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Objectives: The aim of the present study was to compare a novel tapered, double-threaded self-tapping tissue-Level design implant (TLC) to a well-established parallel walled tissue-level (TL) implant in terms of primary and secondary stability over time., Materials and Methods: Test TLC (n = 10/per timepoint) and control TL (n = 10/per timepoint) implants were placed in the mandible of minipigs and left for submerged healing for 3, 6, and 12 weeks. Maximum insertion torque and implant stability quotient (ISQ) were measured for each implant at placement. Osseointegration and cortical bone maintenance were histologically evaluated by measuring total bone-to-implant contact (BIC) and first bone-to-implant contact (fBIC)., Results: A significantly higher maximum insertion torque was measured for the test implant TLC compared to the control TL implant (57.83 ± 24.73 Ncm and 22.62 ± 23.16 Ncm, respectively; p < .001). The mean ISQ values were comparable between the two implant types (75.00 ± 6.70 for TL compared to 75.40 ± 3.20 for TLC, p = .988). BIC was comparable between both implant types at each of the evaluated time points. The fBIC was found to be significantly more coronal at 12 weeks for the TLC implant compared to the TL implant (0.31 ± 0.83 mm for TLC compared to -0.22 ± 0.85 for TL, p = .027)., Conclusion: The novel tapered tissue level design implant showed improved primary stability and an overall improved crestal bone height maintenance compared to the parallel walled design at 12 weeks., (© 2024 The Author(s). Clinical Oral Implants Research published by John Wiley & Sons Ltd.)

Objectives: Bioactive surfaces were designed to increase the interaction between the surface and the cells. This may speed up the biological stability and loading protocols., Materials and Methods: 36 patients with D3-D4 bone density were recruited and allocated into two groups. 30 bioactive (test group) and 30 traditional (control group) surfaced implants were placed. Insertion torque value (Ncm), insertion torque curve integral (cumulative torque, Ncm), torque density (Ncm/sec), implant stability quotient (ISQ) measured at three timepoints (baseline (T0), 30 (T30) and 45 (T45) days after surgery), and marginal bone loss (MBL) at 6 months of loading were assessed., Results: The mean ISQ and standard deviation at T0, T30, T45 were respectively 74.57 ± 7.85, 74.78 ± 7.31, 74.97 ± 6.34 in test group, and 77.12 ± 5.83, 73.33 ± 6.13, 73.44 ± 7.89 in control group, respectively. Data analysis showed significant differences between groups in ΔISQ at T0-T30 (p = 0.005) and T30-T45 (p = 0.012). Control group showed a significant decrease in ISQ at T30 (p = 0.01) and T45 (p = 0.03) compared to baseline, while no significant change was observed in test group. Due to the stability of the ISQ value ≥ 70, 26 test group and 23 control group implants were functionally loaded after 45 days. Conversely, due to the ISQ < 70 at T45, four test group implants and one control group implant were loaded after 90 days, and 6 control group implants were loaded after 180 days. Neither insertion torque nor ISQ at baseline were correlated with bone density (in Hounsfield units). There was no significant correlation between cumulative torque and ISQ at baseline. There was a significant positive slope in the correlation between torque density and ISQ at baseline, more accentuated in D3 than D4. This correlation remained significant for the test group in D3 bone at day 30 and 45 (p < 0.01 in both time frames), but not in D4 bone, and it was not significant in CG., Conclusions: The bioactive surface showed better behavior in terms of implant stability in D3-D4 bone quality in the early stages of bone healing. Clinical relevance This study demonstrated that the transition from primary to secondary stability is improved using bioactive surface, especially in cases of poor bone environment (D3/D4 bone)., (© 2024. The Author(s).)

Objective: To evaluate the clinical outcome of different designs of zirconia dental implants., Data: This systematic review adhered to the PRISMA checklist and followed the PICO framework. The protocol is registered in PROSPERO (CRD42022337228)., Sources: The search was conducted in March 2023 through four databases (PubMed, Web of Science, Cochrane Library, and Google Scholar) along with a search of references in the related reviews. Three authors reviewed on title, and abstract level and analysed the risk of bias, and all authors reviewed on a full-text level., Study Selection: Clinical studies excluding case reports for patients treated with different designs of zirconia dental implants were included. From a total of 2728 titles, 71 full-text studies were screened, and 27 studies were included to assess the risk of bias (ROBINS-I tool) and data extraction. After quality assessment, four studies were included, and the remaining 23 excluded studies were narratively described., Result: The included prospective studies with moderate risk of bias reported success and survival rates of one-piece implants that ranged between 95 and 98.4 % with no difference between different lengths and diameters. The acid-etched roughened surface showed higher clinical outcomes compared to other surface roughness designs., Conclusion: Promising 5-year clinical outcomes were found for one-piece zirconia implants with no difference between different diameters and lengths. Concerning surface roughness, better outcomes were found when using the acid-etched implant surface. However, due to the limited available studies, further high-quality clinical studies comparing zirconia one-piece and two-piece implants with different diameters, lengths, and surface roughness are needed., Clinical Significance: Based on this systematic review, under suitable clinical situations, the one-piece zirconia implants with diameters of 4.0 mm, 4.5 mm, or 5.5 mm and lengths of 8 mm, 10 mm, 12 mm, or 14 mm have similar promising clinical outcomes. Additionally, the acid-etched roughened implant surface may be preferable., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Background: One of the main factors for the osseointegration of dental implants is the development of an adequate soft tissue barrier, mainly composed by collagen, which protects the implant from bacterial development. The structural features of the peri-implant collagen are influenced by the implant components and, in particular, by the type of the surface. In the clinical practice, healing abutments are characterized by smooth surfaces, named machined. Recently, a new laser technique, Synthegra, has been developed to obtain a topography-controlled surface with micrometric regular pores that seems reducing the risk of peri-implantitis. Based on this background, this study aims investigating the structural organization and spatial distribution of collagen surrounding healing abutments characterized by laser-treated and machined surfaces., Methods: Gingiva portions surrounding custom-made healing abutments (HA), characterized by alternated laser-treated and machined surfaces, were collected and analyzed by combining Fourier Transform InfraRed Imaging (FTIRI) spectroscopy, a non-invasive and high-resolution bidimensional analytical technique, with histological and multivariate analyses., Results: Masson's trichrome staining, specific for collagen, highlighted a massive presence of collagen in all the analyzed samples, evidencing a surface-related spatial distribution. The nature of collagen, investigated by the FTIRI spectroscopy, appeared more abundant close to the laser-treated surface, with a perpendicular disposition of the bundles respect to the HA; conversely, a parallel distribution was observed around the machined surface. A different secondary structure was also found, with a higher amount of triple helices and a lower quantity of random coils in collagen close to the laser treated surfaces., Conclusions: FTIRI spectroscopy demonstrates that the use of a laser treated transmucosal surface can improve the morphological organization of the peri-implant collagen, which presents a distribution more similar to that of natural teeth., Trial Registration: This trial is registered with ClinicalTrials.gov Identifier: (Registration Number: NCT05754970). Registered 06/03/2023, retrospectively registered, https://clinicaltrials.gov/show/NCT05754970 ., (© 2024. The Author(s).)

Objectives: The objective of this study is to qualitatively and quantitatively evaluate biofilm formation on hybrid titanium implants (HS), with moderately rough and turned surface topographies., Materials and Methods: A validated dynamic in vitro multispecies biofilm model, based on bacterial growth under flow and shear conditions resembling the oral cavity, was used to evaluate biofilm formation on the tested implant surfaces. Scanning electron microscopy (SEM) and confocal laser scanning microscopy (CLSM) were used to compare the biofilm structure and microbial biomass deposited on either the moderately rough or the turned surface of HS. Quantitative polymerase chain reaction (qPCR) was used to evaluate the total bacterial counts and counts of each specific bacterium in biofilms formed on implants with either the moderately rough or the turned surfaces, as in the hybrid titanium implants, after 24, 48 and 72 h. A general linear model was applied to compare the CLSM and qPCR results between the tested implant surfaces., Results: A significantly higher bacterial biomass grew on the moderately rough implant surfaces, compared to the turned surface area of HS implants (p < .05), at all incubation times, as evidenced with both CLSM and SEM. qPCR analysis also demonstrated an important increase in the total and specific bacterial counts in moderately rough surface implants at the three incubation times., Conclusions: Implant surface topography (moderately rough versus turned) significantly influenced in vitro biofilm formation in terms of biofilm structure, bacterial biomass and quantity of the specific species selected for the model used., (© 2023 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Objectives: Crestal bone formation represents a crucial aspect of the esthetic and biological success of dental implants. This controlled preclinical study analyzed the effect of implant surface and implant geometry on de novo crestal bone formation and osseointegration., Materials and Methods: Histological and histomorphometrical analysis was performed to compare three implant groups, that is, (1) a novel, commercially available, gradient anodized implant, (2) a custom-made geometric replica of implant "1," displaying a superhydrophilic micro-rough large-grit sandblasted and acid-etched surface, and (3) a commercially available implant, having the same surface as "2" but a different implant geometry. The study applied a standardized buccal acute-type dehiscence model in minipigs with observation periods of 2 and 8 weeks of healing., Results: The amount of newly formed crestal bone (BATA) around control groups (2) and (3) was significantly increased when compared to the test group (1) at the 8 weeks of healing time point. Similar results were obtained for all parameters related to osseointegration and direct bone apposition, to the implant surface (dBIC, VBC, and fBIC), demonstrating superior osseointegration of the moderately rough, compared to the gradient anodized functionalization. After 2 weeks, the osseointegration (nBIC) was found to be influenced by implant geometry with group (3) outperforming groups (1) and (2) on this parameter. At 8 weeks, nBIC was significantly higher for groups (2) and (3) compared to (1)., Conclusions: The extent (BATA) of de novo crestal bone formation in the acute-type dehiscence defects was primarily influenced by implant surface characteristics and their ability to promote osseointegration and direct bone apposition. Osseointegration (nBIC) of the apical part was found to be influenced by a combination of surface characteristics and implant geometry. For early healing, implant geometry may have a more pronounced effect on facilitating osseointegration, relative to the specific surface characteristics., (© 2022 The Authors. Clinical Oral Implants Research published by John Wiley & Sons Ltd.)

