The effect of standardised implantoplasty protocol on titanium surface roughness: an in-vitro study

Abstract: To analyse the changes of surface characteristics of machined and moderately roughened titanium disks following a standardised implantoplasty protocol. Forty titanium discs (machined: n = 20; moderately roughened: n = 20) were instrumented with one half of each disc maintained as the control (non-instrumented). The standardised implantoplasty protocol was carried out using a custom jig with the sequential change of burs: 1) Regular grit diamond [10s], 2) Super-fine grit diamond [10s], 3) Brownie(tm) silicone polisher [15s], 4) Greenie(tm) silicone polisher [15s]. Surface topography was analysed using confocal laser scanning microscopy (CLSM) and scanning electron microscopy (SEM). Energy dispersive x-ray spectroscopy (EDS) was used to measure the elemental profiles of each disc. Quantitative analysis showed similar changes in level of roughness between the machined and moderately roughened titanium discs. CLSM demonstrated an increased roughness (Ra and Sa values) after polishing with a regular grit diamond bur when compared to the uninstrumented surfaces. Although the roughness decreased after the further polishing with the super-fine grit diamond bur, subsequent instrumentation using silicon burs tended to increase the roughness, albeit being statistically insignificant. There was a residue of silicon particles despite the irrigation after each polishing stage. The proposed implantoplasty protocol did not achieve a sufficient level of smoothness on the machined or moderately roughened titanium surfaces when compared to the Ra threshold. Further research is recommended to test the efficacy of each bur on titanium surfaces with longer duration using actual oral implants to allow better comparison.

Changes in surface characteristics of moderately roughened grade iv titanium disc following a standardised implantoplasty technique: an in-vitro study

Aim: To analyze the changes in surface characteristics of moderately roughened grade IV titanium discs following a standardized implantoplasty protocol. Materials and Method: Nine moderately roughened titanium discs (ø9.0 mm; 2-mm thickness) with a comparable surface to commercially available oral implants (Southern Implants (Pty) Ltd, Irene, South Africa) were used. One disc was used as a control sample while the remaining 8 discs were modified using a standardized technique. Each disc was divided into 4 sections of which each quadrant was instrumented in the same manner. Regular grit and superfine grit diamond burs were used for 10s each, followed by brown and green silicone burs for 15s respectively. The surface characteristics of all samples were analysed using scanning electron microscopy (SEM), confocal laser scanning microscopy (CLSM), and energy dispersive x-ray spectroscopy (EDS). Results: SEM analysis of the surfaces showed that as the instrumentation progressed from diamond burs to silicone burs, surface irregularities began to diminish. However, using silicone burs tended to increase the amount of surface debris and the roughness still remained significantly higher than the control sample. EDS identified some foreign elements originating from the silicone burs that were used. Conclusion: The proposed standardized implantoplasty protocol did not decrease the roughness of the surface below that of the control disc. The clinical implications of foreign elements remaining on the titanium surfaces need further investigation.

Bacterial colonization of titanium discs: a pilot study for evaluating implant surface deterioration

Background: Bacterial colonization of dental implant surfaces is considered the main aetiological factor in peri-implant diseases. Aim: To devise a protocol that will yield a consistent and viable biofilm on titanium specimens for the purpose of in vitro experimental investigation of microbially-induced surface deterioration and potential peri-implant therapy efficacy. Materials and Methods: Twelve Southern Implants grade 4 titanium discs, six with machined and six with moderately roughened surfaces were used in this study. Six discs were inoculated with Streptococcus oralis and incubated in brain- heart infusion under anaerobic conditions at 37o C 1, 2 and 3-days. Specimen surface characteristics were evaluated by scanning electron microscopy (SEM) and confocal laser scanning microscopy (CLSM). Energy dispersive x-ray analysis quantified the surface elemental composition of the discs. Qualitative and quantitative SEM analyses evaluated colonisation and consistency of biofilm formation. The pH of the media was determined following each incubation period. Results: There were significant differences in surface roughness between machined (Ra = 0.27μm, Sa = 1.01μm) and moderately roughened (Ra = 2.14μm, Sa= 1.34μm) surfaces. SEM revealed widespread surface irregularities (spikes, valleys and grooves) on the moderately roughened surfaces compared to the machined surfaces. pH measurements of the medium indicated an acidic level (pH = 4.4) after an initially neutral value (pH = 7.0). Colonisation of the disc surface was evident after 24 hours as a multilayered biofilm for both titanium surfaces. Conclusions: A protocol capable of yielding a consistent viable biofilm on titanium specimens has been devised. This can be used in future studies to investigate the effect of bacterial accumulation and the efficacy of peri-implant therapy on bacterial colonization on implant surfaces

Effect of a cordless retraction paste on titanium surface: a topographic, chemical and biocompatibility evaluation

Good exposure of the preparation margins and haemostasis in the sulcular gingiva are necessary for accurate impressions to produce precise restorations. The use of cordless retraction paste material in implant dentistry is a relatively novel application. However, few studies have been conducted on the use of retraction pastes and their possible interaction with implant surfaces. Recent literature has described remnants on titanium implant surfaces and expressed the need for an assessment of the biocompatibility of the exposed surface (Chang et al.). This in vitro study evaluated the effect of a cordless gingival retraction paste on sterile titanium disks. Surface chemistry was determined using energy-dispersive X-ray spectroscopy (EDS), and further investigated using laser ablation inductively coupled plasma mass spectrometry (LA-ICP-MS). After exposure to retraction paste, surface chemistry alterations were identified. A fibroblast cell line (L929) was exposed to the disks and the live/dead viability/cytotoxicity assay was used to determine any effects on the proliferation and health of cells. The disks exposed to the retraction paste showed fewer dead cells compared to the unexposed disks. This was statistically significant.

