Implantoplasty: Carbide burs vs diamond sonic tips. An in vitro study

Abstract

Objectives Implantoplasty (IP) is a treatment option for peri‐implantitis. Mechanical concerns were raised on fracture resistance of implants subjected to this procedure. This study aimed to compare two methods of IP in terms of implant wear and fracture resistance, and of surface topography. Material and methods Eighteen cylindrical screw‐shaped dental implants (4 mm diameter, 13 mm length) with an external hexagonal connection were used. IP was performed on the first 6‐mm implant surface with a sequence of burs or diamond sonic tips, both followed by an Arkansas finishing. IP duration and implant weight variation were recorded. Micro‐computed tomography (micro‐CT) was used to evaluate material loss. Implant fracture resistance was assessed by static compression test. Surface topography analysis was performed with a stylus profilometer. Scanning electron microscopy–energy dispersive X‐ray spectroscopy (SEM‐EDS) was applied for implant surface morphology and elemental characterization. Results Micro‐CT showed less material loss in sonic compared to burs. No statistically significant difference was found between the mean fracture resistance values reached in bur and sonic, both followed by Arkansas, and with respect to control. IP performed with burs led to a smoother surface compared to sonic. Equivalent final surface roughness was found after Arkansas in both IP procedures. SEM‐EDS showed a deburring effect associated to sonic and revealed carbon and aluminum peaks attributable to contamination with sonic diamond tips and Arkansas bur, respectively. Conclusions IP with sonic diamond tips was found to be more conservative in terms of structure loss. This could have a clinical relevance in case of narrow‐diameter implants.

The effect of implantoplasty on dental implant fracture resistance: a systematic review

“…However, there is some indication that internal hexagon connection may be the weakest abutment connection design. Interestingly, the other studies which used implants with external hexagon connection showed that implantoplasty did not affect fracture resistance (Costa-Berenguer et al, 2018;Leitao-Almeida et al, 2020;Leitão-Almeida et al, 2021;Sivolella et al, 2021).…”

“…The rationale given was that the test implants fractured at the abutment screw, which did not influence the implant body. Out of the six studies which involved regular diameter implants, three studies (Chan et al, 2013;Costa-Berenguer et al, 2018;Sivolella et al, 2021) concluded that implantoplasty did not affect the fracture resistance while the other three (Bertl et al, 2020;Gehrke et al, 2016;Jorio et al, 2021) found a significant decrease in fracture resistance after implantoplasty.…”

“…Most of the articles used tungsten carbide burs with or without additional silicone polishing burs or Arkansas stones (Bertl et al, 2020;Camps-Font et al, 2020;Chan et al, 2013;Costa-Berenguer et al, 2018;Gehrke et al, 2016;Jorio et al, 2021;Leitao-Almeida et al, 2020;Leitão-Almeida et al, 2021;Sivolella et al, 2021). Two of the included studies performed the implantoplasty with diamond burs of various grits followed by polishers (Chan et al, 2013;Jorio et al, 2021).…”

“…Bertl et al (2020) and Gehrke et al (2016) were the only studies which carried out computer-controlled implantoplasty to standardise the complete removal of implant threads for all of the tested implants. Sivolella et al (2021) investigated the difference between tungsten carbide burs with Arkansas stones and diamond sonic tips with Arkansas stone on fracture resistance. They found that the implants treated with diamond sonic tips were more conservative in terms of structure loss but did not have a significantly higher fracture resistance compared to the tungsten carbide burs group.…”

Peri-implant disease: early diagnosis and non-surgical treatment—a narrative literature review

“…For accessible surface, implantoplasty can be performed using a high speed carbide bur with rigorous water cooling to further remove residual dental plaque and their associated debris and to convert a rough to a smoothened surface, allowing more effective plaque removal during maintenance phase by patients and treating clinicians (56,90,91). Various adjunctive therapeutic modalities in addition to non-surgical therapy were reported utilizing systemic antibiotics, locally delivered antimicrobial, laser, photodynamic therapy, and air polishing; however clinicians should carefully utilize these modalities considering a limited availability of evidence in the literature (74,85,87,88,(92)(93)(94).…”