Instrumentation With Ultrasonic Scalers Facilitates Cleaning of the Sandblasted and Acid-Etched Titanium Implants
Mechanical instrumentation is widely used to debride dental implants, but this may alter the surface properties of titanium, which in turn may influence bacterial adhesion and make it more difficult to remove the biofilm. This in vitro study was performed (1) to assess the amount of biofilm formation on a sand-blasted and acid-etched titanium fixture treated with ultrasonic scalers with metal, plastic, and carbon tips and (2) to evaluate how this treatment of titanium surfaces affects implant cleaning by brushing with dentifrice. The titanium fixtures were treated with various ultrasonic scaler tips, and surface roughness parameters were measured by confocal microscopy. Biofilm was formed on the treated fixtures by using pooled saliva from 10 subjects, and the quantity of the adherent bacteria was compared with crystal violet assay. The fixture surfaces with biofilm were brushed for total of 30 seconds with a toothbrush with dentifrice. The bacteria remaining on the brushed fixture surfaces were quantified by scanning electron microscopy. Surface changes were evident, and the changes of the surfaces were more discernible when metal tips were used. A statistically significant decrease in roughness value (arithmetic mean height of the surface) was seen in the 2 metal-tip groups and the single plastic-tip group. After brushing with dentifrice, the treated surfaces in all the treatment groups showed significantly fewer bacteria compared with the untreated surfaces in the control group, and the parts of the surfaces left untreated in the test groups. Within the limits of this study, treatment of titanium fixture surfaces with ultrasonic metal, plastic, or carbon tips significantly enhanced the bacterial removal efficacy of brushing. Thorough instrumentation that smooths the whole exposed surface may facilitate maintenance of the implants.
Overview of the study design.
Metal and nonmetal ultrasonic scaler tips and toothbrush. (a) Manufacturer A metal tip. (b) Manufacturer A plastic tip. (c) Manufacturer B metal tip. (d) Manufacturer B carbon tip. (e) Toothbrush.
Gross morphology of the untreated and treated sand-blasted and acid-etched surface of the titanium fixtures. (a) No treatment. (b) Manufacturer A metal tip. (c) Manufacturer A plastic tip. (d) Manufacturer B metal tip. (e) Manufacturer B carbon tip.
Surface characteristics of the examined area. One representative valley area from each treatment group is shown. It can be observed that b, c, and d show smoother areas compared with the original sand-blasted and acid-etched surface. (a) No treatment. (b) Manufacturer A metal tip. (c) Manufacturer A plastic tip. (d) Manufacturer B metal tip. (e) Manufacturer B carbon tip.
Gross morphology of the surface of the pretreated titanium fixtures after biofilm formation and application of crystal violet. (a) No treatment. (b) Manufacturer A metal tip. (c) Manufacturer A plastic tip. (d) Manufacturer B metal tip. (e) Manufacturer B carbon tip.
Figure 6. The bacteria were grown on pretreated surfaces and all surfaces were brushed with dentifrice. The figures were achieved from the no-treatment group and nonscratched surfaces from the treated groups. (a) No treatment. (b) Manufacturer A metal tip. (c) Manufacturer A plastic tip. (d) Manufacturer B metal tip. (e) Manufacturer B carbon tip. Figure 7. Average number of bacteria in each group (no treatment surface or nonscratched surface from treated groups) seen from scanning electron microscopy images.
Figure 8. The images were obtained after the no-treatment surface or scratched surfaces from the treated groups were brushed with dentifrice. (a) No treatment. (b) Manufacturer A metal tip. (c) Manufacturer A plastic tip. (d) Manufacturer B metal tip. (e) Manufacturer B carbon tip. Figure 9. Average number of bacteria was calculated after the no-treatment surface or scratched surfaces from the treated groups were brushed with dentifrice.
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