Background: Inflammation triggered by bacterial biofilms in the surrounding tissue is a major etiological factor for peri-implantitis and subsequent implant failure. However, little is known about the direct effects of bacterial corrosion and recolonization on implant failure PURPOSE: To investigate the influence of oral commensals on bacterial corrosion and recolonization of titanium surfaces., Materials and Methods: Streptococcus sanguinis (S. sanguinis) and Porphyromonas gingivalis (P. gingivalis), which are key bacteria in oral biofilm formation, were cultured on commercially pure titanium and titanium-aluminum-vanadium (Ti6Al4V) plates in artificial saliva/brain heart infusion medium under aerobic or anaerobic conditions. Biofilm formation was examined after 7 and 21 days by crystal violet and live/dead staining. Titanium ions released into culture supernatants were analyzed over a period of 21 days by atomic absorption spectrometry. Visual changes in surface morphology were investigated using scanning electron microscopy. Biofilm formation on sterilized, biocorroded, and recolonized implant surfaces was determined by crystal violet staining., Results: S. sanguinis and P. gingivalis formed stable biofilms on the titanium samples. Bacterial corrosion led to a significant increase in titanium ion release from these titanium plates (p < 0.01), which was significantly higher under aerobic conditions on pure titanium (p ≤ 0.001). No obvious morphological surface changes, such as pitting and discoloration, were detected in the titanium samples. During early biofilm formation, the addition of titanium ions significantly decreased the number of live cells. In contrast, a significant effect on biofilm mass was only detected with P. gingivalis. Bacterial corrosion had no influence on bacterial recolonization following sterilization of titanium and Ti6Al4V surfaces., Conclusion: Bacterial corrosion differs between oral commensal bacteria and leads to increased titanium ion release from titanium plates. The titanium ion release did not influence biofilm formation or bacterial recolonization under in vitro conditions., (© 2022 The Authors. Clinical Implant Dentistry and Related Research published by Wiley Periodicals LLC.)

Purpose: To evaluate the in vitro cleaning effects of different decontamination methods and their impacts on surface characteristics using clinically failed TiUnite implants (Nobel Biocare, Kloten, Switzerland)., Materials and Methods: Thirty clinically failed TiUnite implants were treated using different decontamination methods. Group 1 (control group) received physiological saline irrigation; Group 2 underwent erythritol powder air polishing (AIRFLOW Master Piezon, EMS Dental, Nyon, Switzerland); Group 3 was treated with erythritol powder air polishing with ethylenediaminetetraacetic acid brushing (FileRite PRC, Pulpdent, Watertown, MA, USA); Group 4 received ultrasonic scaling with polyetheretherketone tips (EMS Dental); Group 5 underwent ultrasonic scaling with polyetheretherketone tips with ethylenediaminetetraacetic acid; and Group 6 was treated with a combination of ultrasonic scaling with polyetheretherketone tips, erythritol powder air polishing and ethylenediaminetetraacetic acid. Surface cleaning effects, quantified by relative contaminated area reduction and visual analogue scale score, as well as surface roughness and chemistry, were assessed after decontamination. The cleaning effects of each decontamination method were also compared between TiUnite and SLA (sandblasted, large-grit acid-etched; Straumann, Basel, Switzerland) implants., Results: Group 6 showed the highest relative contaminated area reduction (stereoscopic microscopy 83.92%, scanning electron microscopy 96.40%), visual analogue scale score (2.83) and reduction in surface roughness (thread bottom -0.78 μm, tip -1.35 μm), as well as an almost maximal decrease in the proportion of carbon (thread bottom -12.33%, tip -8.77%) and increase in that of titanium (thread bottom 13.71%, tip 10.73%). Polyetheretherketone remnants were observed in Groups 4 and 5 but appeared to be reduced in Group 6. When comparing the outcomes with those for SLA implants, no significant differences were found., Conclusion: Within the limitations of the present study, the combination of ultrasonic scaling with polyetheretherketone tips, erythritol powder air polishing and ethylenediaminetetraacetic brushing achieved reasonable cleaning effects. The original surface modification did not seem to have any impact on the decontamination results for any of the methods examined.

Aim: To evaluate the effect of surgical treatment of experimental peri-implantitis at implants with different surface characteristics using mechanical and chemical decontamination methods., Materials and Methods: Following extraction of mandibular premolars, four implants with two different surface characteristics (A, moderately rough and B, smooth) were placed in each side of the mandible of six dogs. Experimental peri-implantitis was induced. Surgical treatment of the peri-implantitis sites was carried out using four implant surface decontamination protocols: (i) deposition of a citric acid gel, (ii) mechanical cleaning using a rotating titanium brush, (iii) a combination of the mechanical and chemical procedures, and (iv) saline (control). Clinical and radiographic examinations were performed. Block biopsies were obtained 6 months after therapy and prepared for histological analysis., Results: Irrespective of the treatment group, treatment resulted in 0.63 ± 0.92 and 0.65 ± 0.67 mm radiographic bone gain around implants A and B, respectively. Histological analyses revealed that persisting soft tissue inflammation as assessed using an infiltrated connective tissue (ICT) score was significantly lower at implant type B than at implant type A for all treatment groups. The test decontamination procedures did not demonstrate better results regarding resolution of peri-implantitis lesions, as indicated by the ICT scores, than the control procedure. The control treatment resulted in significantly superior outcomes of resolution of peri-implantitis lesions than the citric acid regimen., Conclusions: It is concluded that decontamination procedures including citric acid gel or rotating titanium brush did not improve outcomes following surgical treatment of experimental peri-implantitis. Results were, however, influenced by the implant surface characteristics., (© 2022 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

The objective of this in vitro study was to evaluate surface cleanness and cytocompatibility following mechanical instrumentation of biofilm-contaminated titanium surfaces. Titanium discs (non-modified [Ti(s)] and shot-blasted surfaces [Ti(r)]) contaminated with Streptococcus gordonii were instrumented using four different techniques: (i) gauze soaked in saline (GS), (ii) ultra-sonic device (US), (iii) rotating nickel-titanium brush (TiB), or (iv) air-polishing device (AP). Non-contaminated, untreated titanium disks were used as controls (C). Residual deposits and cytocompatibility for osteoblast-like cells were evaluated using scanning electron microscopy, immunofluorescence, and reverse transcriptase polymerase chain reaction. While the number of residual bacteria on Ti(s) discs was close to 0 in all treatment groups, significantly higher mean numbers of residual bacteria were observed on Ti(r) discs for GS (152.7 ± 75.7) and TiB (33.5 ± 22.2) than for US (0) and AP (0). Instrumentation with US resulted in deposition of foreign material (mean area% of foreign material: 3.0 ± 3.6% and 10.8 ± 9.6% for Ti(s) and Ti(r) discs, respectively). AP was the most effective decontamination procedure in reducing bacteria without depositing residual foreign material on Ti(r) discs. TiB and AP were superior methods in restoring cytocompatibility, although no method of mechanical decontamination resulted in pristine levels of cytocompatibility., (© 2021 The Authors. Journal of Biomedical Materials Research Part B: Applied Biomaterials published by Wiley Periodicals LLC.)

The aim of the present systematic review was to analyse studies using inorganic implant coatings and, in a meta-analysis, the effect of specifically tricalcium phosphate (TCP) and hydroxyapatite (HA) implant surface coatings on bone formation according to the PRISMA criteria. Inclusion criteria were the comparison to rough surfaced titanium implants in large animal studies at different time points of healing. Forty studies met the inclusion criteria for the systematic review. Fifteen of these analyzed the bone-to-implant contact (BIC) around the most investigated inorganic titanium implant coatings, namely TCP and HA, and were included in the meta-analysis. The results of the TCP group show after 14 days a BIC being 3.48% points lower compared with the reference surface. This difference in BIC decreases to 0.85% points after 21-28 days. After 42-84 days, the difference in BIC of 13.79% points is in favor of the TCP-coatings. However, the results are not statistically significant, in part due to the fact that the variability between the studies increased over time. The results of the HA group show a significant difference in mean BIC of 6.94% points after 14 days in favor of the reference surface. After 21-28 days and 42-84 days the difference in BIC is slightly in favor of the test group with 1.53% points and 1.57% points, respectively, lacking significance. In large animals, there does not seem to be much effect of TCP-coated or HA-coated implants over uncoated rough titanium implants in the short term., (© 2021 The Authors. Journal of Biomedical Materials Research Part B: Applied Biomaterials published by Wiley Periodicals LLC.)

