for in vitro investigation of the accessibility and changes of the implant surface after mechanical and chemical decontamination.

Diagnosis and Treatment of Periimplant Mucositis and Periimplantitis: An Overview and Related Controversial Issues

Periimplant mucositis and periimplantitis are common complications of dental implant. This article provides a comprehensive overview of the 2017 World Workshop's new definition, clinical and radiographic presentation, pathogenesis, risk factors, and classification of periimplant diseases. Also, the authors discuss various types of instruments, materials, and techniques commonly used for treatment of nonsurgical and surgical periimplantitis. Lastly, the authors include some controversial topics surrounding this subject.

Effect of Air Polishing on the Treatment of Peri-Implant Diseases: A Systematic Review and Meta-Analysis

Peri-implant diseases have become one of the notable biological complications of postrehabilitation with implant-supported restorations. Effective modalities for decontamination of biofilm deposits around implant surfaces are critical for resolution of the inflammation. Air polishing is one of the recommended clinical methods for treating peri-implant diseases. This systematic review assessed clinical evidence on efficacy of using air polishing technology for the management of peri-implant diseases, including peri-implant mucositis and peri-implantitis. Four electronic databases from January 1990 to December 2022 were searched to identify the relative human randomized clinical trials that applied air polishing for nonsurgical and surgical treatment of peri-implant mucositis and peri-implantitis. Twelve articles were selected. For treating peri-implant mucositis, air polishing showed a comparable effect to ultrasonic scaling in the reduction of bleeding on probing (BOP) and probing pocket depth (PPD). The nonsurgical approach of air polishing in treating peri-implantitis varied in the reduction of BOP, PPD, and clinical attachment level (CAL) in evaluated studies. Air polishing in the surgical treatment of peri-implantitis was comparable to mechanical cleaning, implantoplasty, and the use of Ti-brush, in regards to the significant reduction of BOP, PPD, and CAL, as well as the improvement of the bone level between baseline and follow-ups. The standardized mean difference with a 95% confidence interval of the studied parameters was estimated using the random effect model; however, statistical differences were not detected between air polishing and comparative modalities in the treatment of peri-implantitis. Within the limitations of this review, the application of air polishing did not result in more favorable outcomes in the treatment of peri-implant diseases compared to other modalities.

In vitro efficacy of non-surgical and surgical implant surface decontamination methods in three different defect configurations in the presence or absence of a suprastructure

OBJECTIVES

Analysis of the in vitro efficacy of non-surgical and surgical dental implant surface decontamination with or without suprastructure.

MATERIALS AND METHODS

Three hundred and sixty implants were dipped in indelible red and distributed to 30°, 60°, or 90° angulated bone defect models. One hundred and twenty implants were used for each bone defect, 40 of which were assigned to a decontamination method (CUR: curette; SOSC: soundscaler; APA: air powder abrasion). Of these, 20 were subjected to a simulated non-surgical (NST) or surgical treatment (ST), with/without mucosa mask, of which 10 were carried out with (S+) or without (S-) suprastructure. Uncleaned implant surface was assessed by both-sided implant surface photography. Surface morphology changes were analyzed using scanning electron microscopy (SEM).

RESULTS

Cleaning efficacy was significantly better within NST if the suprastructure was removed (p < 0.001). No significant difference was found within ST (p = 0.304). Overall, cleaning efficacy in the order APA > SOSC>CUR decreased significantly (p < 0.0001) for both S+ and S- in NST as well as ST. Separated by NST/ST, S+/S-, defect angulation and decontamination method, only isolated significant differences in cleaning efficacy were present. Linear regression analysis revealed significant associations of remnants with the treatment approach, decontamination method, and defect angle (p < 0.0001). SEM micrographs showed serious surface damage after use of CUR and SOSC.

CONCLUSIONS

Suprastructure removal is an additional option to improve cleaning efficacy of non-surgical implant surface decontamination in this in vitro model.

In-Vitro Biofilm Removal Efficacy Using Water Jet in Combination with Cold Plasma Technology on Dental Titanium Implants

Peri-implantitis-associated inflammation can lead to bone loss and implant failure. Current decontamination measures are ineffective due to the implants' complex geometry and rough surfaces providing niches for microbial biofilms. A modified water jet system (WaterJet) was combined with cold plasma technology (CAP) to achieve superior antimicrobial efficacy compared to cotton gauze treatment. Seven-day-old multi-species-contaminated titanium discs and implants were investigated as model systems. The efficacy of decontamination on implants was determined by rolling the implants over agar and determining colony-forming units supported by scanning electron microscopy image quantification of implant surface features. The inflammatory consequences of mono and combination treatments were investigated with peripheral blood mononuclear cell surface marker expression and chemokine and cytokine release profiles on titanium discs. In addition, titanium discs were assayed using fluorescence microscopy. Cotton gauze was inferior to WaterJet treatment according to all types of analysis. In combination with the antimicrobial effect of CAP, decontamination was improved accordingly. Mono and CAP-combined treatment on titanium surfaces alone did not unleash inflammation. Simultaneously, chemokine and cytokine release was dramatically reduced in samples that had benefited from additional antimicrobial effects through CAP. The combined treatment with WaterJet and CAP potently removed biofilm and disinfected rough titanium implant surfaces. At the same time, non-favorable rendering of the surface structure or its pro-inflammatory potential through CAP was not observed.