Name: Pilot In Vitro Study to Assess Cleaning Ability and Effects of Different Decontamination Methods on Implant Surfaces (Video) | JoVE Journal
Uploaded: 2025-11-21T14:40:00.000+00:00
Duration: 3 min 10 s
Description: Learn to compare mechanical decontamination methods for dental implant surfaces using standardized photography and SEM analysis. This study evaluates cleaning efficacy and surface alterations to improve peri-implantitis treatment outcomes.

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5 minutes

The study implants were provided by Bilimplant.

NOTE: The procedures of this investigation were conducted in accordance with the recommended criteria for standardizing in vitro experiments14. Ethical approval was not necessary, as the study utilized commercially available implant surfaces. The study included implants with a diameter of 3.2 mm and a length of 10 mm, featuring a sandblasted, large-grit, acid-etched (SLA) surface. Implants with different dimensions and surface characteristics were excluded. Sample size calculation was performed according to Khalil et al.15. Effect size was taken as 0.90, alpha error as 0.05, and 95% statistical power yielded eight subjects for each group.
1. Preparation of study samples
<ol>
	<li>Submerge implants in a recipient with red permanent ink fully covering the implant surface for 10 s and air-dry to achieve even distribution of the ink over the implant surfaces described by Sanz-Martin et al.16 with a driver handpiece.</li>
	<li>Once dried for 48 h at room temperature17, confirm uniform red ink coverage without pooling after drying.</li>
	<li>Insert the implants 5 mm into the acrylic blocks with dimensions of 20 x 20 x 20 mm manually using an implant driver to ensure controlled insertion and uniform positioning until the 5 mm depth mark on the implant body, mimicking Class I horizontal peri-implant defects18 (Figure 1A).</li>
	<li>To maintain consistent angulation and vertical positioning, use a custom-made parallelometer guide to align the implant&#39;s long axis perpendicular (90&#176;) to the acrylic block surface during placement. 
	NOTE: Implant surfaces should be protected from hand contact and isolated with the driver handpieces during the drying process.</li>
</ol>
2. Creating the setup for the standardization of photographs
<ol>
	<li>Set the camera parameters: ISO 100, aperture f/32, and exposure 1/80 s. In manual focus mode, use a macro lens with a 100 mm focal length.</li>
	<li>Position the ring flash (dual-point macro flash, daylight-balanced 5500 K) at a 45&#176; angle relative to the implant surface to ensure uniform illumination and minimize reflections. Use a diffuser to soften the light and reduce glare from the metallic surface.</li>
	<li>Place the camera 15 cm away from the implant surface and take standardized photographs at a frontal view (0&#176;) from the longitudinal implant axis at the buccal and oral surfaces of each implant (Figure 1B).</li>
	<li>Verify the alignment of the camera with a calibration ruler before each imaging session.</li>
	<li>Prepare a custom-made acrylic splint to position the camera with angulations of 30&#176; (upper view) and 60&#176; (lower view) to the implant long axis to assess the coronal and apical threads in a standardized manner (Figure 1C).</li>
</ol>
3. Application of treatments and obtaining photographs
<ol>
	<li>Apply three different decontamination methods (see Table of Materials) to the exposed buccal and oral surfaces per implant (8 surfaces from 4 implants) commonly used in the treatment of peri-implantitis for 2 min by a single operator to eliminate bias (Figure 2). Control the instrumentation time with a stopwatch.</li>
	<li>Perform all procedures under sterile saline irrigation only to eliminate potential confounding effects of chemical agents on cleaning efficacy or surface integrity.
	<ol>
		<li>For TiC, apply type 11/12 mini Gracey curette with lateral pressure at a 60&#176; angle to the surface.</li>
		<li>Apply ChB, soaked in sterile saline prior to treatment, placed in a low-speed handpiece set at 800 rpm, with a gentle probing movement in a circular fashion.</li>
		<li>Apply TiB, placed in a low-speed handpiece set at 800 rpm, with a gentle probing movement in a circular fashion.</li>
	</ol>
	</li>
	<li>Obtain post-treatment standardized photographs again, as described in step 2 (Figure 3).</li>
</ol>
4. Analysis of photographs
<ol>
	<li>Once all the photographs are obtained, digitize and calibrate them with imaging software (ImageJ v 1.54f). Since the implants were embedded 5 mm vertically into the acrylic, input the remaining 5 mm part seen in the photographs, along with the standard 3.2 mm diameter, into the program by using the Straight-Line tool to ensure calibration.</li>
	<li>Crop the photographs to include only the remaining 5 mm of the exposed implant surface , representing the region of interest (ROI) .</li>
	<li>Process the images in red, green, and blue (RGB) color mode. Convert to color stacks by clicking Image &#62; Type &#62; RGB Stack to isolate the red-stained regions, representing residual ink.</li>
	<li>Select the red channel. Apply a color threshold by clicking Image &#62; Adjust &#62; Color Threshold, using the Hue 0&#176;-25&#176; and 330&#176;-360&#176; range, Saturation 50-255, and Brightness 30-255. Enable the Dark Background option to ensure accurate detection of the stain.</li>
	<li>Delineate the implant body manually using the Polygon Selection tool, excluding the background. Save the selected area to the ROI Manager by clicking Analyze &#62; Tools &#62; ROI Manager to ensure the same surface region is consistently analyzed.</li>
	<li>Calculate the whole implant surface area and the red ink remnants by clicking Analyze &#62;&#160;Measure &#62;&#160;Area.</li>
	<li>Refer complete ink removal to the total absence of red-stained pixels within the ROI. Keep the settings constant during image analysis for standardization.</li>
	<li>Calculate the residual stain percentage as: residual stain x 100/total implant surface area using ImageJ (Figure 4).</li>
</ol>
5. Analysis of the implant surface morphology
<ol>
	<li>Code the samples, dehydrate in ethanol, and mount to the aluminum stubs with carbon tape, and place in the ion sputtering device.</li>
	<li>Define the middle third of the exposed implant surface as the ROI for SEM analysis.</li>
	<li>Coat the samples with a 20 nm gold layer in a sputter coater for 90 s and place in the vacuum chamber at 10-3 torr vacuum pressure and 10 mA power. Always wear protective laboratory gear and ensure adequate ventilation during sample preparation.</li>
	<li>Place the gold-coated samples in the vacuum chamber of the scanning electron microscope and examine them at a 0&#176; tilt angle at 5 kV acceleration voltage with a 9 mm working distance.</li>
	<li>Capture SEM micrographs at 20x, 500x, 1000x, and 5000x magnifications to evaluate topographic changes.</li>
</ol>
6. Statistical analysis
<ol>
	<li>Perform the statistical analysis using SPSS software (version 27). Express the categorical variables as mean &#177; standard deviation, median, and minimum and maximum values.</li>
	<li>Assess normality of distribution by the Shapiro-Wilk test. Use the Kruskal-Wallis test for comparisons among three groups. Apply the Bonferroni-corrected Mann-Whitney U test for pairwise comparisons when data are non-normally distributed. Set the significance at p &#60; 0.05.</li>
</ol>

