Treating contaminated dental implants is going to be an increasingly common treatment modality dentists offer in the future. Currently, there is little research to show what is the best treatment for the implant that has been exposed to the oral environment. In my experience, these contaminated implants can lose bone fast, sometimes faster than periodontitis patients.
This systematic review looks at 14 studies comparing means to clean contaminated titanium implants. The most common ways to clean the contaminated surfaces were: air-abrasives, plastic and metal tipped ultrasonics, metal hand scalers, and titanium brushes. Keep in mind that all of these studies are in vitro.
Some take homes from the various studies:
- Air abrasives with sodium bicarbonate powder is capable of removing all viable cells.
- No real difference in effectiveness of plastic covered or metal ultrasonic tips
- Ultrasonic scalers show a significant decrease in biofilm covered areas
- Steel/carbon curette seems to be the least effective means of cleaning a titanium surface
- Rotating titanium brush shows a significant decrease in residual biofilm areas
My personal take-home from all these studies is that air abrasion, titanium brush, and ultrasonics are effective at cleaning titanium surfaces IN VITRO. IN VIVO, may be a different experience. Peri-implantitis usually creates a circumferential defect that tapers toward the implant as it moves apically. This creates a difficult lesion to gain access to and clean properly, even when properly flapped.
My guess is that the titanium brush and ultrasonic will be the easiest to use under surgical conditions and the air abrasive will be the least convenient due to the grit and mess in a flapped surgical site.
The authors conclude that there is still a lot of work needed in this area. I agree
Louropoulou A, Slot DE, Van der Weijden F. The effects of mechanical instruments on contaminated titanium dental implant surfaces: a systemic review. Clin. Oral Impl. Res. 00, 2013, 1-12
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