Objectives: To answer the focused question, 'In animals or patients with dental implants, does implant surface characteristics and/or implant material have an effect on incidence and progression of peri-implantitis?', Material and Methods: Pre-clinical in vivo experiments on experimental peri-implantitis and clinical trials with any aim and design, and ≥5 years follow-up, where the effect of ≥2 different type of implant material and/or surface characteristics on peri-implantitis incidence or severity, and/or progression, implant survival or losses due to peri-implantitis, and/or marginal bone levels/loss was assessed., Results: Meta-analyses based on data of pre-clinical experiments, using the ligature induced peri-implantitis model in the dog, indicated that after the spontaneous progression phase implants with a modified surface showed significantly greater radiographic bone loss (effect size 0.44 mm; 95%CI 0.10-0.79; p = .012; 8 publications) and area of infiltrated connective tissue (effect size 0.75 mm 2 ; 95%CI 0.15-1.34; p = .014; 5 publications) compared to non-modified surfaces. However, in 9 out of the 18 included experiments, reported in 25 publications, no significant differences were shown among the different implant surface types assessed. Clinical and/or radiographic data from 7605 patients with 26,188 implants, reported in 31 publications (20 RCTs, 3 CTs, 4 prospective cohort, and 4 retrospective studies; 12 with follow-up ≥10 years), overall did not show significant differences in the incidence of peri-implantitis, when this was reported or could be inferred, among the various implant surfaces. In general, high survival rates (90-100%) up to 30 years and no clinically relevant differences in marginal bone loss/levels, merely compatible with crestal remodelling, were presented for the various implant types., Conclusion: Pre-clinical in vivo experiments indicate that surface characteristics of modified implants may have a significant negative impact on peri-implantitis progression, while clinical studies do not support the notion that there is a difference in peri-implantitis incidence among the various types of implant surfaces. No assumptions can be made regarding the possible impact of implant material on incidence and/or peri-implantitis progression due to limited information., (© 2021 The Authors. Clinical Oral Implants Research published by John Wiley & Sons Ltd.)

Objectives: The purpose of this experimental in vivo investigation was to evaluate the influence of modifying the implant surface by adding a monolayer of multi-phosphonate molecules on the de novo bone formation and osseointegration., Material and Methods: The study was designed as an animal preclinical trial with intra-animal control and two healing periods, 2 and 8 weeks, to compare implants with an identical macro-design but with two different surfaces. Eight female Beagle dogs participated in the study. Control implants had a moderately rough surface combining sandblasting and acid etching; test implants had an additional monophosphonate layer covalently bonded to titanium. Histologic and radiographic (micro-CT) outcome variables were evaluated., Results: The first bone-to-implant contact (fBIC) was located more coronally for the test implants at the first (0.065 mm (95% CI = -0.82, 0.60)) and second healing milestones (0.17 mm (95% CI = -0.9, 0.55)). Most coronal BIC of the test implants displayed a higher percentage of osseointegration, +6.33% and +13.38% after 2 and 8 weeks, respectively; however, the differences were not statistically significant. The micro-CT examination did not show any BIC difference., Conclusions: The monophosphonate layer coating demonstrated clinical, histological, and radiographic results similar to the control surface., (© 2021 The Authors. Clinical Oral Implants Research published by John Wiley & Sons Ltd.)

Background: Although 5-year clinical data exist for different zirconia implants, no analysis has yet been performed focusing on how the surface topography of the implant affects clinical parameters., Purpose: To analyze the influence of zirconia implant topography on first bone implant contact (fBIC)., Materials and Methods: In a prospective two-center cohort investigation 63 zirconia implants were evaluated at implant placement, prosthetic delivery, 1, 3, and 5 years. The distance (DIB) between implant shoulder and fBIC was measured at each time point in periapical radiographs at mesial and distal sites. Two-way ANOVA/Bonferroni was used to analyze the effects of time and center (α < 0.05)., Results: Between the centers, the mean DIB varied significantly at implant placement (Freiburg [FR]: 1.4 ± 0.6 mm; Zurich [ZH]: 0.8 ± 0.5 mm). Thereafter, no statistically significant difference in DIB was observed, neither between centers nor between time points (prosthetic delivery: FR: 1.9 ± 0.6 mm, ZH: 1.7 ± 0.8 mm; 1 year: FR: 1.8 ± 0.6 mm, ZH: 1.6 ± 0.8 mm; 3 years: FR: 1.9 ± 0.8 mm, ZH: 1.7 ± 0.8 mm; 5 years: FR: 1.9 ± 0.8 mm, ZH 1.8 ± 0.6 mm). The overall mean DIB at prosthetic delivery to 5 years of both centers (1.8 ± 0.7 mm) is located within the transition zone between the smooth neck and the moderately rough intraosseous part (1.6-2.0 mm from the implant shoulder). However, individual DIB values are ranging from 0.1 to 4.2 mm overlapping the transition zone., Conclusions: The standard deviation of the DIB indicates that the fBIC establishes on moderately rough and smooth surfaces. Consequently, soft tissue adapts to both topographies as well., (© 2021 Wiley Periodicals LLC.)

Objectives: The purpose of this experimental in vivo investigation was to evaluate the influence of modifying the implant surface by adding a monolayer of multi-phosphonate molecules on the development of experimental peri-implantitis., Material and Methods: Eight beagle dogs received 5 tests and 5 control implants each following a split-mouth design 3 months after premolar and molar extraction. On the most mesial implant of each side, a 3-mm buccal dehiscence was artificially created. Experimental peri-implantitis was induced by silk ligatures over a 4-month period; after ligature removal, peri-implantitis was left to progress for another 4 months without plaque control. Clinical, histological, and radiographic outcomes were evaluated., Results: Radiographically, both implant groups showed a similar bone loss (BL) at the end of the induction and progression phases. BL measured on the histological sections of the test and control groups was 3.14 ± 0.42 mm and 3.26 ± 0.28 mm, respectively; the difference was not statistically significant (p > 0.05). The remaining buccal bone to implant contact (bBIC) percentage of the test and control groups was 59.38 ± 18.62 and 47.44 ± 20.46%, respectively; the difference, however, was not statistically significant (p > 0.05). Bone loss observed at dehiscent sites compared to non-dehiscent ones showed no statistically significant difference (p > 0.05)., Conclusions: Addition of a monophosphonate layer to a moderately rough implant surface did not affect development of experimental peri-implantitis., Clinical Relevance: Influence of implant surface on peri-implantitis may condition implant selection by the clinician, especially on patients with disease risk factors. In that sense, monophosphate layer implants do not show higher peri-implantitis risk than control implants.

Objectives: To compare the marginal bone level around implants with a thin multi-phosphonate coated surface after either an early or conventional loading protocol., Material and Methods: A randomized pilot clinical trial was conducted. Dental impressions were obtained after either 4 (test) or 8 weeks (control) and single crowns screwed-in 2 weeks later. Several variables were evaluated including radiographical marginal bone level (MBL), patient's level variables, and those related to the restoration and surrounding tissues. These data were obtained at several time points up to a 1-year follow-up., Results: Thirty-four patients were included in the study, 18 assigned to the test group. No differences at implant placement were detected for tissue thickness, keratinized mucosa, nor any other clinical or radiological variable. At the time of impressions, tissue was thinner in the test group (2.30 (0.46) versus 2.78 (0.66) mm, test versus control, respectively; p = .012) so shorter abutments were used in this group. Regardless, no significant changes in marginal bone level were detected neither within group along time nor between groups. The average MBL at the 1-year follow-up was -0.15 (0.32) versus -0.22 (0.37) (p = .443) (test versus control, respectively). None of the clinical or radiological variables evaluated had a determinant influence on the MBL at any visit nor group., Conclusion: The use of implants with a multi-phosphonate coated surface for early loading offers successful radiographical outcomes 1 year after loading. MBL over time was not affected by taking the impressions 4 or 8 weeks after implant placement and loading them 2 weeks later., (© 2020 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Objective: Mechanical plaque removal may alter the surface morphology of the gingival penetration part of the implant. We applied an air-powered abrasive system (AP), titanium curette (TC), stainless curette (SC), ultrasound scaler (US), and titanium brush (TB) which are commonly used to remove plaque, to titanium or zirconia and the changes in surface morphology and the epithelial attach against substrata., Materials and Methods: (a) The morphological changes of titanium and zirconia after mechanical cleaning were assessed by scanning electron microscopy and a roughness analyser. (b) Oral epithelial cells of rats were inoculated on the surface of the materials after mechanical cleaning, and the adherence of epithelial cells was observed. (c) The maxillary first molars were extracted from the rats and replaced by experimental titanium or zirconia implants. The length of the immunoreactive laminin-332 band was observed at the implant-peri-implant epithelium interface., Results: (a) The surface roughness increased in experimental groups except the AP group. (b) Among the experimental groups, the AP group showed the highest number of attached cells. (c) The length of the immunoreactive laminin-332 band was longer in the control group than those in all five experimental groups. Among the experimental groups, the AP group showed the longest band., Conclusion: All mechanical cleaning methods increased the surface roughness of the materials except AP. AP did not cause distinct implant surface alterations. Surface alteration caused by mechanical cleaning may evoke inferior for epithelial attachment and reduce resistance against foreign infiltration., (© 2019 John Wiley & Sons Ltd.)

