Skip to main content
NCBI home page
Journal of Periodontal & Implant Science logoLink to Journal of Periodontal & Implant Science
. 2022 Dec 2;53(4):295–305. doi: 10.5051/jpis.2203500175

The efficacy of different implant surface decontamination methods using spectrophotometric analysis: an in vitro study

Roberto Giffi 1, Davide Pietropaoli 1, Leonardo Mancini 1,2,✉, Francesco Tarallo 1, Philipp Sahrmann 3, Enrico Marchetti 1
PMCID: PMC10465813  PMID: 36731864

Abstract

Purpose

Various methods have been proposed to achieve the nearly complete decontamination of the surface of implants affected by peri-implantitis. We investigated the in vitro debridement efficiency of multiple decontamination methods (Gracey curettes [GC], glycine air-polishing [G-Air], erythritol air-polishing [E-Air] and titanium brushes [TiB]) using a novel spectrophotometric ink-model in 3 different bone defect settings (30°, 60°, and 90°).

Methods

Forty-five dental implants were stained with indelible ink and mounted in resin models, which simulated standardised peri-implantitis defects with different bone defect angulations (30°, 60°, and 90°). After each run of instrumentation, the implants were removed from the resin model, and the ink was dissolved in ethanol (97%). A spectrophotometric analysis was performed to detect colour remnants in order to measure the cumulative uncleaned surface area of the implants. Scanning electron microscopy images were taken to assess micromorphological surface changes.

Results

Generally, the 60° bone defects were the easiest to debride, and the 30° defects were the most difficult (ink absorption peak: 0.26±0.04 for 60° defects; 0.32±0.06 for 30° defects; 0.27±0.04 for 90° defects). The most effective debridement method was TiB, independently of the bone defect type (TiB vs. GC: P<0.0001; TiB vs. G-Air: P=0.0017; TiB vs. GE-Air: P=0.0007). GE-Air appeared to be the least efficient method for biofilm debridement.

Conclusions

T-brushes seem to be a promising decontamination method compared to the other techniques, whereas G-Air was less aggressive on the implant surface. The use of a spectrophotometric model was shown to be a novel but promising assessment method for in vitro ink studies.

Keywords: Air flow, Decontamination, Gracey curette, Implant, Peri-implantitis, Surgical, Brush, Ultrasonic scaler

Graphical Abstract

graphic file with name jpis-53-295-abf001.jpg

INTRODUCTION

Peri-implantitis is a plaque-associated pathological condition that occurs in tissues around dental implants, characterised by inflammation in the peri-implant mucosa and subsequent progressive loss of supporting bone [1]. The long-term stability of dental implants is dependent on these biological factors [2]. Due to the increasing number of implants that are being placed, peri-implantitis cases have also become more common in dental practice [3]. Moreover, peri-implant diseases are highly prevalent and are often not perceived by patients [4,5]. From a clinical point of view, bleeding on probing (BoP) seems to be relatively sensitive in the diagnosis of peri-implantitis, and the co-occurrence of BoP and marginal bone loss is a sign of active peri-implantitis [6,7].

Nowadays, peri-implantitis treatment is becoming an integral part of standard treatment protocols [8]. A recognised key factor of these inflammatory conditions is the development of bacterial biofilms on implant surfaces [9], which are not properly removed by daily oral practice. Moreover, factors such as resistance to topical disinfectants and systemic antibiotics suggest mechanical removal of intact biofilms as the leading therapy [10,11]. Several devices are commonly used for dental implant decontamination, but their efficacy is still limited due to defect-specific characteristics and the implant’s thread structure, especially in advanced cases where nonsurgical techniques alone still do not provide predictable and successful outcomes [12,13,14]. Moreover, in the most advanced cases, surgical therapy is more predictable, as it allows for proper access to the implant surface for both mechanical debridement and chemical decontamination [15]. Surgical approaches usually include access surgery, resective surgery, or a regenerative procedure. The choice of which method to use is mostly dependent on the defect type and the position of the implant in the oral cavity [15]. Decontamination should ideally not modify the implant surface micromorphology, in order not to interfere with biocompatibility and the regenerative procedure. According to several authors, powder-abrasive devices employing glycine powder showed superior cleaning potential on both rough and smooth surfaces of threaded implants with different models of defects (30°, 60°, and 90°), when compared with ultrasonic or manual debridement [16,17]. Moreover, the morphological roughness was not altered at all with respect to the alternative devices. However, a recent study presented evidence that the apical area of the bone defect remained unchanged [18,19].

