Anna Louropoulou

Titanium surface alterations following the use of different mechanical instruments: a systematic review

OBJECTIVE To systematically collect and evaluate existing evidence on the effects of different mechanical instruments on the surface characteristics of smooth and rough titanium surfaces. MATERIALS AND METHODS PubMed-MEDLINE, Cochrane-CENTRAL and EMBASE databases were searched up to December 2010 to identify appropriate studies. The eligible studies were controlled studies investigating titanium surface alterations following treatment with different mechanical instruments. RESULTS In total, 3275 unique papers were identified. A screening of the titles and abstracts resulted in 34 publications that met all of the eligibility criteria. Surface roughness was evaluated using scanning electron microscopy in most studies and using a profilometer in only 10 studies. The rough surfaces evaluated were titanium plasma sprayed and sandblasted and acid-etched surfaces only. Non-metal instruments were found to cause minimal or no damage to both smooth and rough titanium surfaces. Metal instruments were found to cause major damage to smooth surfaces. Burs seemed to be the instruments of choice, if smoothening of a rough surface was required. CONCLUSION Non-metal instruments and rubber cups seem to be the instruments of choice for the treatment of smooth surfaces. Similarly, for rough implant surfaces, non-metal instruments and air abrasives are the instruments of choice, if surface integrity needs to be maintained. Metal instruments and burs are recommended only in cases requiring the smoothening of the surface roughness. The clinical impact of these findings requires clarification.

The effect of chemotherapeutic agents on contaminated titanium surfaces: a systematic review

OBJECTIVE To systematically collect and evaluate the existing evidence for the abilities of different chemotherapeutic agents to decontaminate biofilm-contaminated titanium surfaces. MATERIAL AND METHODS PubMed-MEDLINE and the Cochrane-CENTRAL databases were searched, covering research published on or before June 2010, to identify appropriate studies. The eligible studies were controlled studies on the effects of chemical treatments on biofilm-contaminated titanium surfaces. RESULTS In total, 2425 unique papers were identified. Independent screening of the titles and abstracts resulted in only four publications that met all of the eligibility criteria. None of the in vivo studies assessed titanium surface decontamination in a controlled fashion. Three studies provided in vitro data, and one used an ex vivo protocol. Citric acid was found to be the most effective treatment in lipopolysaccharide removal as compared with an untreated control, although its effectiveness was equivalent to those of water and saline. In addition, citric acid demonstrated the greatest efficacy in cleaning the contaminated titanium surface, as evidenced by scanning electron microscopy. CONCLUSION The data reported for the efficacy of chemotherapeutic agents in cleaning contaminated titanium surfaces are scarce, which precludes the generation of firm conclusions. Based on the lack of robust data, we cautiously conclude that citric acid is the chemotherapeutic agent with the highest potential for the removal of biofilms from contaminated titanium surfaces in vitro, although it does not achieve complete removal. To date, the killing effect of citric acid against biofilms has not been investigated on titanium surfaces.

The effects of mechanical instruments on contaminated titanium dental implant surfaces: a systematic review

OBJECTIVE The objective of this systematic review was to evaluate the ability of mechanical instruments to clean contaminated implant titanium surfaces. MATERIALS AND METHODS MEDLINE, Cochrane-CENTRAL and EMBASE databases were searched up to May 2013 to identify controlled studies on the cleaning efficacy of mechanical instruments on contaminated titanium surfaces. RESULTS A comprehensive search identified 1893 unique potential papers. Fourteen studies met the inclusion criteria and were selected for this systematic review. Most of the studies were in vitro studies. Different surfaces and different contamination methods were used. Most studies used titanium discs, strips and cylinders. The air abrasive was the treatment mostly evaluated. The available studies had a high heterogeneity that precluded any statistical analysis of the data. Therefore, the conclusions are not based on quantitative data. Non-metal curettes and rubber cups were found to be ineffective. Positive results were reported for (ultra)sonic scalers with a metal tip on polished surfaces, (ultra)sonic scalers with a non-metal tip on smooth and sand-blasted and acid-etched (SLA) surfaces, metal curettes and rotating titanium brushes on SLA surfaces. The air abrasive was found to be effective in cleaning machined, SLA and titanium plasma-sprayed (TPS) surfaces. CONCLUSION The available data suggest that the air abrasive may remove plaque effectively from machined, SLA and TPS titanium surfaces. Positive results were also observed for rotating titanium brushes on SLA surfaces and ultrasonic scalers with non-metal tip on polished and SLA surfaces. However, the clinical impact of these findings requires further clarification.

Mannose-binding lectin gene polymorphisms in relation to periodontitis

AIM To investigate the correlation of six functional polymorphisms in the MBL gene with MBL plasma levels in relation to periodontitis. MATERIAL AND METHODS A total of 92 periodontitis patients and 70 controls, all of Caucasian origin, were included. Patients and controls were genotyped for the L/H, X/Y, P/Q, A/D, A/B and A/C polymorphisms. Distributions of genotypes, rate of allele carriage and allele frequencies were compared between patients and controls. Patients and controls were subdivided in groups of genotypes. Plasma MBL levels were compared between different genotype groups. RESULTS On the basis of genotyping, three phenotypes with regard to mannose-binding lectin (MBL) production were distinguished: high-producers, low-producers and deficient subjects. No differences in the genotype frequencies were observed between patients and controls. Within patients and controls, subjects with the high-producing genotypes had significantly higher MBL plasma levels than low-producers and deficient subjects (p<0.001). Plasma MBL was higher in low-producer patients compared with low-producer controls (p(adjusted)=0.021). CONCLUSION No association could be observed between MBL gene polymorphisms and susceptibility to periodontitis in Caucasians. However, now that genotyping could distinguish the low producing and deficient subjects from the high-producers, it was observed, for the first time, that MBL acts as a weak acute-phase protein in periodontitis.