Background: Plasma of argon was demonstrated to improve protein and cell adhesion on implant surface. On the other hand, increased surface energy and hydrophilicity could potentially amplify the risks of implant surface contamination during clinical phases, risks that have not yet been evaluated in Literature. The aim of the present in vitro study was to verify if Plasma treatment could alter the implant surface characteristics and its ability to remain sterile., Materials and Methods: Implants from 9 brands were collected (n=11). One implant for each company was used for SEM surface analysis. To perform the microbiological analysis, ten implants from each company were used and randomly split by allocation either in test or control group. To replicate the surgical work flow, both test and control samples were left 60s in clinical environment. Bacterial growth analysis was performed. Optical density at 600nm was measured as readout of bacterial growth and colony forming unit (CFU) after 24h was evaluated. Statistical analysis was performed by using the Wilcoxon Mann Whitney test. A p-value lower than 0.05 was considered significant., Results: SEM analysis revealed different categories of implant surface roughness. The optical density confirmed a readout of bacterial growth between 4 and 7 with no significant differences within groups. The number of CFU/ml for each measured sample (test and control) was lower than 102 and failed to present significant differences., Conclusion: Surface activation using plasma of argon did not affect the degree of implant contamination, allowing to maintain a substantial sterility of the implant independently of its morphology. This may allow in the next future the use of bioactivation through plasma of argon to exploit the superhydrophilicity deriving from this biophysical process., (Copyright © 2020 Elsevier GmbH. All rights reserved.)

The purpose of this study is to investigate, in vitro, how two different implant placement methods (one and two-stage implant placement) affect implant surface temperature after thermal stimulation. Two titanium screw implants were used and three thermocouples were attached to the implant surface at 0.5 mm (ch1), 5.5 mm (ch2) and 9.0 mm (ch3) under each platform. Experimental devices were fabricated pouring polymerization resin under a condition that imitated the two embedded technique with the one-stage implant placement model (1-stage) and the two-stage implant placement model (2-stage). A hot water storage device was installed in each model and hot water at three temperatures (60 °C, 70 °C and 100 °C) was flowed. The temperature change over time at the implant surface by the thermocouple was recorded. From the measurement data, the maximum temperature (Max-temp) at the implant surface, the time to reach 47 °C (47 °C r-time), and the duration of 47 °C or more (47 °C c-time) were calculated, and the test was repeated 26 times using the same method. The mean of repeated measurements was determined and statistical analysis was performed. Max-temp showed significant differences between each implant placement method, each channel and each thermal stimulation (p < 0.01). In this study suggested that the implant surface could reach 47 °C with 60 °C thermal stimulation in a 1-stage. In addition, it rose over 47 °C at 70 °C. The 2-stage implant surface did not rise to 47 °C.

Objective: To examine the progression of experimental peri-implantitis around different implants placed in augmented and pristine sites., Materials and Methods: Six labrador dogs were used. Three months after tooth extraction, four implants with different surface modifications were installed on each side of the mandible. A standard osteotomy was applied on one side, while on the contralateral side the osteotomy was modified, resulting in a gap between the implant and the bone wall. The gap was filled with a bone substitute and covered by a resorbable membrane. Three months after implant installation, implants were exposed and healing abutments were connected. Two months later, oral hygiene procedures were abandoned and a cotton ligature was placed in a submarginal position around the neck of all implants and kept in place for 4 weeks. Following ligature removal, plaque formation continued for 6 months (spontaneous progression period). Radiographs were obtained throughout the experiment, and biopsies were collected and prepared for histological evaluation at the end of the spontaneous progression period., Results: Differences in bone loss during the spontaneous progression period between pristine and augmented sites were small. The size and vertical dimension of the peri-implantitis lesion were larger at augmented than at pristine sites. Implants with non-modified surfaces exhibited smaller amounts of bone loss and smaller dimensions of peri-implantitis lesions than implants with modified surfaces., Conclusion: Small differences in spontaneous progression of peri-implantitis were detected between pristine and augmented sites. Implants with modified surfaces exhibited more bone loss and larger lesions than implants with non-modified surfaces, irrespective of the type of surrounding bone., (© 2019 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Background: The main goal of the treatment of the peri-implantitis is to decontaminate the surface of the implant, thereby enabling further treatment involving, e.g., guided bone regeneration. Since new implants of the rougher surface were introduced to the common dental practice, decontamination is even more difficult., Objectives: The aim of the study was to evaluate 3 different methods of decontaminating implants with 3 different surfaces., Material and Methods: A total of 30 dental implants with 3 different surface types (machined, sandblasted, and acid-etched (SLA) and hydroxyapatite (HA)-coated) were used in the study. Each group of implants was coated with Escherichia coli biofilm and cultivated. Afterwards, the implants were transferred to the jaw model and treated with a different method: sonic scaler mechanical debridement with a Woodpecker PT5 sonic scaler (1st group), and mechanical debridement with sonic scaler and with the combination with chemical agent Perisolv® (2nd group), and with Er:YAG laser treatment (3rd group). Each implant was treated with the specific method and sent for further microbiological evaluation., Results: The highest level of decontamination was achieved for machined-surface implants and the lowest for HA-coated implants. The method with the highest biofilm reduction was the scaler and Perisolv® group. The highest level of decontamination of HA-coated implants were achieved for Er:YAG laser irradiation method., Conclusions: In the following paper, the superiority of combined chemical-mechanical method of decontaminating the surface of the implant on SLA and machined-surface implants was proved. On the contrary, Er:YAG laser irradiation was reported as the best option for decontamination of the HA-coated implants. In our opinion, it is a significant finding, revealing that the method of peri-implantitis management should be considered in accordance to the type of the surface of the implant (customized to the surface of the implant).

Background: Implantoplasty is an option in peri-implantitis treatment, but little is known about the effect on the soft tissue. The aim of the study was to characterize surface roughness following experimental implantoplasty and to examine its effect on human fibroblast growth and secretion of selected proteins., Methods: Titanium grade IV coins were mechanically treated with six different rotating bur sequences; diamond burs or carbide burs alone, or followed by either Arkansas stone bur or silicone burs. Machined and rough-surface sandblasted, acid-etched (SLA) coins were used as control. The surface topography was characterized by scanning electron microscope and profilometer. Human gingival fibroblasts from two donors were cultured on the coins to quantify the effect on cell morphology, growth, and protein secretion by confocal microscopy and multiplex immunoassay., Results: All surface roughness parameters were lower for the surfaces treated with experimental implantoplasty than for the SLA surface, and the sequence of carbide burs followed by silicone burs rendered the least rough surface of the test groups. The implantoplasty procedures changed the elemental composition of the titanium surface. High surface roughness showed a weak to moderate negative correlation to fibroblast growth, but induced a higher secretion of VEGF, IL-6 and MCP-3 to the cell medium compared to the least rough surfaces of the test groups. At day 30 fibronectin levels were higher in the SLA group., Conclusions: The surface roughness following implantoplasty demonstrated a weak to moderate negative correlation with the growth of fibroblasts. The addition of Arkansas stone and silicon burs to the experimental implantoplasty bur protocol rendered an initial increase in fibroblast growth. Implantoplasty altered the elemental composition of the titanium surface, and had an effect on the fibroblast cytokine secretion and fibronectin levels.

Zirconia is widely employed as a material during dental implant work because of its superior esthetics. This study sought to evaluate the impact of titanium or zirconia implant abutments on epithelial attachments after ultrasonic cleaning. These implants were inserted into the extraction socket of rat maxillary first molars. Then, the length of the horseradish peroxidase (HRP) reaction was measured. In addition, titanium and zirconia disks were cleaned using an ultrasonic scaler, surface morphology changes were observed, and the number of epithelial cell attachments to the surface was measured. Ultimately, the surfaces of the titanium disks were easier to damage than those of the zirconia ones. There was no difference in the number of epithelial cell attachments between the two materials with the ultrasonic cleaning. The length of the HRP reaction was shorter on the zirconia implant abutment surface than on the titanium one after mechanical cleaning. In conclusion, zirconia is harder than titanium and a better choice for use in the epithelial tissue attachment. Zirconia is more suitable as a material for implant abutments than titanium.

This pilot study evaluates the effectiveness of the Mini-Invasive Surgical Approach (MISA) in the treatment of peri-implantitis defect. MISA is based on the use of the deproteinized bovine bone mineral with 10% collagen in combination with a minimal flap. The main principle is the elevation of a flap to access to the peri-implantitis defect only on one side (palatal aspect), leaving the opposite site intact. The study was designed as a non-controlled, non-randomized pilot study. In 10 consecutive subjects, 10 implants with diagnosis of perimplantitis were selected. In all the treated sites, primary closure was obtained at completion of the surgical procedure. No relevant pain, edema and hematoma were noted. The reported surgical approach resulted in significant clinical and radiographic improvements while limiting patient morbidity. After 1-year follow-up minimal mucosal recession, probing depth reduction and radiographic bone gain were noted., (Copyright 2020 Biolife Sas. www.biolifesas.org.)