Currently, software-aided photographic analysis is extensively used to assess the efficiency of different types of debridement methods in in vitro and ink-based models of plaque accumulation. However, bidimensional rendering, technical biases (shadows, parallax error, software setup, equipment quality), and inter-operator variability may be considered potential limitations of that technique. Herein, we propose a reliable and cost-effective alternative, based on spectrophotometry, for the evaluation of debridement efficiency on implants.

The primary aim of this in vitro study was to evaluate the efficacy of various decontamination methods. Additionally, this study aimed to propose a new spectrophotometric assay for assessing decontamination methods in vitro.

MATERIALS AND METHODS

Ethics approval was not required for this in vitro study. Prama implants sponsored by Sweden & Martina (Due Carrare, Italy) were used for both the validation protocol and experimental phase with the following features: a pitch of 1.0 mm and a depth of 0.4 mm. The implant surface was sandblasted with zirconium oxide, and etched with mineral acids, reaching an average roughness of 1.6 Sa depending on the tested area of the implant. The ultrathin threaded microsurface, which was present on the neck of the implant, was micro-threaded anodised surface (Sa: 0.6).

Definition of the ink absorption peak (ABS)

The spectrophotometric ink ABS was derived from different dilutions of ink in 95% ethanol (Sigma Aldrich #49351, St. Louis, MO, USA). Specifically, solutions with concentrations of 0.1, 0.2, 0.5, and 1 μL/mL were evaluated using an automatic function provided by a monochromator spectrophotometer (Multiskan™ GO Microplate Spectrophotometer; Thermo Fisher Scientific, Waltham, MA, USA). ABS plots were then generated by dedicated software, and the ABS peak of the ink was derived (SkanIT Software 3.2, Research Edition for Multiskan GO; Thermo Fisher Scientific). Since the 0.1 μL/mL solution provided the best readings, this concentration was used to determine the ABS. Therefore, the software identified the ABS peak of the 0.1 μL/mL ink in ethanol solution at a wavelength of 534 nm, and these values were used for subsequent analyses [20,21].

Experimental ink biofilm: staining protocol validation

Twenty-one new dental implants (Prama, Sweden & Martina Spa, Lot. 0000180215) with a length of 13 mm and a diameter of 4.25 mm were randomly assigned to 3 different groups, where the apical part was stained with permanent ink at different apical heights: a) no ink; b) 4 mm, and c) 12 mm. Each group, composed of 5 implants, was stained simultaneously with a custom-made jig that consisted of a tray allowing 15 implants to be screwed. Therefore, the implants were simultaneously coloured at a set reference, submerging the tray in a tank containing red permanent ink (Staedtler Lumocolor Lot.485 23-2, Nurnberg, Germany) for 30 seconds, gently air-dried in order to spread the stain over the implant surface, and then left to dry overnight in the same jig at room temperature. In order to verify that staining was complete, each implant was then analysed with stereomicroscopy (Figure 1). Following the staining process, the inked implants were dissolved in ethanol and analysed through the ABS spectrophotometry method. The absorbance showed a statistically significant difference among the no ink, 4- and 12-mm-stained implants, validating the experimental assessment of the residual ink (Figure 2).

Figure 1. Workflow of the study with the first phase of spectrophotometric evaluation, the second phase of implants staining and spectrophotometric analysis validation, the third phase of treatment, and the fourth phase of analysis and surface evaluations.

Figure 1

Open in a new tab

Figure 2. Box plot of the experimental ABS analysis among the 3 groups: no ink, 4 mm, and 12 mm inked implants.

Figure 2

Open in a new tab

ABS: absorption peak.