Influence of mechanical instruments on the biocompatibility of titanium dental implants surfaces: a systematic review

OBJECTIVE The objective of this systematic review was to evaluate the effect of mechanical instruments on the biocompatibility of titanium dental implant surfaces. MATERIALS AND METHODS MEDLINE, Cochrane-CENTRAL and EMBASE databases were searched up to December 2013, to identify controlled studies on the ability of cells to adhere and colonize non-contaminated and contaminated, smooth and rough, titanium surfaces after instrumentation with different mechanical instruments. RESULTS A comprehensive search identified 1893 unique potential papers. Eleven studies met the inclusion criteria and were selected for this review. All studies were in vitro studies. Most studies used titanium discs, strips and cylinders. The air abrasive was the treatment mostly evaluated. The available studies had a high heterogeneity which precluded any statistical analysis of the data. Therefore, the conclusions are not based on quantitative data. Instrumentation seems to have a selective influence on the attachment of different cells. In the presence of contamination, plastic curettes, metal curettes, rotating titanium brushes and an ultrasonic scaling system with a carbon tip and polishing fluid seem to fail to restore the biocompatibility of rough titanium surfaces. The air-powder abrasive system with sodium bicarbonate powder does not seem to affect the fibroblast-titanium surface interaction after treatment of smooth or rough surfaces, even in the presence of contamination. CONCLUSION The available data suggest that treatment with an air-powder abrasive system with sodium bicarbonate powder does not seem to adversely affect the biocompatibility of titanium dental implant surfaces. However, the clinical impact of these findings requires further clarification.

Recommendations on the clinical application of air polishing for the management of peri-implant mucositis and peri-implantitis

Air polishing was introduced as an alternative approach for the supra- and submucosal biofilm management at dental implants. An international expert meeting involving competent clinicians and researchers took place during the EUROPERIO 8 conference in London, UK, on 4 June 2015. Prior to this meeting a comprehensive systematic review dealing with the efficacy of air polishing in the treatment of peri-implant mucositis and peri-implantitis was prepared and served as a basis for the group discussions. This paper summarizes the consensus statements and practical recommendations on the clinical application of air polishing for the management of peri-implant mucositis and peri-implantitis.

Influence of various air‐abrasive powders on the viability and density of periodontal cells: An in vitro study

Remnants of air-abrasive powders on treated surfaces and tissues may affect tissue healing. The purpose of this in vitro study was to investigate the possible effect of five commercially available air-abrasive powders on the viability and cell density of three types of periodontal cells. A sodium bicarbonate powder, two amino acid glycine powders, an amino acid glycine and tricalcium phosphate powder and an erythritol powder were tested. Suspensions of these powders in three different concentrations were prepared and incubated with gingival epithelial cells, gingival fibroblasts, and periodontal ligament (PDL) fibroblasts for 6 hours. Mitochondrial activity, as a measure for cell viability, was evaluated by means of fluorescence activity of a redox indicator. Amount of DNA was measured as indication of cell density. All powders affected in different degrees cell viability and/or density. The most pronounced adverse effect was observed with the sodium bicarbonate followed by the erythritol-containing powder and at the highest concentration. A fivefold reduction or more in the number of cells was observed. The tricalcium phosphate containing powder had the least effect on all types of cells. Even, increased numbers of epithelial cells (twofold) were observed. Within the limits of the present study, it was concluded that careful selection of the powder is important to improve the clinical outcomes of air powder abrasive treatment. A tricalcium phosphate containing powder may improve the biologic responses. A sodium bicarbonate powder should be used with caution.

Prevention and Treatment of Peri-implant Diseases: Current Evidence on Cleaning of Titanium Dental Implant Surfaces

Decontamination of an implant surface is an important component of the prevention and treatment of peri-implant diseases. The most suitable instrument for surface cleaning should be chosen depending on surface characteristics, localization of the surface, and treatment goals. The best results in the available data have been reported for air-abrasive devices, and the selection of powders seems to be of importance. However, proper maintenance of peri-implant soft tissue health is largely in control of the patient and dependent on daily self-care. Subsequently, oral hygiene around dental implants should be a priority of the research agenda in dentistry. Prevention and early diagnosis are key for long-term success with dental implants.

Parodontitis en implantaten: implanteren is mogelijk, maar vraagt om strenge nazorg

SamenvattingImplantaten hebben een slechte prognose als zij geplaatst worden in een ontstoken mond. In deze casus wordt een patiënt besproken bij wie sprake is van lokaal ernstige parodontitis in de esthetische zone alsmede agenesie van de 23 waarvoor een implantaat gewenst wordt. Hoe nu verder?

Mechanisch reinigen van implantaatoppervlakken

Het verwijderen van biofilm van geïnfecteerde titaniumoppervlakken is essentieel om peri-implantaire infecties te voorkomen en te behandelen. De hulpmiddelen die ons hiervoor ter beschikking staan zijn o.a. mechanische instrumenten. In dit artikel willen we uitgebreid aandacht besteden aan de mechanische reiniging van titanium implantaatoppervlakken. Methoden en middelen zullen worden besproken aan de hand van systematische reviews, op basis waarvan een keuze zal worden gemaakt voor de meest geschikte instrumenten.