<ol><li>Berglundh, T., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Peri-implant+diseases+and+conditions%3A+Consensus+report+of+workgroup+4+of+the+2017+World+Workshop+on+the+Classification+of+Periodontal+and+Peri-Implant+Diseases+and+Conditions%5BTitle%5D)+AND+%22J+Clin+Periodontol%22%5BJournal%5D)">Peri-implant diseases and conditions: Consensus report of workgroup 4 of the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions.</a> J Clin Periodontol. 45 (20), S286-S291 (2018).</li>
<li>Diaz, P., Gonzalo, E., Villagra, L. J. G., Miegimolle, B., Suarez, M. J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((What+is+the+prevalence+of+peri-implantitis%3F+A+systematic+review+and+meta-analysis%5BTitle%5D)+AND+%22BMC+Oral+Health%22%5BJournal%5D)">What is the prevalence of peri-implantitis? A systematic review and meta-analysis.</a> BMC Oral Health. 22 (1), 1-13 (2022).</li>
<li>Wada, M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Prevalence+and+risk+indicators+for+peri-implant+diseases%3A+A+literature+review%5BTitle%5D)+AND+%22Jpn+Dent+Sci+Rev%22%5BJournal%5D)">Prevalence and risk indicators for peri-implant diseases: A literature review.</a> Jpn Dent Sci Rev. 57, 78-84 (2021).</li>
<li>Berglundh, T., Jepsen, S., Stadlinger, B., Terheyden, H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Peri-implantitis+and+its+prevention%5BTitle%5D)+AND+%22Clin+Oral+Implants+Res%22%5BJournal%5D)">Peri-implantitis and its prevention.</a> Clin Oral Implants Res. 30 (2), 150-155 (2019).</li>
<li>İnce Kuka, G., Gürsoy, H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Reconstructive+surgical+treatment+of+peri-implantitis+with+use+of+a+chitosan+brush+for+decontamination-+case+series+with+1-year+follow-up%5BTitle%5D)+AND+%22Int+J+Implant+Dent%22%5BJournal%5D)">Reconstructive surgical treatment of peri-implantitis with use of a chitosan brush for decontamination- case series with 1-year follow-up.</a> Int J Implant Dent. 10 (1), 60(2024).</li>
<li>Renvert, S., Roos-Jansåker, A. M., Persson, G. R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Surgical+treatment+of+peri-implantitis+lesions+with+or+without+the+use+of+a+bone+substitute-a+randomized+clinical+trial%5BTitle%5D)+AND+%22J+Clin+Periodontol%22%5BJournal%5D)">Surgical treatment of peri-implantitis lesions with or without the use of a bone substitute-a randomized clinical trial.</a> J Clin Periodontol. 45 (10), 1266-1274 (2018).</li>
<li>Baima, G., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Surface+decontamination+protocols+for+surgical+treatment+of+peri-implantitis%3A+A+systematic+review+with+meta-analysis%5BTitle%5D)+AND+%22Clin+Oral+Implants+Res%22%5BJournal%5D)">Surface decontamination protocols for surgical treatment of peri-implantitis: A systematic review with meta-analysis.</a> Clin Oral Implants Res. 33 (11), 1069-1086 (2022).</li>
<li>Cosgarea, R., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Efficacy+of+mechanical%2Fphysical+approaches+for+implant+surface+decontamination+in+non-surgical+submarginal+instrumentation+of+peri-implantitis.+A+systematic+review%5BTitle%5D)+AND+%22J+Clin+Periodontol%22%5BJournal%5D)">Efficacy of mechanical/physical approaches for implant surface decontamination in non-surgical submarginal instrumentation of peri-implantitis. A systematic review.</a> J Clin Periodontol. 50 Suppl 26, 188-211 (2023).</li>
<li>Sahrmann, P., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Cleaning+potential+of+glycine+air-flow+application+in+an+in+vitro+peri-implantitis+model%5BTitle%5D)+AND+%22Clin+Oral+Implants+Res%22%5BJournal%5D)">Cleaning potential of glycine air-flow application in an in vitro peri-implantitis model.</a> Clin Oral Implants Res. 24 (6), 666-670 (2013).</li>
