Cleaning effect of osteoconductive powder abrasive treatment on explanted human implants and biofilm-coated titanium discs.

The aim of this study is to test the cleaning effect and surface modification of a new implant surface treatment on explanted dental implants and titanium discs. It is a modified air powder abrasive (APA) treatment applied using osteoconductive powders. Twenty-eight in vitro Ca-precipitated organic film-coated titanium discs and 13 explanted dental implants were treated. In a 2-step approach, 3 powders were used: hydroxylapatite (HA) and biomimetic calcium phosphate (BioCaP), which are osteoconductive, and erythritol, which is not. APA treatment was applied. (Air pressure: 2.4 bar; water flow for cleaning: 41.5 ml/min, for Coating 1: 2.1 ml/min, and for Coating 2: 15.2 ml/min.) The test groups were as follows: Group 1: HA cleaning + BioCaP Coating 1; Group 2: HA cleaning + BioCaP Coating 2; Group 3: erythritol cleaning + BioCaP Coating 1; Group 4: erythritol cleaning + BioCaP Coating 2; Group 5: HA cleaning; Group 6: erythritol cleaning; and control: no powder. Cleaned areas were calculated by point counting method. Surface changes and chemical content were evaluated using light microscopy, scanning electron microscopy, and energy-dispersive X-ray spectroscopy. Cleaning effect between groups was compared by a pairwise Student's t test. The significance level was fixed at p < .05. Cleaning effect on the discs was 100% in all test groups and 5% in the control. Powder particles in varying size and shape were embedded on the surface. All HA- or CaP-treated surfaces showed Ca and P content but no surface damage. Calcified biofilm remnants were removed from the implant surface by the test groups, whereas in control groups, they remained. APA treatment with CaP and HA powders under clinically applicable pressure settings gives positive results in vitro; therefore, they could be promising when used in vivo.

Re-establishment of Biocompatibility of the In Vitro Contaminated Titanium Surface Using Osteoconductive Powders With Air-Abrasive Treatment.

To achieve re-osseointegration on implant surfaces exposed to peri-implant infections, treatment should re-establish biocompatibility. The aim of this study was to test whether air powder abrasive treatment (APA) using osteoconductive powders can, in addition to cleaning, increase the biocompatibility of the contaminated implant surface. Ninety-six in vitro Ca-precipitated, organic film layer-coated sandblasted and acid-etched titanium discs were treated by APA using erythritol, hydroxylapatite (HA), and biocalcium phosphate (BioCaP) powders (n = 16 per group). Six treatment modalities were created (HA or erythritol cleaning with/without BioCaP coating). MC3T3-E1cells were seeded on discs, and cell attachment, viability, proliferation, and differentiation were evaluated. Pristine discs were used as control (control 1). Contaminated and nontreated discs were used as control (control 2). The cells were stretched and attached in all test groups. The cell viability and proliferation (DNA amount) in all test groups were significantly higher than in the pristine and contaminated disc groups. There was no significant difference between the test groups. The differentiation (alkaline phosphatase activity) of the cells on treated discs was significantly higher than on the contaminated discs but lower than in the pristine group. The cell viability in control 2 was significantly lower than the control 1. The APA with osteoconductive powder on contaminated titanium surfaces promoted the cell viability, proliferation, and differentiation of the MC3T3-E1 cells. The biocompatibility of the surface was higher than that of the contaminated discs. The tested aspects of cell response, with the exception of differentiation, reached to the level of the pristine surface. The in vitro results showed that APA with osteoconductive powders could be a promising method for implant surface treatment.

Parameters That Improve Cleaning Efficiency of Subgingival Air Polishing on Titanium Implant Surfaces: An In Vitro Study.

BACKGROUND: This study aims to reveal how air polishing behaves on a titanium surface by evaluating the size and shape of the cleaned area and the influence of different device settings, probing depths, and cleaning movements. METHODS: Forty-eight titanium sandblasted large-grit acid-etched surface film-coated disks were treated with an air abrasive system using a subgingival plastic nozzle. Two subgingival models were used: open-ended (step 1) and defined-size (step 2). In step 1, the most effective parameters were investigated by 5-second static applications under different settings. In step 2, the best settings were used for dynamic application to test influence of different movements (up-down, slowly up, rotation). For both steps, powder and water consumption and total cleaned area were calculated. RESULTS: Air pressure was the main factor with the strongest effect on cleaning. Increasing air pressure extended cleaning area. Other factors, such as nozzle depth and excessive powder flow amount, had weak influence. Cleaning effect reached deeper than the nozzle physically reached. Step 2 showed that there was no significant difference between different nozzle movements; however, cleaning efficiency decreased significantly without movement. CONCLUSIONS: For the most effective clinical use of air polishing, it should be applied with high pressure, deep insertion of nozzle, and enough water flow. Additionally, the nozzle has to be moved to get the best cleaning effect.

