Effect of implant cleaning on titanium particle dissolution and cytocompatibility.

BACKGROUND: Peri-implantitis treatments are mainly based on protocols for teeth but have not shown favorable outcomes for implants. The potential role of titanium dissolution products in peri-implantitis necessitate the consideration of material properties in devising treatment protocols. We assessed implant cleaning interventions on (1) bacterial removal from Ti-bound biofilms, (2) Ti surface alterations and related Ti particle dissolution, and (3) cytocompatibility. METHODS: Acid-etched Ti discs were inoculated with human peri-implant plaque biofilms and mechanical antimicrobial interventions were applied on the Ti-bound biofilms for 30 seconds each: (1) rotary nylon brush; (2) Ti brush; (3) water-jet on high and (4) low, and compared to sterile, untreated and Chlorhexidine-treated controls. We assessed colony forming units (CFU) counts, biofilm removal, surface changes via scanning electron microscopy (SEM) and atomic force microscopy (AFM), and Ti dissolution via light microscopy and Inductively-coupled Mass Spectrometry (ICP-MS). Biological effects of Ti particles and surfaces changes were assessed using NIH/3T3 fibroblasts and MG-63 osteoblastic cell lines, respectively. RESULTS: Sequencing revealed that the human biofilm model supported a diverse biofilm including known peri-implant pathogens. WJ and Nylon brush were most effective in reducing CFU counts (P < 0.01 versus control), whereas Chlorhexidine was least effective; biofilm imaging results were confirmatory. Ti brushes led to visible streaks on the treated surfaces, reduced corrosion resistance and increased Ti dissolution over 30 days of material aging as compared to controls, which increase was amplified in the presence of bacteria (all P-val < 0.05). Ti particles exerted cytotoxic effects against fibroblasts, whereas surfaces altered by Ti brushes exhibited reduced osteoconductivity versus controls (P < 0.05). CONCLUSIONS: Present findings support that mechanical treatment strategies selected for implant biofilm removal may lead to Ti dissolution. Ti dissolution should become an important consideration in the clinical selection of peri-implantitis treatments and a necessary criterion for the regulatory approval of instruments for implant hygiene.

Correction: Determinants of corrosion resistance of Ti-6Al-4V alloy dental implants in an In Vitro model of peri-implant inflammation.

[This corrects the article DOI: 10.1371/journal.pone.0210530.].

Determinants of corrosion resistance of Ti-6Al-4V alloy dental implants in an In Vitro model of peri-implant inflammation.

BACKGROUND: Titanium (Ti) and its alloys possess high biocompatibility and corrosion resistance due to Ti ability to form a passive oxide film, i.e. TiO2, immediately after contact with oxygen. This passive layer is considered stable during function in the oral cavity, however, emerging information associate inflammatory peri-implantitis to vast increases in Ti corrosion products around diseased implants as compared to healthy ones. Thus, it is imperative to identify which factors in the peri-implant micro-environment may reduce Ti corrosion resistance. METHODS: The aim of this work is to simulate peri-implant inflammatory conditions in vitro to determine which factors affect corrosion susceptibility of Ti-6Al-4V dental implants. The effects of hydrogen peroxide (surrogate for reactive oxygen species, ROS, found during inflammation), albumin (a protein typical of physiological fluids), deaeration (to simulate reduced pO2 conditions during inflammation), in an acidic environment (pH 3), which is typical of inflammation condition, were investigated. Corrosion resistance of Ti-6Al-4V clinically-relevant acid etched surfaces was investigated by electrochemical techniques: Open Circuit Potential; Electrochemical Impedance Spectroscopy; and Anodic Polarization. RESULTS: Electrochemical tests confirmed that most aggressive conditions to the Ti-6Al-4V alloy were those typical of occluded cells, i.e. oxidizing conditions (H2O2), in the presence of protein and deaeration of the physiological medium. CONCLUSIONS: Our results provide evidence that titanium's corrosion resistance can be reduced by intense inflammatory conditions. This observation indicates that the micro-environment to which the implant is exposed during peri-implant inflammation is highly aggressive and may lead to TiO2 passive layer attack. Further investigation of the effect of these aggressive conditions on titanium dissolution is warranted.