<li>Toma, S., Brecx, M. C., Lasserre, J. F. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Clinical+Evaluation+of+Three+Surgical+Modalities+in+the+Treatment+of+Peri-Implantitis%3A+A+Randomized+Controlled+Clinical+Trial%5BTitle%5D)+AND+%22J+Clin+Med%22%5BJournal%5D)">Clinical Evaluation of Three Surgical Modalities in the Treatment of Peri-Implantitis: A Randomized Controlled Clinical Trial.</a> J Clin Med. 8 (7), 966(2019).</li>
<li>de Araújo, C. J., da Silva, M. M., Gonzalez, C. H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((A+comparative+study+of+Ni-Ti+and+Ni-Ti-Cu+shape+memory+alloy+processed+by+plasma+melting+and+injection+molding%5BTitle%5D)+AND+%22Mater+Design%22%5BJournal%5D)">A comparative study of Ni-Ti and Ni-Ti-Cu shape memory alloy processed by plasma melting and injection molding.</a> Mater Design. 32 (10), 4925-4930 (2011).</li>
<li>Wohlfahrt, J. C., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((A+novel+non-surgical+method+for+mild+peri-implantitis-+a+multicenter+consecutive+case+series%5BTitle%5D)+AND+%22Int+J+Implant+Dent%22%5BJournal%5D)">A novel non-surgical method for mild peri-implantitis- a multicenter consecutive case series.</a> Int J Implant Dent. 3 (1), 38(2017).</li>
<li>Wang, H. L., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((AO%2FAAP+consensus+on+prevention+and+management+of+peri-implant+diseases+and+conditions%3A+Summary+report%5BTitle%5D)+AND+%22J+Periodontol%22%5BJournal%5D)">AO/AAP consensus on prevention and management of peri-implant diseases and conditions: Summary report.</a> J Periodontol. 96 (6), 519-541 (2025).</li>
<li>Krithikadatta, J., Gopikrishna, V., Datta, M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((CRIS+Guidelines+%28Checklist+for+Reporting+In-vitro+Studies%29%3A+A+concept+note+on+the+need+for+standardized+guidelines+for+improving+quality+and+transparency+in+reporting+in-vitro+studies+in+experimental+dental+research%5BTitle%5D)+AND+%22J+Conserv+Dent%22%5BJournal%5D)">CRIS Guidelines (Checklist for Reporting In-vitro Studies): A concept note on the need for standardized guidelines for improving quality and transparency in reporting in-vitro studies in experimental dental research.</a> J Conserv Dent. 17 (4), 301-304 (2014).</li>
<li>Khalil, M. I., Sakr, H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Implant+Surface+Topography+Following+Different+Laser+Treatments%3A+An+In+Vitro+Study%5BTitle%5D)+AND+%22Cureus%22%5BJournal%5D)">Implant Surface Topography Following Different Laser Treatments: An In Vitro Study.</a> Cureus. 15 (5), e38731(2023).</li>
<li>Sanz-Martín, I., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Significance+of+implant+design+on+the+efficacy+of+different+peri-implantitis+decontamination+protocols%5BTitle%5D)+AND+%22Clin+Oral+Investig%22%5BJournal%5D)">Significance of implant design on the efficacy of different peri-implantitis decontamination protocols.</a> Clin Oral Investig. 25 (6), 3589-3597 (2021).</li>
<li>Luengo, F., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((In+vitro+effect+of+different+implant+decontamination+methods+in+three+intraosseous+defect+configurations%5BTitle%5D)+AND+%22Clin+Oral+Implants+Res%22%5BJournal%5D)">In vitro effect of different implant decontamination methods in three intraosseous defect configurations.</a> Clin Oral Implants Res. 33 (11), 1087-1097 (2022).</li>
