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Purpose: To assess the amount of contamination remaining on used healing abutments after autoclaving and to compare the effectiveness of two additional decontamination methods., Materials and Methods: After autoclaving, a total of 120 used healing abutments were divided equally into three groups: used healing abutments after autoclaving only (group 1); used healing abutments after autoclaving and air-flow polishing (Master Piezon, EMS) using erythritol powder (AIR-FLOW PLUS, EMS) (group 2); and used healing abutments after autoclaving and sodium hypochlorite (NaOCl; 25 g/L) treatment (group 3). Residual contaminants were stained using Phloxine B (400 g/mL), and healing abutments were photographed using a light microscope with digital capture system (Nikon SMZ800). The proportion of stained (ie, contaminated) areas on each healing abutment was then measured using imaging software (ImageJ). The healing abutments were also examined using scanning electron microscopy (SEM)., Results: Mean proportion of surface area affected by residual contaminants on the body, top (screwdriver-engaging), and bottom (implant-abutment interface) surfaces for group 1 was 38.2% ± 28.34%, 30.0% ± 19.55%, and 18.7% ± 17.87%, respectively; group 2 showed 3.5% ± 4.90%, 5.3% ± 3.74%, and 5.4% ± 8.49%, respectively; and group 3 showed 0.3% ± 0.16%, 1.9% ± 2.14%, and 0.7% ± 1.02%, respectively. Autoclaving alone was insufficient for successful decontamination, while additional decontamination procedures significantly reduced remaining contaminants. NaOCl was significantly more effective than air polishing. SEM analysis showed no detectable differences in the surface appearance of titanium healing abutments., Conclusion: The results show that decontamination of used healing abutments is achievable, thus strengthening the feasibility of reusing healing abutments.

To analyse the changes of surface characteristics of machined and moderately roughened titanium disks following a standardised implantoplasty protocol. Forty titanium discs (machined: n = 20; moderately roughened: n = 20) were instrumented with one half of each disc maintained as the control (non-instrumented). The standardised implantoplasty protocol was carried out using a custom jig with the sequential change of burs: 1) Regular grit diamond [10s], 2) Super-fine grit diamond [10s], 3) Brownie(tm) silicone polisher [15s], 4) Greenie(tm) silicone polisher [15s]. Surface topography was analysed using confocal laser scanning microscopy (CLSM) and scanning electron microscopy (SEM). Energy dispersive x-ray spectroscopy (EDS) was used to measure the elemental profiles of each disc. Quantitative analysis showed similar changes in level of roughness between the machined and moderately roughened titanium discs. CLSM demonstrated an increased roughness (Ra and Sa values) after polishing with a regular grit diamond bur when compared to the uninstrumented surfaces. Although the roughness decreased after the further polishing with the super-fine grit diamond bur, subsequent instrumentation using silicon burs tended to increase the roughness, albeit being statistically insignificant. There was a residue of silicon particles despite the irrigation after each polishing stage. The proposed implantoplasty protocol did not achieve a sufficient level of smoothness on the machined or moderately roughened titanium surfaces when compared to the Ra threshold. Further research is recommended to test the efficacy of each bur on titanium surfaces with longer duration using actual oral implants to allow better comparison.

Purpose: The aims of this in vitro study were to evaluate morphological changes induced by glycine powder air-polishing on titanium surfaces, biofilm removal, and biocompatibility., Material and Methods: Titanium grade IV discs were allocated into two groups: (1) discs without biofilm and (2) discs for Streptococcus mutans biofilm formation. Discs in each group were further subdivided into (a) no treatment and (b) air-polishing treatment with glycine powder. Discs were characterized by scanning electron microscopy (SEM), electron-dispersive spectroscopy (EDS), and confocal microscopy. Bacterial biofilms were quantified using a crystal violet dye-binding assay. Biocompatibility was evaluated by measuring the coverage and viability of L929 fibroblast cells cultured on the discs., Results: Air-polishing increased the roughness of treated discs (P < 0.05). EDS analysis did not show significant differences in the chemical composition of treated and nontreated discs. The amount of residual biofilm on treated discs was 8.6-fold lower than untreated controls (P < 0.05). Coverage of treated discs by fibroblasts was half that of untreated discs (P < 0.05) although both groups had the same cell viability., Conclusions: Air-polishing removed a significant amount of biofilm from titanium surfaces. The "polishing" was accompanied by increased surface roughness, but there were no changes in chemical and elemental compositions, nor the biocompatibility.

