Scanning Electron Microscopy Analysis and Energy Dispersion X-ray Microanalysis to Evaluate the Effects of Decontamination Chemicals and Heat Sterilization on Implant Surgical Drills: Zirconia vs. Steel

Background: Drills are an indispensable tool for dental implant surgery. Today, there are ceramic zirconium dioxide and metal alloy drills available. Osteotomy drills are critical instruments since they come in contact with blood and saliva. Furthermore, they are reusable and should be cleaned and sterilized between uses. Depending on the material, sterilizing agents and protocols can alter the surface and sharpness of implant drills. The hypothesis is that cleaning and sterilization procedures can affect the surface structure of the drills and consequently reduce their cutting efficiency. Methods: Eighteen zirconia ceramic drills and eighteen metal alloy drills were evaluated. Within the scope of this study, the drills were not used to prepare implant sites. They were immersed for 10 min in human blood taken from volunteer subjects and then separately exposed to 50 cycles of cleansing with 6% hydrogen peroxide, cold sterilization with glutaraldehyde 2%, and autoclave heat sterilization. Scanning Electron Microscopy (SEM) and energy dispersion X-ray (EDX) microanalysis were conducted before and after each cycle and was used to evaluate the drill surfaces for alterations. Results: After exposure to the cleansing agents used in this study, alterations were seen in the steel drills compared to zirconia. Conclusions: The chemical sterilization products used in this study cause corrosion of the metal drills and reduce their sharpness. It was observed that the cycles of steam sterilization did not affect any of the drills. Zirconia drill surfaces remained stable.

How has the introduction of new bearing surfaces altered the biological reactions to byproducts of wear and modularity?

BACKGROUND

Biological responses to wear debris were largely elucidated in studies focused on conventional ultrahigh-molecular-weight polyethylene (UHMWPE) and some investigations of polymethymethacrylate cement and orthopaedic metals. However, newer bearing couples, in particular metal-on-metal but also ceramic-on-ceramic bearings, may induce different biological reactions.

QUESTIONS/PURPOSES

Does wear debris from the newer bearing surfaces result in different biological responses compared with the known responses observed with conventional metal-on-UHMWPE bearings?

METHODS

A Medline search of articles published after 1996 supplemented by a hand search of reference lists of included studies and relevant conference proceedings was conducted to identify the biological responses to orthopaedic wear debris with a focus on biological responses to wear generated from metal-on-highly crosslinked polyethylene, metal-on-metal, ceramic-on-ceramic, and ceramic-on-polyethylene bearings. Articles were selected using criteria designed to identify reports of wear debris particles and biological responses contributing to prosthesis failure. Case reports and articles focused on either clinical outcomes or tribology were excluded. A total of 83 papers met the criteria and were reviewed in detail.

RESULTS

Biological response to conventional UHMWPE is regulated by the innate immune response. It is clear that the physical properties of debris (size, shape, surface topography) influence biological responses in addition to the chemical composition of the biomaterials. Highly crosslinked UHMWPE particles have the potential to alter, rather than eliminate, the biological response to conventional UHMWPE. Metal wear debris can generate elevated plasma levels of cobalt and chromium ions. These entities can provoke responses that extend to the elicitation of an acquired immune response. Wear generated from ceramic devices is significantly reduced in volume and may provide the impression of an "inert" response, but clinically relevant biological reactions do occur, including granulomatous responses in periprosthetic tissues.

CONCLUSIONS

The material composition of the device, the physical form of the debris, and disease pathophysiology contribute to complex interactions that determine the outcome to all wear debris. Metal debris does appear to increase the complexity of the biological response with the addition of immunological responses (and possibly direct cellular cytotoxicity) to the inflammatory reaction provoked by wear debris in some patients. However, the introduction of highly crosslinked polyethylene and ceramic bearing surfaces shows promising signs of reducing key biological mechanisms in osteolysis.