<li>Monje, A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Morphology+and+severity+of+peri-implantitis+bone+defects%5BTitle%5D)+AND+%22Clin+Implant+Dent+Relat+Res%22%5BJournal%5D)">Morphology and severity of peri-implantitis bone defects.</a> Clin Implant Dent Relat Res. 21 (4), 635-643 (2019).</li>
<li>Sahrmann, P., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((In+vitro+cleaning+potential+of+three+different+implant+debridement+methods%5BTitle%5D)+AND+%22Clin+Oral+Implants+Res%22%5BJournal%5D)">In vitro cleaning potential of three different implant debridement methods.</a> Clin Oral Implants Res. 26 (3), 314-319 (2015).</li>
<li>Giffi, R., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((The+efficacy+of+different+implant+surface+decontamination+methods+using+spectrophotometric+analysis%3A+an+in+vitro+study%5BTitle%5D)+AND+%22J+Periodontal+Implant+Sci%22%5BJournal%5D)">The efficacy of different implant surface decontamination methods using spectrophotometric analysis: an in vitro study.</a> J Periodontal Implant Sci. 53 (4), 295-305 (2023).</li>
<li>Jordan, A., Smojver, I., Budimir, A., Gabrić, D., Vuletić, M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Evaluation+of+Different+Procedures+for+Titanium+Dental+Implant+Surface+Decontamination-In+Vitro+Study%5BTitle%5D)+AND+%22Bioengineering+%28Basel%29%22%5BJournal%5D)">Evaluation of Different Procedures for Titanium Dental Implant Surface Decontamination-In Vitro Study.</a> Bioengineering (Basel). 11 (4), 326(2024).</li>
<li>Larsen, O. I., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Antimicrobial+Effects+of+Three+Different+Treatment+Modalities+on+Dental+Implant+Surfaces%5BTitle%5D)+AND+%22J+Oral+Implantol%22%5BJournal%5D)">Antimicrobial Effects of Three Different Treatment Modalities on Dental Implant Surfaces.</a> J Oral Implantol. 43 (6), 429-436 (2017).</li>
<li>Ozgu, I., Ustun, K. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Effects+of+Mechanical+Methods+Used+in+Peri-implantitis+Treatment+on+Implant+Surface+Decontamination+and+Roughness%5BTitle%5D)+AND+%22J+Vis+Exp%22%5BJournal%5D)">Effects of Mechanical Methods Used in Peri-implantitis Treatment on Implant Surface Decontamination and Roughness.</a> J Vis Exp. (217), e67778(2025).</li>
<li>Ronay, V., Merlini, A., Attin, T., Schmidlin, P. R., Sahrmann, P. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((In+vitro+cleaning+potential+of+three+implant+debridement+methods.+Simulation+of+the+non-surgical+approach%5BTitle%5D)+AND+%22Clin+Oral+Implants+Res%22%5BJournal%5D)">In vitro cleaning potential of three implant debridement methods. Simulation of the non-surgical approach.</a> Clin Oral Implants Res. 28 (2), 151-155 (2017).</li>
<li>Sammons, R. L., Lumbikanonda, N., Gross, M., Cantzler, P. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Comparison+of+osteoblast+spreading+on+microstructured+dental+implant+surfaces+and+cell+behaviour+in+an+explant+model+of+osseointegration.+A+scanning+electron+microscopic+study%5BTitle%5D)+AND+%22Clin+Oral+Implants+Res%22%5BJournal%5D)">Comparison of osteoblast spreading on microstructured dental implant surfaces and cell behaviour in an explant model of osseointegration. A scanning electron microscopic study.</a> Clin Oral Implants Res. 16 (6), 657-666 (2015).</li>
<li>Maher, N., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((An+updated+review+and+recent+advancements+in+carbon-based+bioactive+coatings+for+dental+implant+applications%5BTitle%5D)+AND+%22J+Adv+Res%22%5BJournal%5D)">An updated review and recent advancements in carbon-based bioactive coatings for dental implant applications.</a> J Adv Res. 72, 265-286 (2025).</li>
</ol>