Background: In the past few decades, very little research has been carried out to modify implant surfaces to improve osteointegration through the regulation of immune cells., Purpose: The aim of this study is to investigate whether the poly(dopamine) (pDA)-assisted immobilization of IL4 on titanium surfaces could modulate the inflammatory profile of macrophages in vitro and search for the possibility of enhancing implant integration in this way., Material and Methods: The surface composition, topography, and roughness of SLA, SLA-pDA, and SLA-pDA-IL4 discs were examined by scanning electron microscope (SEM) and energy dispersive spectrometer (EDS). Then the releasing profile of the SLA-pDA-IL4 implants was recorded for 1 week and the bioactivity of released IL4 was investigated by ELISA. Then macrophage polarization was investigated via three methods including: (a) surface marker via immunofluorescence; (b) mRNA levels of M1 and M2 polarization markers via real-time PCR, and (c) cytokine release via ELISA., Results: SEM and EDS revealed that pDA and IL4 were coated successfully on SLA surfaces. The ELISA results showed that IL4 remained its bioactivity on SLA surface and were immobilized on the SLA surface. The immobilization of IL4 through pDA has no significant influence on the attachment, morphology, and proliferation of macrophages, while it increased the M2/M1 proportion in human macrophages revealed by immunofluorescence. The real-time PCR and ELISA results demonstrated that SLA-pDA-IL4 surface reduced the pro-inflammatory profile compared with SLA-pDA and SLA surfaces., Conclusions: The SLA-pDA-IL4 surfaces described here is able to activate adherent macrophages into M2 phenotype and reduce the release of pro-inflammatory cytokines. Immobilization of IL4 via pDA is convenient and effective, thus providing an applicable way to control macrophage behavior upon implant insertion and is anticipated to accelerating further bone integration., (© 2019 Wiley Periodicals, Inc.)

The surface modifications of titanium dental implants play important roles in the enhancement of osseointegration. The objective of the present study was to test two different implant surface treatments on a rabbit model to investigate the osseointegration. The tested surfaces were: a) acid-etched surface with sandblasting treatment (SA) and b) an oxidized implant surface (OS). The roughness was measured by an interferometeric microscope with white light and the residual stress of the surfaces was measured with X-ray residual stress Bragg-Bentano diffraction. Six New Zealand white rabbits were used for the in vivo study. Implants with the two different surfaces (SA and OS) were inserted in the femoral bone. After 12 weeks of implantation, histological and histomorphometric analyses of the blocks containing the implants and the surrounding bone were performed. All the implants were correctly implanted and no signs of infection were observed. SA and OS surfaces were both surrounded by newly formed trabeculae. Histomorphometric analysis revealed that the bone-implant contact % (BIC) was higher around the SA implants (53.49 ± 8.46) than around the OS implants (50.94 ± 16.42), although there were no significant statistical differences among them. Both implant surfaces (SA and OS) demonstrated a good bone response with significant amounts of newly formed bone along the implant surface after 12 weeks of implantation. These results confirmed the importance of the topography and physico-chemical properties of dental implants in the osseointegration.

The implant surface must withstand high insertion torque during implant insertion. The aim of this study was to investigate the damage to implant surfaces caused by two different insertion protocols in vitro. Fifteen titanium implants per group were inserted in standardized polyurethane foam models, group 1 according to a non-threaded surgical protocol and group 2 according to a threaded surgical protocol. Before and after insertion, the surfaces were visualized by scanning electron microscopy (SEM) and non-contact laser profilometry. Different surface area parameters were evaluated and maximum torque during insertion was determined. SEM detected topographical changes such as deposition of the test block and smoothening of the surface in the region of the thread crests in both groups. The laser profilometry analysis revealed significant changes in the surface topography of the implants in both groups, but no differences between the groups. Insertion torque was significantly decreased in the threaded group. Both types of surgical intervention resulted in surface damage. Less damage was detected to the thread crests with the use of a thread cutter, and most of the surface was not visibly affected by the surgical protocol at the microscopic level. The surgical protocol seems to have a minor influence on preservation of the implant surface., (Copyright © 2018 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.)

Purpose: The objective of this study was to assess the influence of a novel surface of dental implants (ContacTi ® ) on the osseointegration process in a minipig model. The surface was compared with other existing surfaces on the market (SLA ® and SLActive ® ) by employing bone implant contact analysis (BIC) and implant stability., Method: Twelve minipigs were used with prior authorisation from an ethics committee. Three types of surfaces were tested: SLA ® (sand-blasted acid-etched titanium), SLActive ® (same but hydrophilic, performed under a nitrogen atmosphere), and ContacTi ® (alumina particle bombardment of titanium, bioactivated when treated thermochemically) in 4.1 mm × 8 mm implants with internal connection and a polished neck. Twelve implants of each surface type ( N = 36) were placed, sacrificing 1/3 of the animals at 2 weeks of placement, 1/3 at 4 weeks and the remaining 1/3 at 8 weeks. Numerical variables were compared with Analysis of Variance, and the correlation between ISQ and BIC was established with the Spearman's rank correlation coefficient., Results: SLActive ® and ContacTi ® surfaces showed elevated osteoconductivity at 4 weeks, maintaining a similar evolution at 8 weeks (large amount of mature lamellar tissue with high maturity and bone quality). The SLA ® surface showed slower maturation. The ISQ values in surgery were elevated (above 65), higher at necropsy and higher at 4 and 8 weeks in the SLA ® group than in the other two (SLActive ® and ContacTi ® ). No significant correlation was found between ISQ and BIC for each implant surface and necropsy time., Conclusion: The three surfaces analysed showed high RFA and BIC values, which were more favourable for the SLActive ® and ContacTi ® surfaces. No statistical correlation was found between the RFA and BIC values in any of the three surfaces analysed., Competing Interests: The authors reported no conflicts of interest related to this study.

A randomized controlled trial was performed to evaluate and compare the changes in implant stability quotient (ISQ) of implants of the same brand, design, length, and diameter but with two different surface treatments, placed in the posterior mandible: sandblasted and acid-etched (SAE) and chemically modified SAE (hydrophilic). Twenty implants of the same design, length, and diameter (cylindrical and compressive, 3.75×11mm) but with different surface treatments (control group: 10 SAE; test group: 10 modified SAE) were randomly assigned to placement in the posterior mandibular region in 20 different patients. ISQ values were assessed in a blinded manner for six consecutive weeks. The maximum and minimum ISQ values observed during follow-up were 76.0 and 48.5, respectively, in the test group, and 76.0 and 49.0, respectively, in the control group. There was no statistically significant difference (P=0.19) in ISQ variation for the test group implants (modified SAE). Comparison between the test and control groups revealed a significant difference in the measurements: the ISQ in the test group was higher than that in the control group during the follow-up period (parametric Mann-Whitney test). This study demonstrated that implants with a modified SAE surface installed in the posterior mandible showed higher and faster ISQ stability during the healing period when compared to implants with a SAE surface., (Copyright © 2019. Published by Elsevier Ltd.)

Objective: To evaluate the effect of bone substitute materials on hard and soft tissue healing in reconstructive surgical therapy of experimental peri-implantitis at implants with different surface characteristics., Material and Methods: Six female, Labrador dogs were used. 3 months after tooth extraction, four implants with two different surface characteristics (A and B) were installed on each side of the mandible. Experimental peri-implantitis was induced 3 months later. During surgical treatment of peri-implantitis, the implants were cleaned with curettes and cotton pellets soaked in saline. The implant sites were allocated to one of four treatment categories; (a) Group C; no augmentation, (b) Group T1; bone defect filled with deproteinized bovine bone mineral (c) Group T2; bone defect filled with a biphasic bone graft material, (d) Group T3; bone defect filled as T1 and covered with a collagen membrane. Clinical and radiological examinations were performed, and biopsies were obtained and prepared for histological analysis 6 months after peri-implantitis surgery., Results: Implant B (smooth surface) sites showed significantly (a) larger radiographic bone level gain, (b) enhanced resolution of peri-implantitis lesions, and (c) larger frequency of re-osseointegration than implant A (moderately rough surface) sites. Implant B sites also showed superior preservation of the mucosal margin. Differences between bone substitute materials and control procedures were overall small with limited advantages for T1 and T2 sites., Conclusion: Healing following reconstructive surgical treatment of experimental peri-implantitis was superior around implants with a smooth surface than implants with a moderately rough surface. Benefits of using bone substitute materials during surgical therapy were overall small., (© 2019 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Background: Poor osseointegration of dental implants often occurs in osteoporotic patients and processed implant surfaces could help to improve the dilemma., Purpose: This study aimed to compare the effects of different titanium (Ti) surfaces on bone-implant osseointegration in ovariectomized (OVX) sheep., Materials and Methods: Four groups were included: smooth titanium (ST) was merely polished Ti; micro titanium (MT) was treated with hydrofluoric acid (HF) for 30 minutes; strontium-loaded nano titanium (NT-Sr) was formed by magnetron sputtering; strontium-loaded micro/nano titanium (MNT-Sr) was fabricated by HF etching combined with magnetron sputtering. The biological responses were evaluated by human bone marrow-derived mesenchymal stem cells (hBMMSCs) experiments in vitro. Osseointegration was evaluated in vivo after each surface implant was inserted into OVX sheep' mandibles., Results: The numbers of adhered and mineralized hBMMSCs increased significantly in the MNT-Sr group. The bone-implant contact and the maximal pull-out force increased significantly with MNT-Sr surface. The bone volume ratio and trabecular number of the MNT-Sr group were significantly higher than others, whereas trabecular separation decreased., Conclusions: These results indicated that an MNT-Sr surface promotes the differentiation of hBMMSCs in vitro and enhances bone-implant osseointegration in vivo, which may be a promising option for clinical implants in osteoporotic patients., (© 2019 Wiley Periodicals, Inc.)

