Decontamination Of Titanium Dental Implants Using Physical Methods

"Bacterial contamination of titanium (Ti) implants is a major cause for peri-implant infections and eventual implant failure, a problem that could affect ~ 5 million patients every year worldwide. Many implant decontamination techniques have been assessed to manage these infections. However, they all present inconsistent clinical outcomes especially when it comes to achieving complete re-osseointegration. The lack of knowledge on the effect of the available techniques on implant contaminants could be the reason behind these unpredictable results. We hypothesized that even though these techniques could be useful in elimination of bacteria, they might be unsuccessful in removing organic contaminants and restoring the original surface composition. To test this hypothesis, we measured the level of Ti surface contaminants before and after contamination using X-ray photoelectron spectroscopy (XPS); the most sensitive technique available for characterization of surface chemistry. Then we used XPS to evaluate and compare the decontamination efficiency of commonly employed methods (metal and plastic curettes, Ti brush and laser). The effects of these methods on the bacterial load and Ti surface morphology were also evaluated. Based on this information, two new techniques specially designed for Ti implant decontamination were then developed and optimized; which are electrochemical treatments and an implant-paste.In the first study, we were able to demonstrate the superiority of Ti brushes for mechanical decontamination and laser treatment for bacterial eradication from Ti surfaces, indicating that different decontamination techniques interact in a different manner with the Ti surface contaminants. In addition, this study demonstrated that complete elimination of bacteria does not necessarily indicate complete decontamination of the Ti surfaces, and all the tested decontamination techniques failed to remove the organic contaminants or restore the original properties of Ti surface. Subsequently, it could be recommended that an efficient clinical protocol for the management of peri-implant infections should involve an initial cleaning of contaminated implant surfaces with Ti-brushes to eliminate bacteria and organic contaminants followed by a laser treatment to eradicate the remaining bacteria.The second study presented a new decontamination approach (the optimized electrochemical treatment) that was able to disinfect contaminated Ti surfaces using alternating currents (-2.3mA, +22.5[mu]A) and voltages as low as the titanium standard electrode potential (1.8V). We demonstrated that this method is bactericidal and able to completely decontaminate saliva-contaminated titanium within 5 minutes while preserving surface integrity. Furthermore, with the aid of mechanical brushing, this optimized electrochemical treatment was able to achieve complete decontamination of biofilm-contaminated Ti surfaces. In the third study, we demonstrated that a novel inorganic implant-paste developed by us had superior decontamination efficiency compared to prophylaxis brushes and a commercial toothpaste. The implant-paste was able to remove biofilm from contaminated Ti without affecting its surfaces integrity. This is the first prophylaxis paste specially designed to decontaminate implant surfaces, although future studies will be needed to assess its efficiency for surgical decontamination of implant surfaces or implant maintenance therapy." --