Effectiveness of implant surface debridement using particle beams at differing air pressures

Abstract

Because implant surface decontamination is challenging, air powder abrasive systems have been suggested as an alternative debridement method. This in vitro study investigated the effectiveness of different powder formulations and air pressures in cleaning implant surfaces and the extent of surface damage. A validated ink model of implant biofilm was used. Sterile 4.1 × 10 mm Grade 4 titanium implants were coated in a blue indelible ink to form a uniform, visually detectable biofilm‐like layer over the implant threads and mounted into a bone replica material with bony defects to approximate peri‐implantitis. Air powder abrasive treatments were undertaken using glycine, sodium bicarbonate, or calcium carbonate powder at air pressures of 25, 35, 45, and 55 psi. Digital macro photographs of the threads were stitched to give composite images of the threads, so the amount of ink remaining could be quantified as the residual area and expressed as a percentage. Implant surfaces were also examined with scanning electron microscopy to grade the surface changes. No treatment cleaned all the surface of the threads. The powders were ranked in order of decreasing effectiveness and decreasing surface change into the same sequence of calcium carbonate followed by sodium bicarbonate followed by glycine. Higher air pressure improved cleaning and increased surface change, with a plateau effect evident. All powders caused some level of surface alteration, with rounding of surface projections most evident. With air powder abrasive systems, there is a trade‐off between cleaning efficacy and surface damage. Using this laboratory model, sodium bicarbonate and calcium carbonate powders were the most effective for surface cleaning when used at air pressures as low as 25 psi.

Effects of air abrasive decontamination on titanium surfaces: A systematic review of in vitro studies

“…After reading the full‐text articles, 10 articles were excluded: three articles due to using the AA in combination with other decontamination methods, one study was not about titanium surface, two articles did not use AA for decontamination, one study was not in English and not published in a peer‐review journal, one study used the AA powder in an antimicrobial solution but did not use the AA device, one study had an in vivo design with decontamination procedures taking place in the beagle dogs, and the full text for one study was not retrieved . The 48 included articles were ultimately processed for data extraction . The summary of the search strategy is depicted in Figure .…”

“…The publication dates ranged from 1989 to 2018. Seven out of thirteen studies in this group were also presented in Section 3.3.1 . The included studies reported a significant decrease in surface contamination by abrasive powders.…”

“…Except for one study, the others reported that glycine powder performed similarly to or better than SB . Glycine was more effective than TiO 2 but less effective than calcium carbonate, and a mixtures of glycine and tricalcium phosphate (TCP), erythritol and chlorhexidine, and hydroxyapatite (HA) and TCP . Total decontamination by AA was shown with SB against Streptococcus sanguis on nonmodified (smooth and machined) and modified (structured and rough) surfaces; SB and glycine against oral bacterial biofilm on sandblasted and acid‐etched (SLA) surfaces; erythritol, HA plus erythritol, and mixture of erythritol and HA with Biomimetic‐calcium phosphate (BioCaP) against Ca‐precipitated organic film layer on SLA surfaces; and SB against Actinomyces viscosu s on plasma‐sprayed surfaces…”

“…There was no clear‐cut difference between the cleaning efficacy of SB and glycine, and the results seemed to be mostly dependent on the interaction between type of the powder and the type of contamination, surface modification, AA settings, and particle size. That being said, SB in higher pressure and longer duration was more successful than glycine in cleaning the artificial contamination but posed more damage as well . However, in surfaces contaminated by bacterial biofilm which was abraded for 60 seconds and less, glycine was as effective as SB or even more successful .…”

“…Depending on the moderating effect of the type and size of the powders, device settings, surface texture, and contamination protocols, AA resulted in a range of cleanliness. Also, it seems there is a trade‐off between the cleaning efficacy and surface change . Therefore, finding a decontamination method with the highest cleaning efficacy and the least surface damage, which can also maintain the surface biocompatibility or improve it, is favorable.…”