The authors report no conflict of interest.

In the present study, implant surface debridement with three different instrumentation methods was tested. Among the three tested mechanical decontamination methods, the TiB demonstrated the highest cleaning efficacy&#160;and&#160;minimal surface alteration on implant surfaces. SEM analysis confirmed that TiB preserved the implant surface morphology more effectively, while TiC caused the most surface damage, and the study hypothesis was rejected. The results revealed that available decontamination methods have limited ef...

Peri-implantitis is defined as inflammation of the peri-implant mucosa accompanied by progressive bone loss. It is a biofilm-associated condition affecting the tissues surrounding dental implants1. Patients with a history of severe periodontitis, poor oral hygiene, or lack of regular maintenance following implant therapy are at higher risk of developing peri-implantitis1,2. The mean prevalence of peri-implantitis was reported by Diaz et al. to be 19.53% at the patient level, whereas it was 4.8%-23.0% at the implant level3, and this data was highly variable even following restrictions to the clinical case definition2. Diabetes and periodontitis history are stated to be risk indicators for peri-implantitis. However, there is no consensus regarding the relationships between peri-implantitis and smoking, implant superstructure, and the amount of keratinized mucosa2,3. Although there are currently no standardized, proven methods for the prevention of peri-implantitis, prophylaxis, adequate oral hygiene, and compliance with regular maintenance are thought to be the most crucial steps in doing so3,4.
Given the complex histopathological features and unpredictable, rapid disease progression, peri-implantitis presents a challenge for every clinician4,5. The primary goal of peri-implantitis treatment is to suppress inflammation and halt peri-implant bone loss. Clinically, the goal is to reduce probing depth (PD), eliminate bleeding on probing (BoP), and/or pus drainage6. An essential part of the peri-implantitis treatment is decontaminating the surfaces of the implants. The ideal decontamination technique should be safe to use without causing any injury to patients or implant damage, even though it should be effective at removing biofilm7. However, the implant&#39;s surface morphology and characteristics hinder ideal decontamination, limiting treatment success, since total access to affected sites is mostly limited by the implant surface characteristics5,8. These situations necessitate the need for new materials or techniques for proper decontamination in the treatment of peri-implantitis.
Up to date, numerous implant surface decontamination agents/methods have been introduced, and their effectiveness and application modes are still under investigation9. Techniques used for peri-implant surface decontamination are generally categorized under mechanical/physical and chemical methods, and clear scientific evidence regarding the superiority of these techniques is not yet available7,8. Results of a recent meta-analysis reported that titanium-coated curettes, specifically produced for implant surface debridement, do not cause scratches on the surface because they have a hardness similar to the implant surface and can be safely used for decontamination7. In the same meta-analysis, the use of rotating titanium brushes alone for implant surface decontamination has been shown to provide significant improvement in clinical periodontal parameters, such as reduction of PD and BoP. In a randomized clinical study comparing the biofilm removal effectiveness of steel and plastic curettes, ultrasonics, and titanium rotary brushes from implant surfaces, Toma et al. reported that rotary brushes were clinically more effective and preserved the surface morphology10. Titanium brush (TiB), consisting of nickel-titanium (NiTi) bristles, has a lower elastic modulus than that of the implant surface, giving the brush flexibility and reducing the risk of scratching the implant surface11. Another promising decontamination agent is a non-toxic, biodegradable brush made from the natural polysaccharide chitosan, derived from chitin, valued for its biocompatibility, biodegradability, bacteriostatic, and anti-inflammatory properties. Chitosan was reported to exhibit bacteriostatic and anti-inflammatory properties and induce significant improvements in clinical parameters in the treatment of peri-implant diseases12. Unlike metallic instruments, it is non-abrasive and intended to reduce bacterial load biologically and mechanically5,12. However, there is still not any clear-cut consensus available on the ideal implant decontamination agent13, and more studies are needed to evaluate the effectiveness of these novel chitosan brushes during the decontamination phase of the peri-implant treatment.
Despite the extensive research on implant surface decontamination, identification of a decontamination method/agent that achieves optimal cleaning efficacy while preserving surface integrity still remains a significant clinical challenge. From this standpoint, the aim of the present study is to evaluate the cleaning ability and surface modification of three different mechanical decontamination protocols. The null hypothesis is that the TiB, chitosan brush (ChB), and titanium curette (TiC) have no significant difference in cleaning performance or surface modifications on implant surfaces after mechanical decontamination.