Cleaning and modification of intraorally contaminated titanium discs with calcium phosphate powder abrasive treatment.

OBJECTIVE: The aim of this study was to evaluate the cleaning efficiency on intraorally contaminated titanium discs by using calcium phosphate and air powder abrasive (APA) treatment. The modification of titanium surface (SLA) was evaluated and compared with the conventional air powder abrasive methods and phosphoric acid. This treatment modality might give new perspectives for peri-implant surface treatment. MATERIALS AND METHODS: A total of 36 SLA surface titanium discs were kept in the human mouth for 48 h by 14 volunteers. The intraorally contaminated discs were stained with erythrosine dye to make the biofilm visible. Discs were randomly assigned to one of the six groups: APA without powder-only water and air (Control). APA with Hydroxylapatite (HA). APA with Hydroxylapatite and Calcium Phosphate (HA + TCP). APA with Titanium Dioxide (TiO2). APA with EMS Soft Subgingival powder (EMS). Phosphoric Acid. Light microscope photos were taken during the treatment. Following the cleaning, the residual biofilm, surface changes, and surface chemical content were evaluated using Scanning Electron Microscopy (SEM) and Energy Dispersive X-Ray Spectroscopy (EDS). A systematic random sampling protocol and a point counting method were applied for the quantitative evaluation of the remaining biofilm. Multiple comparisons within and between groups are performed by Kruskall Wallis test and if significant Mann-Whitney U-test as post hoc testing is applied. The significance level was P < 0.05. RESULTS: All methods with the exception of phosphoric acid could decrease the initial amount of biofilm significantly. Among all air powder abrasive treatments, the HA + TCP group showed the best results with 99% biofilm removal, followed by HA and EMS powders. The cleaning method caused minimal changes to the surface structure. With the exception of the control group, all air powder applications caused sharp edges around the grooves in the implant surface to be rounded. TiO2 powder caused less change than HA and HA + TCP. Phosphoric acid did not cause a visible surface change on the SEM photos. Powder particles remnants were observed on and impacted in the titanium surface. In the HA and HA + TCP group, a Ca content was observed varying between 2% and 5%. In the control group, saliva and biofilm-related elements were observed. CONCLUSIONS: Using the air powder abrasive method with calcium phosphate powders on contaminated titanium discs, an efficient implant cleaning and surface modification can be achieved. This method should be further improved as it has possible potential to be used as an implant surface treatment method for implants involved with peri-implantitis.

Air powder abrasive treatment as an implant surface cleaning method: a literature review.

OBJECTIVE: To evaluate the air powder abrasive treatment as an implant surface cleaning method for peri-implantitis based on the existing literature. MATERIALS AND METHODS: A PubMed search was conducted to find articles that reported on air powder abrasive treatment as an implant surface cleaning method for peri-implantitis. The studies evaluated cleaning efficiency and surface change as a result of the method. Furthermore, cell response toward the air powder abrasive-treated discs, reosseointegration, and clinical outcome after treatment is also reported. RESULTS: The PubMed search resulted in 27 articles meeting the inclusion criteria. In vitro cleaning efficiency of the method is reported to be high. The method resulted in minor surface changes on titanium specimens. Although the air powder abrasive-treated specimens showed sufficient levels of cell attachment and cell viability, the cell response decreased compared with sterile discs. Considerable reosseointegration between 39% and 46% and improved clinical parameters were reported after treatment when applied in combination with surgical treatment. The results of the treatment are influenced by the powder type used, the application time, and whether powder was applied surgically or nonsurgically. CONCLUSION: The in vivo data on air powder abrasive treatment as an implant surface cleaning method is not sufficient to draw definitive conclusions. However, in vitro results allow the clinician to consider the method as a promising option for implant surface cleaning in peri-implantitis treatment.