Background: The chemical surface structure of the porous titanium grafts has not been found to study in the literature on the similarity of chemical surfaces of different commercial dental implants., Purpose: The purpose of this study is to investigate the chemical composition and surface energies of white (WPTG) and black porous titanium granules (PTG) by energy dispersive x-ray spectrometry (EDX) analysis to compare with different commercial dental implant surface., Materials and Methods: The surface chemical compositions of six commercially available dental implants with different surface structures, PTG and WPTG were examined by EDX analysis. Surface analyzes were performed on the apical, middle, and coronal parts of each implant and on the top, flank, and valley regions on each side. Surface analyzes of dental implants were evaluated at ×200 and ×2000 magnifications. The EDX evaluation of PTG grafts were evaluated at ×250, ×2000, ×5000, and ×50 000 magnifications., Results: PTG grafts showed elements of Na (8.88 ± 9.98%), Cl (2.44 ± 1.96%), and Al (0.99 ± 0.37%) as well as Ti (90.06 ± 11.34%) molecule at ×5000 magnification. In WPTG, Ti (%34.55 ± 6.41%) and O (%65.44 ± 6.42%) molecules were detected., Conclusions: It has been found that PTG surface was not made of pure titanium, it has different chemical molecules at larger magnifications. Cell culture and experimental studies are needed to establish a relationship between the different commercial implants and the surface structure of the titanium granules., (© 2019 Wiley Periodicals, Inc.)

Natural teeth are supported by connective tissue collagen fibers that insert perpendicularly in the tooth cementum. Perpendicular insertion plays an important role in the maintenance of the junction between the oral epithelium and the periodontal connective tissue. Most titanium dental implant surfaces have no micro or macro structure to support perpendicularly oriented collagen attachment. Without this tight biologic seal to resist bacterial invasion and epithelial downgrowth, progressive bone loss in peri-implantitis is seen around dental implants. The purpose of this study was to establish the perpendicularly oriented collagen attachment to titanium oxide nanotube (TNT), and to assess its binding stability. TNT was prepared on the titanium-surface by anodization. Scanning electron microscopy (SEM) showed a regularly aligned TNT with an average 67 nm-diameter when anodized at 30 V for 3 h. Subsequently, collagen type I (CoI) was electrophoretically fused to anodic TNT in native polyacrylamide gel system where negatively charged CoI-C term was perpendicularly navigated to TNT. SEM and atomic force microscopy (AFM) were used to analyze CoI on the TiO 2 and TNT surface. Several tens of nanometers of CoI protrusion were recorded by AFM. These protrusions may be long enough to be priming sites for cell-secreted CoI. CoI laid parallel to the titanium surface when fused by a chemical linker. Binding resistance of CoI against drastic ultrasonication was measured by Fourier-transform infrared spectroscopy attenuated total reflection (FTIR-ATR). The electrophoretically fused CoI in the titanium nanotube (TNT-CoI EPF ) showed the significantly greatest binding resistance than the other groups (P < 0.01, a 1-way ANOVA and Tukey HSD post hoc test). Furthermore, TNT-CoI EPF surface rejected epithelial cell stretching and epithelial sheet formation. Chemically linked horizontal CoI on titanium oxide (TiO 2 ) facilitated epithelial cell stretching and sheet formation.

Background: The understanding of mechanisms of osseointegration as well as applied knowledge about oral implant surfaces are of paramount importance for successful clinical results., Purpose: The aim of the present article is to present an overview of osseointegration mechanisms and an introduction to surface innovations with relevance for osseointegration that will be published in the same supplement of Clinical Implant Dentistry and Related Research., Materials and Methods: The present article is a narrative review of some osseointegration and implant surface-related details., Results and Conclusions: Osseointegration has a changed definition since it is realized today that oral implants are but foreign bodies and that this fact explains osseointegration as a protection mechanism of the tissues. Given adequate stability, bone tissue is formed around titanium implants to shield them from the tissues. Oral implant surfaces may be characterized by microroughness and nanoroughness, by surface chemical composition and by physical and mechanical parameters. An isotropic, moderately rough implant surface such as seen on the TiUnite device has displayed improved clinical results compared to previously used minimally rough or rough surfaces. However, there is a lack of clinical evidence supporting any particular type of nanoroughness pattern that, at best, is documented with results from animal studies. It is possible, but as yet unproven, that clinical results may be supported by a certain chemical composition of the implant surface. The same can be said with respect to hydrophilicity of implant surfaces; positive animal data may suggest some promise, but there is a lack of clinical evidence that hydrophilic implants result in improved clinical outcome of more hydrophobic surfaces. With respect to mechanical properties, it seems obvious that those must be encompassing the loading of oral implants, but we need more research on the mechanically ideal implant surface from a clinical aspect., (© 2019 Wiley Periodicals, Inc.)

Purpose: To study the incidence of early implant failures in edentulous jaws and to describe the effects of some patient- and implant-related factors on the risk for early implant failures., Materials and Methods: The study retrospectively analyzed 4615 edentulous jaws (4067 patients), consecutively treated with dental implants at one referral clinic from 1986 to 2013. Implant failures that occurred from implant surgery up to the first recall examination 1 year after prosthesis insertion were recorded and defined as early implant failures. All removed implants were included as failures. Features of the study group and early implant failure rates were reported. A multivariable logistic regression model was used for analyzing possible associations between clinical factors, and the risk for early implant failures. Implant surfaces were categorized by means of roughness: turned (S a 0.5-1.0 μm) and moderately rough (S a 1.0-2.0 μm)., Results: Three hundred twenty-seven patients (344 jaws) were lost to follow-up. Early implant failures occurred in 8.6% of the jaws. In the maxilla there was a significantly higher incidence of early failures compared to the mandible both with turned implants, OR 5.93 (95% CI 4.21; 8.36), and moderately rough implants, OR 2.52 (95% CI 1.19; 5.34). The impact of implant surface roughness was significant in the maxilla with higher incidence of early failures with turned implants, OR 3.51 (95% CI 2.27; 5.42). There was a significant interaction between implant surface and jaw type on early failures (p = 0.034). Older age was associated with lower risk for early implant failures, OR 0.9 (95%CI 0.82; 0.99). In total, 63% of the jaws with failure could proceed with the prosthetic treatment without further implant insertions. Twenty-six percent of the early failures occurred after prosthesis insertion and 59% of those could maintain the same prosthesis after implant loss with or without adjustments., Conclusions: Changing the implant surface from turned to moderately rough decreased the incidence of early implant failures significantly in the maxilla, but not in the mandible. Older age at implant insertion was associated with lower risk for early implant failures in edentulous patients., (© 2018 by the American College of Prosthodontists.)

Purpose: The aim of current split-mouth study is to compare crestal bone loss of hybrid with moderately rough implants in patients with a bar-supported mandibular overdenture., Materials and Methods: Fully edentulous patients were enrolled for treatment with implant-supported overdentures. Each patient received two implants of which one moderately rough (Sa: 1.3 μm) and one hybrid surface implant (moderately rough implant body [Sa: 1.3 μm] and a minimally rough implant neck [Sa: 0.9 μm]). Beside the difference in implant surface the two implants are identical. After 3 and 12 months, peri-apical radiographs were taken to assess crestal bone levels and a Wilcoxon signed-rank test was used for pairwise comparison., Results: Forty-two implants were placed in 21 patients and no failures occurred after 1 year. An overall mean crestal bone loss of 0.40 mm (SD: 0.76; range: 0-3.93) and 0.35 mm (SD: 0.59; range: 0-2.56) was registered after a mean follow-up of 3.4 and 15.8 months. There was no statistical significant difference in crestal bone loss between the different implant surfaces or between the different time intervals., Conclusion: From this randomized controlled trial, it can be concluded that hybrid surface implants may be a viable alternative for implant treatment in the edentulous mandible., (© 2018 Wiley Periodicals, Inc.)