<table><tbody><tr><td>Acrylic</td><td>Imicryl</td><td>Konya, Turkiye</td><td>Used for the production of the stands for photographs and experimental horizontal defects</td></tr><tr><td>Camera&amp;nbsp;</td><td>Canon EOS 80D</td><td>Tokyo, Japan</td><td>Used for obtaining standardized photographs of implants</td></tr><tr><td>Chitosan brush&amp;nbsp;</td><td>Labrida BioClean, Institut Straumann AG</td><td>Basel, Switzerland</td><td>Used for the implant surface decontamination&amp;nbsp;</td></tr><tr><td>Flash lighting system&amp;nbsp;</td><td>Sigma</td><td>Roedermark, Germany</td><td>Used for obtaining standardized photographs of implants</td></tr><tr><td>Image software</td><td>ImageJ</td><td>NIH, MD, USA</td><td>Used for the image analysis</td></tr><tr><td>Implants</td><td>Bilimplant, PBL 3210</td><td>Istanbul, Turkiye</td><td>Main study material</td></tr><tr><td>Low-speed handpiece</td><td>NSK AR-Y</td><td>Nippon, Japan</td><td>Used in decontamination performed with rotating brushes</td></tr><tr><td>Red permanent ink&amp;nbsp;</td><td>Staedtler Lumocolor</td><td>Nuernberg, Germany</td><td>Staining of the implant to imitate the oral biofilm</td></tr><tr><td>Scanning Electron Microscope</td><td>Jeol, JSM 6335F</td><td>Peabody, MA, USA</td><td>Used for the surface analysis</td></tr><tr><td>Sputter coater</td><td>Polaron Emitech, SC7640</td><td>East Essex, UK</td><td>Reduce the electric charging of SEM samples toattain the highest quality of imaging possible</td></tr><tr><td>Statistical software</td><td>SPSS 27, IBM</td><td>New York, USA</td><td>Used for the statistical analysis of the results</td></tr><tr><td>Sterile saline&amp;nbsp;</td><td>Polifarma, % 0.9&amp;nbsp;</td><td>Istanbul, Turkiye</td><td>Used for irrigation during decontamination&amp;nbsp;</td></tr><tr><td>Ti Brush</td><td>NiTi Brush, Hans Korea</td><td>Gyeonggi, Korea</td><td>Used for the implant surface decontamination&amp;nbsp;</td></tr><tr><td>Ti curette (11/12T mini)</td><td>Hu-Friedy</td><td>Chicago, USA</td><td>Used for the implant surface decontamination&amp;nbsp;</td></tr></tbody></table>

pilot in vitro study to assess cleaning ability and effects of different decontamination methods on implant surfaces

Pilot In Vitro Study to Assess Cleaning Ability and Effects of Different Decontamination Methods on Implant Surfaces