Experimental biofilm removal

Forty-five (n=45) dental implants (Prama, Sweden & Martina Spa, Lot. 0000180215) with a length of 13 mm and a diameter of 4.25 mm were dip-coated with red indelible, non-covering ink for 30 seconds (Staedtler permanent lumocolor, Nurnberg, Germany) to simulate an optically identifiable plaque accumulation on the machined collar and the rough surface of the screw according to a previously published protocol [16]. After dipping, a complete, homogeneous, and clearly visible red stain completely covered the rough and machined surfaces. The implants were mounted into resin bases to simulate crater-shaped peri-implantitis defects of 3 angulations (30°, 60°, 90°) [16]. The resin bases were 3D printed (75-μm increments) with a special material (E-denstone; EnvisionTEC GMBH, Gladbeck, Germany). This material showed a high melting point and a high water and chemical resistance, making it the ideal material for implant site preparation. This procedure ensured accuracy and uniformity [17]. The implants were placed perpendicularly to the implant axis, so that the lower 6 mm of the implant was buried, and the upper 7 mm was exposed on the resin simulating the bone defect. Three implants for each modality and defect type were utilised, for a total number of 45 implants. Four different instrumentations and a positive control were tested (Figure 3):

Figure 3. (A) Tested debridement instruments: GC, TiB, G-Air, and E-Air; (B) Optical microscope analysis of implants screwed off the 30° defects; (C) Scanning electron microscopy images of untreated control and surfaces treated by different instruments at a magnification of ×500 and ×5,000.

Figure 3

Open in a new tab

GC: Gracey titanium curette, TiB: titanium implant brush, G-Air: glycine, E-Air: erythritol.

  • ● Gracey titanium curette type 11/12 (GC) (implant mini Gracey curette 11/12; LM-ErgoMix, LM Dental, Parainen, Finland)

  • ● Titanium implant brush (TiB) (Peri-Set 261/018CAXL, Sweden & Martina)

  • ● Air-powder device (APD) with glycine (G-Air) (Perio Powder; EMS, Nyon, Switzerland)

  • ● Air-powder device with erythritol (E-Air) (Plus Powder; EMS)

  • ● Control (only staining, no treatment)

APD (Airflow Master; EMS) was set at maximum speed for the “water” and “power” parameters. Both mechanical and air-powder devices were used according to the manufacturer’s recommendations.

All the instrumentation was performed by an expert trained dentist (RG). The working distance and angulation were individually chosen. The decontamination time was set at 2 minutes for each sample and the working time was controlled by a stopwatch. Intra-operator variability was tested a priori.

Ink removal assessment

After each step, the implants were carefully removed from the bases to avoid any possible alteration of the inked surface. Subsequently, the stains were dissolved from the implants, and the implants were placed in 5-mL leak-proof tubes with 5 mL of 95% ethanol and then in an amalgam vibrator (Cap Vibrator; Ivoclar Vivadent AG, Schaan, Liechtenstein) for 60 seconds.

The entire mixture was collected and placed in a 96-well cell culture plate (Eppendorf AG, Hamburg, Germany). Then, spectrophotometric analysis (Thermo Scientific Multiskan GO; Thermo Fisher Scientific) was performed to assess the residual colour staining by measuring the absorbance (ABS). Analyses were carried out 3 times in a blinded fashion.

Assessment of surface alterations

Scanning electron microscopy (SEM) was performed for the instrumented implants in order to evaluate any type of modifications. The samples were cleaned with water spray, and surface topography was evaluated using SEM (Carl Zeiss Gemini SEM 500; Carl Zeiss, Oberkochen, Germany) operating at 10 kV with a working distance of 9 mm. All pictures were taken at ×500 and ×5,000 magnification. The surface of an untreated implant served as a control. The area of interest was chosen 1 mm below the implant shoulder, which was the reference point. Moreover, photographs of the implants were taken using a stereomicroscope, then planimetrically analysed with dedicated software (ImageJ v1.46, NIH, Bethesda, MD, USA). The RGB scale was used to assess the altered surface roughness according to the colour value and to compare the control with the tested surfaces. A value of 60-90 RGB (green scale) was considered a sign of a plain and altered surface. However, yellow and red values with an RGB of 110 to 180 were interpreted as signs of a rough and non-altered surface (Figure 4).

Figure 4. Scanning electron microscopy images of an untreated control and surfaces treated by different instruments with the morphological analysis conducted using imaging software on an RGB scale.

Figure 4

Open in a new tab

Statistical analysis

The uniformity of data distribution was tested using Kolmogorov–Smirnov and Shapiro–Wilk tests. Means and standard deviations of the percentage of the uncleaned surface were calculated.