Laser therapy: the future of peri-implantitis management?

Background: Peri-implantitis is an inflammatory process that leads to a loss of supporting bone around an osseointegrated implant. Currently, there is no standard of care for the treatment of peri-implantitis and clinicians are faced with a myriad of treatment choices. Aim: To evaluate articles from the previous ten years that have investigated the use of lasers in the treatment of peri-implantitis. Materials and Methods: The Pubmed electronic database of the US National Library of Medicine was used to search for articles relating to the use of lasers in the treatment of peri implantitis. Results were limited to ten years, and English articles only. Results: Ten articles were selected for review. These studies demonstrated positive treatment outcomes after 6 months with CO2 and Er:YAG lasers, however studies with follow-up of greater than 6 months showed that initial positive outcomes were not maintained throughout the observation period, coinciding with raised plaque index and bleeding scores. Conclusion: The short-term value of laser treatment has been documented, however the authors would like to see in vivo case studies demonstrating Er:YAG, CO2 and diode laser treatment of peri-implantitis with follow-up of at least 12 months, and regular observation periods.

Effect of a cordless retraction paste material on implant surfaces: an in vitro study

Cordless retraction paste material for gingival retraction in implant dentistry has recently become of interest to the clinician. However, few studies have been conducted on the use of retraction pastes and their possible interaction with implant surfaces. This in vitro study evaluated the effect of a cordless retraction paste material, Expasyl® (Acteon), on TiUnite® (Nobel Biocare) implant surfaces. Three areas of the fixtures were evaluated before and after contact with the retraction paste using scanning electron microscopy to evaluate changes in surface topography and energy-dispersive spectroscopy to identify any surface chemistry modifications. Alteration of the initial surface after exposure to Expasyl® was identified, with the implant collar showing the most changes.

Age and oral health: current considerations / Edad y salud oral: consideraciones actuales

Dental plaque is still considered the main etiological factor for periodontal diseases. Our understanding of periodontal disease has advanced from the previous concepts where gingivitis slowly progressed to periodontitis to a more complex scenario that correlates several risk factors in the pathogenesis of periodontal disease. Among these factors, age has been associated with increased rates of periodontal disease as the population gets older. Although the loss of alveolar bone and periodontal attachment is common in the elderly population, and there is evident age-related changes in the periodontium, severe periodontitis is not a natural consequence of ageing. The importance of identifying the risk factors that participate in the pathogenesis of periodontal disease at an early phase, both of the individual and the disease, as well as evaluating the capacity of the individual to control dental plaque will enable the implementation of an adequate preventive program, where the needs and limitations of the individual are considered to specifically tailor the oral hygiene procedures and the mouthwashes to be used.

La placa dental es aún considerada el factor etiológico primario de la enfermedad periodontal. La etiopatogenia de esta enfermedad ha avanzado del concepto anterior donde una gingivitis progresaba lentamente a una periodontitis, a un escenario más complejo donde varios factores de riesgo se correlacionan. Dentro estos factores, el envejecimiento ha sido asociado con mayores porcentajes de enfermedad periodontal a medida que la población envejece. Aunque la pérdida ósea y de inserción es común en el adulto mayor y los cambios del periodonto son evidentes con la edad, la enfermedad periodontal severa no es una consecuencia natural del envejecimiento. La importancia de identificar en una etapa temprana del individuo y de la enfermedad los factores de riesgo que participan en la patogenesis de la enfermedad periodontal, así como la evaluación de la capacidad del individuo para controlar la placa dental, permitirán la implementación de programas preventivos adecuados, donde las necesidades y limitaciones del individuo son consideradas para el establecimiento de procedimientos personalizados de higiene oral y el enjuague oral a utilizar.

Compliance & dexterity, factors to consider in home care and maintenance procedures / Adherencia e destreza: factores a considerar en programas preventivos

Mechanical plaque control appears to be the primary means of controlling supragingival dental plaque build-up. Although daily oral hygiene practices and periodic professional care are considered the basis for any program aimed at the prevention and treatment of oral diseases, these procedures are technically demanding, time consuming and can be affected by the compliance and manual dexterity of the patient. Individual skills and acquired behavior patterns determine effectiveness of a preventive program and oral hygiene practice. Successful preventive programs and home care procedures clearly depend on the interaction and commitment between the dental professional and the patient. Identifying the capacity of the individual to comply with the professional recommendations and evaluating the dexterity of the patient to remove supragingival dental plaque will permit the implementation of an adequate preventive program and can help on the selection of adjunctive antimicrobial agents and devices needed to reach an effective oral care routine.

El control de la placa dental parece ser el mecanismo primario para controlar el crecimiento de la placa dental supragingival. Aunque la práctica diaria de la higiene bucal y el cuidado profesional periódico, son considerados la base para cualquier programa dirigido a la prevención y tratamiento de las enfermedades de la cavidad bucal, estos procedimientos son técnicamente exigentes, consumen tiempo y pueden ser afectados por la aceptación y la destreza manual del paciente. Las destrezas individuales y los patrones de comportamiento adquiridos, determinan la efectividad de un programa preventivo y la práctica de la higiene bucal. El éxito de los programas preventivos y los procedimientos del cuidado bucal en el hogar dependen claramente de la interacción y compromiso entre el odontólogo y el paciente. La importancia de identificar la capacidad del individuo para cumplir con las recomendaciones y la evaluación de la destreza del paciente para remover la placa dental supragingival, permitirán la implementación de un adecuado programa de prevención que podría ayudar a la selección de un agente antibacteriano coadyuvante y los dispositivos necesarios para alcanzar una rutina de cuidado bucal efectivo.