An essential component of peri-implantitis treatment is the effective decontamination of implant surfaces. The ideal decontamination technique should safely and efficiently remove biofilm without damaging the implant surface. This pilot study aimed to evaluate the cleaning efficacy and surface alterations associated with three mechanical decontamination protocols. Here, 12 implants were stained with indelible red ink and mounted into acrylic blocks to simulate horizontal peri-implant defects. Surface decontamination was performed for 2 min by the same examiner using one of the following devices: titanium brush (TiB), chitosan brush (ChB), or titanium curette (TiC). No chemical decontamination agents were used in combination with the mechanical tools. Standardized photographs were taken before and after the decontamination from buccal and oral frontal views, as well as at 30&#176; and 60&#176; angulations. The uncleaned implant surface area was calculated digitally. Scanning electron microscopy (SEM) was used to assess surface morphology. None of the tested methods achieved complete removal of the ink stain. Although 75.98% &#177; 2.42% of the stain remained, TiB showed the highest cleaning efficacy at buccal and oral frontal views (p = 0.027), followed by TiC (80.3% &#177; 0.86% stain remaining) and ChB (90.34% &#177; 6.07% stain remaining). Significant differences were observed between the ChB and TiB groups (p = 0.022). SEM analysis revealed that the TiC caused the greatest surface damage, whereas the TiB produced minimal alterations. Within the limitations of this pilot study, TiB demonstrated effective cleaning while preserving implant surface morphology. These findings suggest that titanium brushes may represent a safer and more efficient mechanical decontamination option during peri-implantitis treatment. However, further studies are warranted to evaluate combinations of mechanical and chemical techniques to enhance cleaning efficacy.

Following treatments, none of the treated surfaces exhibited complete ink stain removal. The percentage of residual ink varied depending on the type of device used, as well as the photograph's angulation. Comparison of the residual staining percentages for each decontamination group is shown in Table 1.
At the buccal and oral frontal view, the highest cleaning efficacy was achieved in each decontamination method. TiB was the most effective method, leaving the lowest amount of ...

The present pilot in vitro study aimed to evaluate the cleaning efficacy of three different decontamination tools and possible surface alterations following treatment, using permanent red ink to mimic the presence of oral biofilm.

An essential component of peri-implantitis treatment is the effective decontamination of implant surfaces. The ideal decontamination technique should ...

The scope of this study is to compare the clinical efficacy and surface effects of three commonly used mechanical decontamination methods for implant surfaces in vitro. To begin, prepare a custom-made acrylic splint to position the camera with angulations of 30 degrees for the upper view and 60 degrees for the lower view relative to the implant long axis to assess the coronal and apical threads in a standardized manner. Position the implant and apply three different decontamination methods separately to the exposed buccal and oral surfaces per implant commonly used in the treatment of peri-implantitis.Perform each method for two minutes by a single operator to eliminate bias, and control the instrumentation time with a stopwatch. Place the camera 15 centimeters away from the implant surface. Take standardized photographs at a frontal view of zero degrees from the longitudinal implant axis at the buccal and oral surfaces of each implant before and after decontamination.None of the treated surfaces showed complete removal of ink stain following decontamination. Residual ink percentages varied depending on the device used and the angulation of the photographs. At the buccal and oral frontal views, TiB resulted in the lowest residual stain percentage at 75.98%followed by TiC at 80.31%and ChB at 90.34%At 60-degree views, all groups showed high levels of residual staining, indicating reduced cleaning efficacy in deeper implant regions.Scanning electron microscopy examination showed that all treatment techniques modified the implant surface in contrast to the negative control, which retained the original uniformly rough topography. Among the treatments, TiB caused minimal surface alterations while TiC and ChB induced extensive surface changes and irregularities. Horizontal scratches were particularly prominent on implants treated with TiC.This study shows that titanium brushes clean implants most effectively with minimal damage, while titanium curettes and chitosan brushes cause more alteration and decontamination. These findings highlight the limitations of the existing methods and the need of combined or improved decontamination strategies. Feature research will focus on understanding methods to fully decontaminate the implant surfaces without causing damage by combining mechanical tools with chemical or electrolytic methods.

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Research

JoVE Journal

Medicine

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Learn to compare mechanical decontamination methods for dental implant surfaces using standardized photography and SEM analysis. This study evaluates cleaning efficacy and surface alterations to improve peri-implantitis treatment outcomes.

Pilot In Vitro Study to Assess Cleaning Ability and Effects of Different Decontamination Methods on Implant Surfaces

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