Differences between the different defect angulations and instrumentations were tested by 2-way analysis of variance. The Tukey test was conducted for post-hoc analysis. In all analyses, P-values lower than 0.05 were considered statistically significant.

RESULTS

Descriptive outcomes

Regardless of the instrument used, remaining ink was distinguishable on all samples. The results of the spectrophotometric analysis showed that ink was most easily debrided from the 60° bone defects, whereas debridement was most difficult for 30° defects (ABS 60°=0.26±0.04; ABS 30°=0.32±0.06; ABS 90°=0.27±0.04) (Figure 5A). The most effective debridement method was TiB, independent of the bone defect angle (TiB vs. GC: P<0.0001; TiB vs. G-Air: P=0.0017; TiB vs. E-Air: P=0.0007). Between the air-polishing techniques, G-Air was significantly more efficient than E-Air in each experimental condition (30°: P=0.0018; 60°: P<0.0001; 90°: P<0.0001) (Figure 5B). GC appeared to be the least effective method for peri-implantitis debridement. Moreover, the apical area of both 60° and 30° defects remained untouched, especially in the samples treated with GC and TiB (Figure 3B).

Figure 5. (A) Amount of residual ink assessed by spectrophotometry according to defect type by debridement technique. No differences in terms of ink residuals were observed for the 60° defects, while multiple comparisons showed a significant difference between TiB and E-Air in 30° defects, between TiB and erythritol, and between E-Air and G-Air in 90° defects; (B) Amount of residual ink assessed by spectrophotometry according to the debridement technique stratified by defect type. All the debridement techniques kept the same amount of ink on the 3 defects. Only E-Air was more effective for the 60° defects than for the 90° defects.

Figure 5

Open in a new tab

ABS: absorption peak, TiB: titanium implant brush, E-Air: erythritol, G-Air: glycine.

Spectrophotometric assessment

Conversely, the SEM analysis (Carl Zeiss Gemini SEM500, Carl Zeiss, Oberkochen, Germany) of surface alterations showed that E-Air and G-Air had less implant surface alterations than GC and TiB, where the variations could already be macroscopically identified, and a nearly complete elimination of the original surface structure after instrumentation was shown (Figure 3C).

DISCUSSION

In this study, we simulated implant surface debridement with 4 instrumentation methods in 3 defect angulations. The results confirmed that mechanical instrumentation remains the gold standard in cleaning peri-implant areas affected by peri-implantitis [22,23]. Despite their efficacy, however, the available decontamination methods were still partially ineffective in ensuring the complete cleaning of the implant surfaces in all 3 model types. Indeed, none of the analysed implant surfaces was completely free of colour stain.

Factors influencing biofilm removal with mechanic instrumentation

Furthermore, recent studies have shown that the effectiveness of major debridement methods is strictly dependent on factors related to both the structure of the defect and the morphology of the implant, such as the width, depth, and angulation of the defect, and the shape, depth, and distance between the threads of the implant [17,20,24,25]. In this regard, the recent study by Sanz-Martín et al. [23] showed that the percentage of residual ink stains on the implant surface was lower when the implant was treated with mechanical tools. The results of our study align with those findings, as TiB proved to be the best debridement method in all types of defects (TiB vs. GC: P<0.0001; TiB vs. G-Air: P=0.0017; TiB vs. E-Air: P=0.0007). This result may be due to the morphology of the metal bristles, which can reach areas that are difficult to reach with other rigid instruments, such as GC. This theory is also supported by the study of Sanz-Martín et al. [23], where TiB was able to better clean the area beneath the thread based on the shape of the coils. For this study, we used Prama implants (Sweden & Martina Spa) with a pitch of 1.0 mm and a depth of 0.4 mm as, according to the recent literature, shallow pits and a low number of threads seem to be important implant-geometry parameters for obtaining efficient peri-implantitis debridement [24]. In our study, GC was the mechanical instrumentation method that achieved the worst results in terms of cleaning efficacy. These results are in agreement with the findings of Keim et al. [24] and could be due to the rigidity of the instrument and the morphology of the tip, which is not suitable for properly cleaning the implant coils, especially in narrow and deep defects and in the most crucial apical part. In addition, the morphology of the implant must also be considered because, in some cases of very close coils, the tip of the GC may not properly enter between the coils; instead, it only cleans the most superficial part of the thread.