Objective: This study assessed the bone formation around titanium surface incorporating the calcium-magnesium (CaMg) deposited by blasted in rabbit tibia bone to determine whether this surface would further enhance bone healing compared with commercially available implant surface., Material and Methods: The deposition of CaMg on the titanium SLA surface were obtained by blasting formed the experimental group (EX group), while implants with traditional SLA surface were used as control group (CO group), in this study. Fifty cylindrical threaded implants with a length of 8 mm were used (P = 25 per group). Five implants of each group were used to surface characterization by scanning electron microscopy, energy dispersive spectrometry, and optical profilometry. Ten New Zealand white rabbits received 40 implants (n = 20 per group). Resonance frequency analysis was performed three times (0, 4, and 6 weeks). Histomorphometric analysis was performed 4 and 6 weeks after implantation. Statistical significance was set at P < 0.05., Results: Blasted CaMg deposition on SLA implant surface displayed almost identical surface morphologies and R(a) values at the micron scale. In comparing the implant stability quotient at the three time points, highly significant statistic differences were found (P < 0.001). Histomorphological analysis showed higher degrees of bone organization in the samples of test implant surfaces at both implantation times., Conclusion: Within the limitations of this study, the results indicate that the deposition of CaMg on the SLA titanium surface may be effective in enhancing the osseointegration of moderately rough grit-blasted implants by increasing the degree of bone-implant contact., (© 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Aim: To evaluate the effect of soft tissue thickness on bone remodelling and to investigate whether implant surface exposure can be avoided by adapting the vertical implant position in relation to the soft tissue thickness., Materials and Methods: Twenty-five patients received two non-splinted implants supporting an overdenture in the mandible. Soft tissue thickness was measured using bone sounding and ultrasonically. One implant was installed equicrestally (control), and the vertical position of the second implant was adapted to the site-specific soft tissue thickness (test). Crestal bone levels were determined on digital peri-apical radiographs and compared with baseline (implant placement)., Results: Twenty-five patients were consecutively treated. No implants failed during the follow-up. A significant correlation was observed between soft tissue thickness and bone level alterations after 6 months (ultrasound ICC = 0.610; bone sounding ICC = 0.641) with inferior bone levels for equicrestal implants when thin tissues are present. Subcrestal implants showed significantly better bone levels after 6-month (n = 24, 0.04 mm versus 0.72 mm; p < .001), 1-year (n = 24, 0.03 mm versus 0.77 mm; p < .001) and 2-year follow-up (n = 24, 0.04 mm versus 0.73 mm; p < .001)., Conclusion: Initial bone remodelling was affected by soft tissue thickness. Anticipating biologic width re-establishment by adapting the vertical position of the implant seemed highly successful to avoid implant surface exposure., (© 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Objectives: Primary healing of dental implants is influenced by their surface morphology. However, little is known about any alterations in morphology during their insertion. Therefore, the aim of this study was to evaluate the surface morphology of four different implant systems, following their insertion in porcine jaw bones., Methods: Four fresh porcine mandible specimens were used. Six new implants of four systems (Ankylos® 4.5 × 14 mm, Frialit Synchro® 4.5 × 15 mm, NobelReplace ® Tapered Groovy RP 4.3 × 13 mm, Straumann SLA® Bone Level 3.3 × 14 mm) were inserted, whereas one implant of each system served as a control. After their removal, implants were cleaned in an ultrasonic bath. All 28 implants were examined quantitatively by 3D confocal microscopy for surface characteristics., Results: In the evaluated zones, implants of the Ankylos, Frialit, and Straumann systems showed mostly a reduction of the mean surface roughness Sa, the maximal surface roughness Sz, and the developed surface area ratio Sdr; Nobel implants showed an increase in these parameters. With respect to all three parameters Sa, Sz, and Sdr, statistical analysis revealed that differences between the four systems were highly significant in the apical region of implants. Controls showed no morphologic alterations., Conclusion: The insertion process had an impact on the surface of all four implant systems. Anodized implant surface modification seems to result in more alterations compared with subtractive surface modifications. Therefore, surgical planning should take into consideration the choice of surface treatment because the characteristics of the implants may be modified during the installation process., Clinical Relevance: The given information is of value for daily implantation practice and the course of osseointegration.

Objective: The aim of this randomized, controlled histologic/histomorphometric study was to compare the early bone formation around immediately loaded implants with nanostructured calcium-incorporated (NCI) and machined (MA) surface, placed in the human posterior maxilla., Materials and Methods: Fifteen fully edentulous patients (six males; nine females; mean age 57.9 ± 6.7 years) were selected for this study. Each patient was installed with two temporary transmucosal implants, with different surfaces: one NCI (test) and one MA (control) implant. All temporary implants were placed in the posterior maxilla, according to a split-mouth design, to help to support an interim complete maxillary denture. After 8 weeks, all temporary transmucosal implants were retrieved for histologic/histomorphometric evaluation. The bone-to-implant contact (BIC%) and the bone density (BD%) were calculated. The Wilcoxon matched-pairs signed-rank test was used to evaluate differences (BIC%, BD%) between the surfaces. The level of significance was set at 0.05., Results: Eight weeks after placement, 24 clinically stable implants (12 test, 12 control) were subjected to histologic/histomorphometric evaluation. In the MA implants, the histomorphometric evaluation revealed a mean BIC(±SD)% and BD(±SD)% of 21.2(±4.9)% and 29.8(±7.8)%, respectively. In the NCI implants, the histomorphometric analysis revealed a mean BIC(±SD)% and BD(±SD)% of 39.7(±8.7)% and 34.6(±7.2)%, respectively. A statistically significant difference was found between the two surfaces with regard to BIC% (p < 0.001), while no significant difference was found with regard to BD% (p = 0.09)., Conclusions: The NCI surface seems to increase the peri-implant endosseous healing properties in the native bone of the posterior maxilla, under immediate loading conditions, when compared with the MA surface., Clinical Relevance: Under immediate loading conditions in the human posterior maxilla, the nanostructured calcium-incorporated surface has led to better histologic and histomorphometric results than the machined surface; therefore, the clinical use of implants with nanostructured calcium-incorporated surface may be beneficial in the posterior maxilla, under immediate loading protocol.

Objectives: To compare the peri-implant bone healing between TiZr implants with hydrophilic SLActive and hydrophobic SLA implant surface in patients receiving anticoagulants, to assess the implant survival and success rate, as well as to evaluate whether small-diameter TiZr implants could be used in patients on OAT in order to avoid augmentation procedures., Material and Methods: A total of 80 small-diameter tissue-level TiZr implants with SLActive and SLA surfaces were placed in 20 anticoagulated patients, following the "split-mouth" study design. Implant stability was measured up to the third postoperative month by resonance frequency measurements (RFA). One-year implant survival and success rate were evaluated., Results: After one year, 100% implant survival and success rate were observed. A significant decrease in ISQ comparing to baseline values was noted in the SLActive group from the first postoperative week, and in the SLA group, from the 3rd week after the surgery. In both groups, a statistically significant decline in ISQ was observed between second and third postoperative week. No significant differences in ISQ values between SLActive and SLA implants were noted, at any time point., Conclusions: Titanium-zirconium small-diameter implants with SLActive and SLA surface predictably achieve and maintain adequate bone tissue integration in patients receiving anticoagulants. OAT appears to influence the bone healing events resulting in lower ISQ in the end of 3-month period in comparison with baseline values, although without compromising implant stability., (© 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Background: Chemical modifications of the dental implant surface that improve the wettability result in a faster and better osseointegration., Purpose: The aim of this randomized clinical trial was to evaluate the implant stability quotient (ISQ) of implants with similar designs, treated with 2 surfaces, sandblasted acid-etched (SAE) and hydrophilic SAE, within the initial 16 weeks of healing., Material and Methods: A total of 64 implants (32 SAE-control group and 32 modified SAE-test group) with the same design, length, and diameter (conical and compressive, 4.3 × 10 mm) were inserted into the posterior maxillae of 21 patients partially edentulous. The ISQ values were collected at post-surgery (T0), 1 week (T1), 2 weeks (T2), 3 weeks (T3), 5 weeks (T4), 8 weeks (T5), 12 weeks (T6), and 16 weeks (T7)., Results: None of the implants failed. Test group presented ISQ values higher than the control group (ANOVA-P < .01) from T5 to T7. When comparing groups regarding the amount of time required to achieve ISQ ≥ 70 as a reference, there was a statistically significant difference (cox regression-P < .01), and a hazard ratio of 2.24 (CI 1.62-3.11). At the 1-year follow-up, there was a drop out of 1 patient, and 2 implants were no longer evaluated. Survival rate for both groups was 100% at the 1-year follow-up., Conclusions: The current study suggests that implants with hydrophilic surface (modified SAE) integrate faster than implants with SAE surface. The stability gain of the test group was 2.24 times faster than the control group after 5 weeks of evaluation at the posterior region of the edentulous maxillae., (© 2017 The Authors Clinical Implant Dentistry and Related Research Published by Wiley Periodicals, Inc.)

Background: The mechanisms behind the impact of smoking on osseointegration are not fully understood., Purpose: To investigate the initial clinical and molecular course of osseointegration of different implants in smokers and non-smokers in a randomized controlled trial (RCT)., Materials and Methods: Smoking (n = 16) and non-smoking (n = 16) patients received 3 implant types: machined, oxidized, and laser-modified surfaces. Baseline bone biopsies were retrieved from the implant sites. After 60 and 90 days, the pain score, implant stability quotient (ISQ), and peri-implant crevicular fluid (PICF) gene expression were analyzed. Furthermore, radiological and clinical assessments were made at 90 days., Results: At 90 days, no pain was reported, irrespective of smoking habit. A higher ISQ was found in smokers compared with non-smokers. Marginal bone loss (MBL) was greater in smokers than in non-smokers. The comparison of implant surfaces revealed greater MBL exclusively at the machined implants in smokers. At 90 days in smokers, the PICF around machined implants revealed a higher expression of the proinflammatory cytokine, interleukin-6 (IL-6), and a lower expression of the osteogenic gene, osteocalcin (OC), compared with the PICF around modified implants. Furthermore, OC expression was lower at machined implants in smokers compared with machined implants in non-smokers. After adjustment for age and implant location (maxilla/mandible), multivariate regression revealed the following predictors of MBL: smoking, bleeding on probing at 90 days, hypoxia-inducible factor 1 alpha (HIF-1α) expression at baseline and IL-6 expression in PICF at 90 days., Conclusions: During the early phase of osseointegration, non-smokers and smokers present a similar, high implant survival. In contrast, smokers present a greater MBL, particularly at machined implants. HIF-1α baseline expression in the recipient bone and IL-6 expression in PICF cells are important molecular determinants for MBL after 90 days. It is concluded that smoking has an early effect on osseointegration, which is dependent on the implant surface properties and the local host response., (© 2017 Wiley Periodicals, Inc.)