Good exposure of the preparation margins and haemostasis in the sulcular gingiva are necessary for accurate impressions to produce precise restorations. The use of cordless retraction paste material in implant dentistry is a relatively novel application. However, few studies have been conducted on the use of retraction pastes and their possible interaction with implant surfaces. Recent literature has described remnants on titanium implant surfaces and expressed the need for an assessment of the biocompatibility of the exposed surface (Chang et al.). This in vitro study evaluated the effect of a cordless gingival retraction paste on sterile titanium disks. Surface chemistry was determined using energy-dispersive X-ray spectroscopy (EDS), and further investigated using laser ablation inductively coupled plasma mass spectrometry (LA-ICP-MS). After exposure to retraction paste, surface chemistry alterations were identified. A fibroblast cell line (L929) was exposed to the disks and the live/dead viability/cytotoxicity assay was used to determine any effects on the proliferation and health of cells. The disks exposed to the retraction paste showed fewer dead cells compared to the unexposed disks. This was statistically significant.

Complications such as peri-implantitis could ultimately affect the survival of a dental implant. The prevention and treatment of peri-implant diseases require managing bacterial biofilm and controlling environmental risks, including the presence of pro-inflammatory titanium (Ti) particles in the peri-implant niche. Objectives included the evaluation of the size and quantity of Ti particles released from moderately roughened Ti surfaces during common mechanical surface decontamination methods. One hundred and forty moderately roughened Ti discs were divided into seven groups (n = 20 per group); six groups received mechanical decontamination procedures (ultrasonic scaling (US) with a metal tip and poly-ether-ketone (PEEK) under low and medium power settings, air-polishing with erythritol powder, and Ti brush), and the control group underwent air–water spray using a dental triplex. The rinsing solution was collected for Ti mass analysis using inductively coupled plasma mass spectrometry (ICPMS), as well as for Ti particle size and count analysis under scanning electron microscopy (SEM) with energy-dispersive spectroscopy (EDS). US metal tip instrumentation generated 34.00 ± 12.54 μg and 34.44 ± 6.08 μg of Ti under low and medium power settings, respectively. This amount of Ti generation was significantly higher than other instrumentation methods. The mean Ti particle size of the US groups ranged from 0.89 ± 0.27 μm to 1.25 ± 0.24 μm. No statistically significant difference was found in the particle size among US groups and Ti brush group (1.05 ± 0.11 μm), except for US with the PEEK tip, where a significantly smaller mean particle diameter was found at the low power setting (0.89 ± 0.27 μm). Mechanical instrumentation can produce Ti particulates and modify the implant surfaces. US using a metal tip generated the highest amount of Ti with smaller Ti size particles compared to all other commonly used mechanical surface instrumentations. The EDS analysis confirmed Ti in PEEK US tips. It can be suggested that deterioration from the PEEK US tip and Ti brush, as observed under SEM, is an additional source of Ti release during Ti surface decontamination. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the presence of metallic particles in the peri-implant mucosa around titanium dental implants after 5 years of loading using single-implant crowns with respect to clinical signs of peri-implant inflammation. Materials and Methods: Sixteen participants from an ongoing, prospective, single-arm clinical trial who had received titanium dental implants restored with single maxillary crowns veneered to zirconia abutments were available for the study. Exfoliative cytology samples were obtained from the peri-implant tissues and contralateral tooth sites using microbrushes and were evaluated by means of light microscopy (LM), scanning electron microscopy, and energy-dispersive spectroscopy (EDS). Trace elemental analysis was also carried out on the microbrushes using inductively coupled plasma mass spectrometry. Peri-implant and periodontal parameters (plaque, bleeding, attachment level, radiographic bone levels) were recorded. Results: Titanium particles were found in both the single-implant crown and contralateral natural tooth sites. LM and EDS analyses showed significantly higher numbers of Ti particles at the implant-abutment interfaces (mean = 14.168; SD = 2.36) and in the internal aspects of peri-implant mucosa in contact with the prostheses (mean = 4.438; SD = 2.22) when compared with other test and control areas. Mean probing depths were ≤ 3 mm, and no differences were found in plaque or bleeding on probing between implant and tooth sites. Median bone levels were within the normal range for both implant (mesial: 0.5 mm; distal: 0.8 mm) and tooth (mesial: 1.5 mm; distal: 1.8 mm) sites. Conclusion: Loading of single-implant zirconia crowns can cause the release of Ti particles because of functional wear at the implant-abutment level. The presence of these metal particles in the peri-implant area did not appear to affect peri-implant health in this patient group. [ABSTRACT FROM AUTHOR]