Factors influencing biofilm removal with air-powder devices

As air-powder devices, G-Air and E-Air were tested. To our knowledge, few studies in the literature have considered the use of E-Air as a method of debridement of the implant surface. The use of G-Air showed a clear superiority over E-Air in terms of cleaning efficacy. The relatively minimal results achieved by the use of erythritol may be related to the size of the particles (14 μm), which may not be as abrasive to remove the ink layer as those of glycine (about 25 μm). Other studies have tested glycine application, showing encouraging results [16,23,25]. In accordance with these studies, in our study, G-Air seems to have displayed good efficacy in removing ink, even though residual stains may be present, especially in the apical part of the defect and in the narrowest defects (i.e., 30°). Contrary to the 2012 study of Sahrmann et al. [16], however, in which the best effects were obtained in 90° defects, as would be expected, in our study excellent results were also obtained in 60° defects. A plausible explanation may be that proposed by Momber [26], who proposed that multiple actions of the particles could be favoured by a rebound effect of the glycine particles on the walls of the defect, enhancing their cleaning efficacy. In addition, the expert operator (RG) was free to choose the distance and the angle of execution for each instrument and defect angulation in order to simulate the clinical decontamination procedure as closely as possible. However, even with air-powder devices, the apical area appeared to be unaffected. For all these probable reasons, the apical area of \\xe2\\x80\\x8b\\xe2\\x80\\x8bthe implant, which is also the most crucial to ensure better healing from peri-implantitis, was the least affected by instrumentation, and a greater amount of residual ink for each method and angle of the defect was detectable.

Spectrophotometric analysis

With regard to the SEM results, the mechanical tools (GC and TiB) showed a greater aggressiveness compared to the air-powder device. The TiB, followed by the GC, was the most abrasive tool and was also associated with macroscopic alterations of the implant-surface roughness. Conversely, the use of G-Air and E-Air caused only minimal changes in surface roughness. Some explanations are needed regarding the quantitative method of analysis as a new and interesting system for detecting the percentage of residual stain. The use of the spectrophotometer allowed an evaluation at 360° of the amount of residual ink after implant decontamination following dilution within ethanol. Consequently, the completeness of biofilm removal could be assessed through our method. We suggest that this method could overcome some possible operator-dependent biases related to data reading through 2D systems (e.g., shadows, parallax error, software setup, equipment quality).

Limitation of the study

The following limitations must be considered: the in vitro mode simplified the clinical reality (no interference from blood, tongue, or saliva), but benefited from standardised, repeatable, and easily measurable conditions. For the same reason, the implants were debrided without any abutments end/or prosthetic crown in order to facilitate access to the defect. In this in vitro study, the bony parts of the implant sites were not considered in terms of possible damage to the surrounding tissues and the microbiome [27]. Moreover, indelible ink was used to assess the performance of several devices instead of a true biofilm. Although stains are easily detectable during the analysis, it remains questionable whether ink is more difficult to remove than oral biofilm, especially for air-powder devices.

According to the results of the present study, TiB seems to be the most efficient instrument for implant decontamination, especially in narrow defects with an angle of less than 60°. Meanwhile, G-Air appears to be more conservative in terms of its effect on implant surfaces. Complete ink removal was not achieved in any case.

These results highlight the possibility of combining different decontamination methods (biological and mechanical) to maximise the cleaning efficacy in biofilm removal. Spectrophotometric analysis was identified as a novel but promising assessment method for in vitro ink models to evaluate the efficacy of several instrumentations in peri-implantitis debridement.

ACKNOWLEDGEMENTS

The authors would like to thank Federica Quartullo and Damiano Novello for their help in the development of the initial project.

Footnotes

Conflict of Interest: No potential conflict of interest relevant to this article was reported. Only Enrico Marchetti had a collaborative relationship with the Sweden & Martina company from 2017 until 2019 in a different field from that of the study.

Data Availability Statement: The authors confirm that the data supporting the findings of this study are available within the article and/or its supplementary materials.

Author Contributions:
  • Conceptualization: Roberto Giffi, Enrico Marchetti.
  • Formal analysis: Davide Pietropaoli, Leonardo Mancini.
  • Investigation: Roberto Giffi.
  • Methodology: Davide Pietropaoli, Enrico Marchetti.
  • Project administration: Enrico Marchetti.
  • Writing - original draft: Leonardo Mancini.
  • Writing - review & editing: Francesco Tarallo, Philipp Sahrmann.

