Effects of Mechanical Methods Used in Peri-implantitis Treatment on Implant Surface Decontamination and Roughness

Summary

The present protocol describes an experimental model based on ink-staining which can be used for in vitro implant surface decontamination and roughness research to contribute to clinical decision-making.

Abstract

Various mechanical methods have been proposed for decontaminating dental implant surfaces with varying success. This in vitro study evaluated the decontamination efficiency of an air abrasion (AA) system with erythritol powder, a polyether-ether-ketone (PEEK) ultrasonic tip, and titanium curettes (TIT) and their effects on implant surface topography using scanning electron microscopy (SEM). A total of 60 implants were stained with permanent red ink and placed in 3D-printed Class 1A and Class 1B peri-implantitis defects, forming six groups (n=10 per group) based on defect type and treatment protocol. Additionally, one positive and one negative control implant was used. Erythritol powder, PEEK ultrasonic tips, and titanium curettes were applied for 2 min in Class 1A defects and 3 minutes in Class 1B defects. Residual red ink areas were quantified with digital software, and implant surface changes were analyzed using SEM and EDS. None of the methods achieved complete decontamination. However, erythritol powder was significantly the most effective, leaving a residual ink rate of 24% ± 6% (p < 0.001). PEEK ultrasonic tips resulted in 41% ± 4% residual ink, while titanium curettes left 55% ± 3%. Significant differences were observed among all methods. No significant difference in decontamination efficacy was found between Class 1A and Class 1B defects. SEM analysis showed minimal surface damage with erythritol powder and PEEK tips, whereas titanium curettes caused moderate to severe damage. Based on both decontamination efficiency and surface preservation, erythritol powder and PEEK tips are safe and effective options for peri-implantitis treatment, while titanium curettes are less effective and cause considerable surface damage. These findings may assist clinicians in peri-implantitis treatment planning.

Introduction

Dental implant treatment is the most common and preferred protocol for replacing missing teeth worldwide. Long-term follow-up studies have shown that the use of implant-supported restorations in the treatment of complete or partial edentulism provides predictable results and high success rates in terms of survival. However, various complications affecting the hard and soft tissues may arise following the surgical placement and restoration of implants¹. In 2017, the World Workshop on the Classification of Periodontal and Peri-implant Diseases and Conditions introduced definitions and differential diagnoses for diseases affecting peri-implant tis

Protocol

The study protocol was approved by the ethical committee (TBAEK-363) of Akdeniz University, Antalya, Turkey. This study was supported by the Akdeniz University Research Fund (Project number: TDH-2024-6676). The study utilized a screw-shaped dental implant (PrimeTaper EV Implant) with dimensions of 4.2 mm x 11 mm, featuring a micro-thread design measuring 1.7 mm on the collar. Surface preparation with sandblasting and acid-etching with diluted hydrofluoric acid to achieve the well-defined OsseoSpeed surface.

1. Preparation of experimental peri-implantitis models

NOTE: Three decontamination mechanica

Results

The experimental protocol described here for analyzing the decontamination of implant surfaces revealed significant differences among various treatment procedures. In addition, the post-treatment SEM protocol also showed significant changes on the implant surfaces with varying degrees among study groups.

Implant-level comparisons (Total implant means) after decontamination
Implant-level comparisons were carried out by comparing the general means of each implant (the meas...

Discussion

The methodology of in vitro surface analysis of dental implants affected by peri-implant disease has always been challenging due to the inflammatory and bacterial nature of the pathogenic mechanisms occurring on the rough surfaces of the implant. Several concerns include the sample material choice, mimicking biofilm on the surface, choosing the peri-implantitis defect type, representing clinical conditions during the in vitro procedures, variations of the decontamination procedures, and the methods of determinin...

Materials

Name	Company	Catalog Number	Comments
3D Printer	DentaFab, Istanbul, Turkey		To produce experimental periimplantitis defects
3D Printing Resin	Alias, Istanbul,Turkey		To produce experimental periimplantitis models
3D Scanner	DOF Inc. EDGE, Seoul ,Republic of Korea		Used to scan the dental phantom model
Air Abrasive system	AIRFLOW Plus PowderE.M.S., Electro Medical Systems S.A., Nyon, Switzerland		Used to decontaminate implant surface
CAD/CAM Software	Exocad 3.2 Elefsina		To produce experimental periimplantitis defects
Camera	Canon EOS 70D, Japan		In order to obtain photographic records of implants
Dental implant	DS PrimeTaper, Dentsply Sirona, Hanau, Germany
Light-Curing Unit	Solidilite V, Japan		Used to curing experimental models in laboratory
Permanent ink	Edding, Germany		Used to stain the implant surface for mimicking biofilm
Physiodispenser	Dentsply Sirona, Hanau, Germany		To place the implants in the experimental models
SEM Device	FEI QUANTA FEG 250 FEI Technologies Inc. (Oregon, United States		Used to analyze topograhic changes on the implant surface
Surgical implant set	Dentsply Sirona, Hanau, Germany		To place the implants in the experimental models
Titanium Currette	Langer ½ Titanium Currette, Hu-Friedy, Chicago, IL, USA		Used to decontaminate implant surface
Ultrasonic PEEK Tip	PI-MAX Implant Scaler, E.M.S., Electro Medical Systems S.A., Nyon, Switzerland		Used to decontaminate implant surface