The aim of this narrative review was to critically evaluate in vitro studies assessing the efficacy of lasers in the bacterial decontamination of titanium implant surfaces. The MEDLINE, Web of Knowledge and Embase electronic databases were used to search for articles relating to the use of lasers in the bacterial decontamination of titanium specimen surfaces using predetermined search statements. Clinical studies, case reports, case series, review articles and animal models were excluded. Study selection was carried out independently and then cross-checked by two authors through abstract viewing. Eighteen articles were selected for full-text analysis. Erbium-doped yttrium-aluminium-garnet lasers had a wide range of powers capable of inducing bacterial decontamination. While carbon dioxide and gallium-aluminium-arsenide diode lasers demonstrated the ability to produce bacterial decontamination, the bacterial sensitivity to each varied depending on the species involved. There is no concensus on the laser type or settings that are optimal for bacterial decontamination of titanium implant surfaces as studies employ various test specimens, contamination methodologies, irradiation settings and protocols, and outcome measures resulting in limited study comparability. More investigations are required to provide guidelines for the use of laser therapy in the decontamination of implant surfaces. [ABSTRACT FROM AUTHOR]

Background: Titanium healing abutments (HAs) are used during the healing period after implant placement to guide the soft tissue profile and protect the internal aspect of dental implants. While this temporary component is marketed as single‐use only, a safe and reliable way to sterilise and reuse this component could result in financial and environmental benefits. Aim/Hypothesis: To assess the amount of contamination remaining on used HAs after sterilisation by autoclave, and to develop and compare the effectiveness of additional decontamination methods. Material and Methods: A total of 120 used HAs after autoclaving was divided equally into three groups. Group 1‐ Used HAs after autoclaving. Group 2‐ Used HAs after autoclaving and mechanical decontamination with air‐flow polishing (EMS Master Piezon_SP_®_sp_) using erythritol powder (EMS Prophylaxis Powder). Group 3‐ Used HAs after autoclaving and chemical decontamination with sodium hypochlorite (NaOCl+ 25 g/L). Residual contaminants were stained using Phloxine B (400 µg/mL) and six aspects of each HA were photographed using a light microscope (2× magnification) with digital capture system (Nikon SMZ800). The proportion of stained (i.e. contaminated) area on each HA was then measured using an imaging software (ImageJ). The HAs were also examined using scanning electron microscopy (SEM) to investigate any adverse effects of each decontamination procedure on the surface characteristics of titanium HAs. Results: The mean proportion of surface area affected by residual contaminants on the body, top (screw driver‐engaging) and bottom (implant‐abutment interface) surfaces for group 1 were 38.2% (sd 28.34), 30.0% (sd 19.55) and 18.7% (sd 17.87) respectively whereas group 2 showed 3.5% (sd 4.90), 5.3% (sd 3.74) and 5.4% (sd 8.49) respectively, and for group 3 the results were 0.2% (sd 0.16), 1.9% (sd 2.14) and 0.7% (sd 1.02) respectively. Autoclaving alone was insufficient for successful decontamination while additional decontamination procedures significantly reduced the proportion of residue remaining on used HAs. NaOCl was significantly more effective than air‐polishing at improving decontamination on all HA surfaces. The body surface of HAs was more readily cleaned, followed by the bottom, then the top surfaces. The SEM analysis showed no detectable differences in the surface appearance of titanium HAs after additional decontamination procedures. Conclusions and Clinical Implications: Currently, there is no decontamination procedure for used HAs that guarantee a successful outcome. The current results support the use of NaOCl in addition to autoclaving to achieve effective decontamination, however, further development such as increasing the concentration or exposure time to NaOCl is warranted. This study also supports the use of NaOCl to decontaminate used titanium healing abutments as the chemical had no significant adverse effects on titanium surface characteristics. [ABSTRACT FROM AUTHOR]