References

  • 1.Berglundh T, Armitage G, Araujo MG, Avila-Ortiz G, Blanco J, Camargo PM, et al. 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. J Clin Periodontol. 2018;45(Suppl 20):S286–S291. doi: 10.1111/jcpe.12957. [DOI] [PubMed] [Google Scholar]
  • 2.Aglietta M, Siciliano VI, Zwahlen M, Brägger U, Pjetursson BE, Lang NP, et al. A systematic review of the survival and complication rates of implant supported fixed dental prostheses with cantilever extensions after an observation period of at least 5 years. Clin Oral Implants Res. 2009;20:441–451. doi: 10.1111/j.1600-0501.2009.01706.x. [DOI] [PubMed] [Google Scholar]
  • 3.Romandini M, Cordaro M, Donno S, Cordaro L. Discrepancy between patient satisfaction and biologic complication rate in patients rehabilitated with overdentures and not participating in a structured maintenance program after 7 to 12 years of loading. Int J Oral Maxillofac Implants. 2019;34:1143–1151. doi: 10.11607/jomi.7465. [DOI] [PubMed] [Google Scholar]
  • 4.Romandini M, Lima C, Pedrinaci I, Araoz A, Costanza Soldini M, Sanz M. Clinical signs, symptoms, perceptions, and impact on quality of life in patients suffering from peri-implant diseases: a university-representative cross-sectional study. Clin Oral Implants Res. 2021;32:100–111. doi: 10.1111/clr.13683. [DOI] [PubMed] [Google Scholar]
  • 5.Romandini M, Berglundh J, Derks J, Sanz M, Berglundh T. Diagnosis of peri-implantitis in the absence of baseline data: a diagnostic accuracy study. Clin Oral Implants Res. 2021;32:297–313. doi: 10.1111/clr.13700. [DOI] [PubMed] [Google Scholar]
  • 6.Mancini L. Peri-implant health and diagnostic considerations. Int J Environ Res Public Health. 2022;19:12008. doi: 10.3390/ijerph191912008. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 7.Berglundh J, Romandini M, Derks J, Sanz M, Berglundh T. Clinical findings and history of bone loss at implant sites. Clin Oral Implants Res. 2021;32:314–323. doi: 10.1111/clr.13701. [DOI] [PubMed] [Google Scholar]
  • 8.Schmidlin PR, Sahrmann P, Ramel C, Imfeld T, Müller J, Roos M, et al. Peri-implantitis prevalence and treatment in implant-oriented private practices: a cross-sectional postal and Internet survey. Schweiz Monatsschr Zahnmed. 2012;122:1136–1144. [PubMed] [Google Scholar]
  • 9.Heitz-Mayfield LJ, Lang NP. Comparative biology of chronic and aggressive periodontitis vs. peri-implantitis. Periodontol 2000. 2010;53:167–181. doi: 10.1111/j.1600-0757.2010.00348.x. [DOI] [PubMed] [Google Scholar]
  • 10.Stewart PS, Costerton JW. Antibiotic resistance of bacteria in biofilms. Lancet. 2001;358:135–138. doi: 10.1016/s0140-6736(01)05321-1. [DOI] [PubMed] [Google Scholar]
  • 11.Renvert S, Polyzois I, Persson GR. Treatment modalities for peri-implant mucositis and peri-implantitis. Am J Dent. 2013;26:313–318. [PubMed] [Google Scholar]
  • 12.Lang NP, Salvi GE, Sculean A. Nonsurgical therapy for teeth and implants-When and why? Periodontol 2000. 2019;79:15–21. doi: 10.1111/prd.12240. [DOI] [PubMed] [Google Scholar]
  • 13.Gianfreda F, Bollero P, Muzzi M, Di Giulio A, Nicolai E, Canullo L. The effects of ultrasonic scaling and air-abrasive powders on the decontamination of 9 implant-abutment surfaces: scanning electron analysis and in vitro study. Dent J. 2022;10:36. doi: 10.3390/dj10030036. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 14.Cha JK, Paeng K, Jung UW, Choi SH, Sanz M, Sanz-Martín I. The effect of five mechanical instrumentation protocols on implant surface topography and roughness: a scanning electron microscope and confocal laser scanning microscope analysis. Clin Oral Implants Res. 2019;30:578–587. doi: 10.1111/clr.13446. [DOI] [PubMed] [Google Scholar]