Aim: To study sequential osseointegration around implants with nano-technologically modified surfaces at different periods of healing., Materials and Methods: After 3 months, two different implant systems with different nano-technologically modified surfaces were randomly installed in the edentulous molar regions of the mandible of 12 dogs. One surface was acid-etched surface, and subsequently modified with calcium ions (UnicCa ® ), while the other was a hydrophilic sandblasted with large grit and acid-etched (SLActive ® ) surface. The implants were fully submerged, and biopsies were obtained representing the healing after 1, 2, 4 and 8 weeks (n = 6 per period). A morphometric evaluation of densities of new soft tissues (provisional matrix and immature bone marrow), new and old bone, mature bone marrow, vessels and other tissues (bone debris/particles and clot) was performed in the spongiosa compartment of the sites of implantation., Results: After 1 week of healing, the soft tissues, mainly composed of provisional matrix, were present at 41.5 ± 23.9% and 30.1 ± 20.0% at the UnicCa ® and SLActive surfaces, respectively. These percentages were >40% at both surfaces after 2 weeks of healing, presenting greater amount of immature bone marrow. Subsequently, these percentages decreased up to disappear after 8 weeks of healing. New bone increased progressively between 1 and 8 weeks of healing from 8.2 ± 3.0% to 77.1 ± 6.4% and from 6.8 ± 2.8% to 67.9 ± 6.8% at the UnicCa ® and SLActive ® , respectively. Old bone decreased progressively over time., Conclusions: The patterns of healing at highly hydrophilic surfaces occurred through the early formation of a provisional matrix followed by the formation of new bone and marrow at various stages of maturation. The healing was similar to those described in different animal models, anatomical sites and surgical procedures., (© 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Objectives: The objective of the study was to assess the influence of implantoplasty (IP) on the diameter, chemical surface composition, and biocompatibility of titanium implants in vitro., Material and Methods: Twenty soft tissue-level (TL; machined transmucosal-M and rough endosseous part-SLA) and 20 bone-level (BL; SLA) implants were allocated to IP covering 3 or 6 mm of the structured surface (SLA) area. The samples were subjected to diameter, energy-dispersive X-ray spectroscopy (EDX), and cell viability (ginigval fibroblasts, 6 days) assessments., Results: Median diameter reductions varied between 0.1 (TL 3 mm) and 0.2 mm (TL 6 mm). EDX analysis revealed that IP and M surfaces were characterized by a comparable quantity (Wt%) of elements C, O, Na, Cl, K, and Si, but a significantly different quantity of elements Ti and Al. When compared to SLA surfaces, significant differences were noted for elements C, O, Na, Ti, and Al. At BL implants, the extension of IP (i.e., 3 to 6 mm) was associated with a significant increase in cell viability., Conclusions: IP applied to SLA implants was associated with (i) a minimal diameter reduction, (ii) an undisturbed cell viability, and (iii) a chemical elemental composition comparable to M surfaces., Clinical Relevance: This specific IP procedure appears to be suitable for the management of exposed SLA implant surfaces.

Background: Smoking is a risk factor for dental implants. The mechanisms behind the impact of smoking on osseointegration are not fully understood., Purpose: To investigate the initial molecular and clinical course of osseointegration of different titanium implants in smokers and nonsmokers., Materials and Methods: Smoker (n = 16) and nonsmoker (n = 16) patients were included. Each patient received three implant types: machined, oxidized and laser-modified surfaces. After 1, 7, 14, and 28 days, the peri-implant crevicular fluid (PICF) was sampled for gene expression analysis of selected factors involved in early processes of osseointegration. Furthermore, pain-score (VAS), resonance frequency analysis (RFA) and baseline clinical assessments were performed., Results: Early failure of osseointegration, associated with a high and sustained perception of pain, was encountered in 3/32 patients. In general, high pain scores were reported during the first days after implantation, irrespective to smoking habit, which correlated to high levels of pro-inflammatory cytokines during the first days after implantation. Higher ISQ values were found in smokers compared to nonsmokers. In smokers exclusively, ISQ values correlated to harder and less atrophic bone quality and quantity, respectively. Smokers displayed a higher expression of osteocalcin (OC), but later peak and lower expression of bone morphogenetic protein (BMP-2) (at 7 days) compared to nonsmokers. In comparison to machined implants, surface-modified implants were associated with higher expression of alkaline phosphatase (ALP) and cathepsin K (CatK) at 28 days in nonsmokers., Conclusions: During the early phase of osseointegration, postoperative pain is linked to the inflammatory cell response and, may tentatively serve as an indicator of biological complication and implant loss. The present study suggests that smokers have an altered bone composition and (ultra)structure based on the observations that ISQ values are higher and correlate to recipient bone quality and quantity in smokers., (© 2017 Wiley Periodicals, Inc.)

Aim: To study tissue components adjacent to implants with nanotechnologically modified surfaces at different periods of healing., Material & Methods: In 12 beagle dogs, two different implant systems with different surface configurations were randomly installed in the edentulous premolar regions of the mandible. One surface was first acid-etched and subsequently, nanotechnologically modified with calcium ions (UnicCa ® ), while the other was first sandblasted and acid-etched, and then additionally treated with a nanometer calcium phosphate deposition (discrete crystalline deposition; DCD ® ). The implants were fully submerged; surgeries and sacrifices were planned to harvest biopsies after 1, 2, 4 and 8 weeks of healing (n = 6 per period). A morphometric evaluation of percentages of new and old bone, bone debris/particles and clot, new soft tissues (provisional matrix and immature marrow), mature bone marrow and vessels was performed in the spongiosa compartment adjacent to the implant surface up to a distance of about 0.4 mm from the surface., Results: After 2 weeks of healing, the soft tissues were represented by 41.0% at the UnicCa ® and 37.9% at the DCD ® surfaces, in both cases mainly being composed of provisional matrix. These percentages decreased over time, being composed of greater amounts of immature bone marrow, and disappeared after 8 weeks. New bone increased progressively between 1 and 8 weeks of healing from 9.7 ± 6.3% to 70.0 ± 8.4% and from 8.2 ± 3.5% to 67.0 ± 6.1% at the UnicCa ® and DCD ® surfaces, respectively. Pristine bone was progressively resorbed., Conclusions: Throughout the periods of healing observed, the formation of a provisional matrix followed by the formation of new bone and marrow was revealed in a similar fashion as for other modified surface configurations., (© 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

The chemical decontamination of infected dental implants is essential for the successful treatment of peri-implantitis. The aim of this study was to assess the antibacterial effect of a hydrogen peroxide-titanium dioxide (H 2 O 2 -TiO 2 ) suspension against Staphylococcus epidermidis biofilms. Titanium (Ti) coins were inoculated with a bioluminescent S. epidermidis strain for 8 h and subsequently exposed to H 2 O 2 with and without TiO 2 nanoparticles or chlorhexidine (CHX). Bacterial regrowth, bacterial load and viability after decontamination were analyzed by continuous luminescence monitoring, live/dead staining and scanning electron microscopy. Bacterial regrowth was delayed on surfaces treated with H 2 O 2 -TiO 2 compared to H 2 O 2 . H 2 O 2 -based treatments resulted in a lower bacterial load compared to CHX. Few viable bacteria were found on surfaces treated with H 2 O 2 and H 2 O 2 -TiO 2 , which contrasted with a uniform layer of dead bacteria for surfaces treated with CHX. H 2 O 2 -TiO 2 suspensions could therefore be considered an alternative approach in the decontamination of dental implants.

Objective: To characterize the profile of microbial communities colonizing titanium implants with different surface treatments after exposure to the oral environment at the genus or higher taxonomic level., Material and Methods: Sixteen titanium disks, machined or sandblasted large-grit and acid-etched (SLA), were mounted on removable intraoral splints worn by four patients. After 24 h of intraoral exposure, biofilm samples were collected from disks and supra/subgingival teeth areas. The 16S rDNA genes from each sample were amplified, sequenced with the Miseq Illumina instrument and analyzed., Results: A total of 29 genera and seven more inclusive taxa, representing the phyla Firmicutes, Proteobacteria, Fusobacteria, Bacteroidetes, Actinobacteria and candidate division TM7 were identified in both titanium surfaces and teeth. No differences were found in relation to the operational taxonomic units (OTUs) and microbial diversity, assessed by Chao 1 and Shannon indices, when comparing SLA and machined titanium surfaces., Conclusions: Machined and SLA surfaces are colonized by similar numbers of prokaryotic OTUs after 24 h of exposure to the oral environment. Higher complexity of the titanium surface topography in the initial phase of biofilm maturation does not seem to significantly influence the colonizing microbiota., (© 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

The aims of this in vitro study are to compare the efficacy of different cleaning methods in removing debris of failed implants and to detect thermal changes of the implants treated by various scaling instruments. Twenty-seven failed implants and two unused implants as control were included to this study-group 1: plastic curette (P), group 2: titanium curette (T), group 3: carbon curette (C), group 4: titanium brush (TB), group 5: Er:YAG laser (laser 1 (L1) 100 mJ/pulse at 10 Hz), group 6: Er:YAG laser (laser 2 (L2) 150 mJ/pulse at 10 Hz), group 7: Er:YAG laser (laser 3 (L3) 200 mJ/pulse at 10 Hz), group 8: ultrasonic scaler appropriate for titanium (US), group 9: air abrasive method (AA) + citric acid, and group 10: implantoplasty (I). The changes on the treated/untreated titanium surfaces and remnant debris were observed by scanning electron microscopy (SEM). Temperature of the implants before and after treatment was detected using a thermocouple. The use of air abrasive and citric acid combination and Er:YAG laser groups was found as the best methods for the decontamination of titanium surfaces of failed implant. When the hand instruments were compared, titanium curette was found better than both the plastic and the carbon curettes which leave plastics and carbon remnants on the titanium surface. The temperature was higher after hand instrumentation when compared to other experimental groups (p < 0.05). Within the limitations of the present in vitro model, it can be concluded that the best method for decontamination of the implant surface is the use of air abrasives and Er:YAG laser.