  • 15.Renvert S, Hirooka H, Polyzois I, Kelekis-Cholakis A, Wang HL Working Group 3. Diagnosis and non-surgical treatment of peri-implant diseases and maintenance care of patients with dental implants - Consensus report of working group 3. Int Dent J. 2019;69(Suppl 2):12–17. doi: 10.1111/idj.12490. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 16.Sahrmann P, Ronay V, Sener B, Jung RE, Attin T, Schmidlin PR. Cleaning potential of glycine air-flow application in an in vitro peri-implantitis model. Clin Oral Implants Res. 2013;24:666–670. doi: 10.1111/j.1600-0501.2012.02445.x. [DOI] [PubMed] [Google Scholar]
  • 17.Matsubara VH, Leong BW, Leong MJ, Lawrence Z, Becker T, Quaranta A. Cleaning potential of different air abrasive powders and their impact on implant surface roughness. Clin Implant Dent Relat Res. 2020;22:96–104. doi: 10.1111/cid.12875. [DOI] [PubMed] [Google Scholar]
  • 18.Steiger-Ronay V, Merlini A, Wiedemeier DB, Schmidlin PR, Attin T, Sahrmann P. Location of unaccessible implant surface areas during debridement in simulated peri-implantitis therapy. BMC Oral Health. 2017;17:137. doi: 10.1186/s12903-017-0428-8. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 19.Sahrmann P, Ronay V, Hofer D, Attin T, Jung RE, Schmidlin PR. In vitro cleaning potential of three different implant debridement methods. Clin Oral Implants Res. 2015;26:314–319. doi: 10.1111/clr.12322. [DOI] [PubMed] [Google Scholar]
  • 20.Pathrose B, Nampoori VP, Radhakrishnan P, Mujeeb A. Measurement of absolute fluorescence quantum yield of basic Fuchsin solution using a dual-beam thermal lens technique. J Fluoresc. 2014;24:895–898. doi: 10.1007/s10895-014-1369-0. [DOI] [PubMed] [Google Scholar]
  • 21.Beard EJ, Sivaraman G, Vázquez-Mayagoitia Á, Vishwanath V, Cole JM. Comparative dataset of experimental and computational attributes of UV/vis absorption spectra. Sci Data. 2019;6:307. doi: 10.1038/s41597-019-0306-0. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 22.Berglundh T, Jepsen S, Stadlinger B, Terheyden H. Peri-implantitis and its prevention. Clin Oral Implants Res. 2019;30:150–155. doi: 10.1111/clr.13401. [DOI] [PubMed] [Google Scholar]
  • 23.Sanz-Martín I, Paeng K, Park H, Cha JK, Jung UW, Sanz M. Significance of implant design on the efficacy of different peri-implantitis decontamination protocols. Clin Oral Investig. 2021;25:3589–3597. doi: 10.1007/s00784-020-03681-y. [DOI] [PubMed] [Google Scholar]
  • 24.Keim D, Nickles K, Dannewitz B, Ratka C, Eickholz P, Petsos H. In vitro efficacy of three different implant surface decontamination methods in three different defect configurations. Clin Oral Implants Res. 2019;30:550–558. doi: 10.1111/clr.13441. [DOI] [PubMed] [Google Scholar]
  • 25.Ronay V, Merlini A, Attin T, Schmidlin PR, Sahrmann P. In vitro cleaning potential of three implant debridement methods. Simulation of the non-surgical approach. Clin Oral Implants Res. 2017;28:151–155. doi: 10.1111/clr.12773. [DOI] [PubMed] [Google Scholar]
  • 26.Momber A. Blast cleaning technology. Berlin, Heidelberg: Spring-Verlag; 2008. [Google Scholar]
  • 27.Kotsakis GA, Olmedo DG. Peri-implantitis is not periodontitis: Scientific discoveries shed light on microbiome-biomaterial interactions that may determine disease phenotype. Periodontol 2000. 2021;86:231–240. doi: 10.1111/prd.12372. [DOI] [PubMed] [Google Scholar]

Articles from Journal of Periodontal & Implant Science are provided here courtesy of Korean Academy of Periodontology

RESOURCES