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. 2020 Jul 31;10(8):1505. doi: 10.3390/nano10081505

Table 1.

Characteristics of the studies dealing with the use of cold atmospheric plasma (CAP) in implantology.

Authors Year [Reference] Ti Component/Surface Texture/Implant company Contamination Method Number of Specimens Per Group (Total) CAP Device CAP Settings: Time (s) Mean Power (W) Gas Distance (D) Decontamination Methods Settings for other Methods Outcome Measured Overall Conclusions
Rupf et al. 2011 [32]
  • -

    Ti discs;

  • -

    Sandblasted acid-etched;

  • -

    Friadent, Mannheim, Germany

 Oral biofilm formed in situ by fixing Ti at the buccal site of molar and premolar teeth for 24 h or 72 h 149:24 h 149:72 h 36: no biofilm (334) Custom built (Leibniz Institute of Surface Modification, Germany)
  • -

    3 or 5 W;

  • -

    He 2.0 slm;

  • -

    D: 2 mm
  • -

    No treatment;

  • -

    CAP 3W;

  • -

    CAP 5W;

  • -

    Air/water spray;

  • -

    CAP 3W + air/water spray;

  • -

    CAP 5W + air/water spray;

  • -

    CAP 3W + air/water spray + CAP 3W;

  • -

    CAP 5W + air/water spray + CAP 5W
  • -

    2 bar;

  • -

    5 s;

  • -

    D: 10 mm
  • -

    Biofilm thickness;

  • -

    Biofilm viability;

  • -

    Biofilm vitality;

  • -

    Total protein

 CAP caused inactivation of bacteria biofilm and significant reduction of protein amounts. For complete elimination, additional application and second series of CAP was necessary
Coelho et al. 2012 [46]
  • -

    Root form Ti implants;

  • -

    (AB/AE);

  • -

    Integra-Ti, Bicon LLC, Boston)

 No contamination 24 implants kiNPen (INP, Greifswald, Germany)
  • -

    60 s per quadrant;

  • -

    Ar

 n/a n/a
  • -

    SE;

  • -

    Surface characterization;

  • -

    Surface chemical assessment;

  • -

    BIC;

  • -

    BAFO

 CAP fostered higher levels of contact with surrounding tissues, promoting more rapid ad higher quantity of bone around rough Ti surfaces
Duske et al. 2012 [7]
  • -

    Ti discs;

  • -

    Machined/coarse diamond grit/airflow-treated/sandblasted etched;

  • -

    SLActive, Straumann, Freiburg, Germany

 No contamination 10 discs per group (360) Plasma jet (INP, Greifswald, Germany)
  • -

    30 and 60 and 120 s;

  • -

    2-3 W;

  • -

    Ar/Ar and O2 1%/Ar and O2 0.2% 5 slm;

  • -

    D: 5 mm
  • -

    1a. Ar CAP 30 s; 1b. Ar CAP 60 s;

  • -

    1c. Ar CAP 120 s;

  • -

    2a. 0.2% O2 Ar CAP 30 s;

  • -

    2b. 0.2% O2 Ar CAP 60 s

  • -

    2c. 0.2% O2 Ar CAP 120 s

  • -

    3a. 1.0% O2 Ar CAP 30 s

  • -

    3b. 1. 0% O2 Ar CAP 60 s

  • -

    3c. 1.0% O2 Ar CAP 120 s

 n/a
  • -

    Disc topography;

  • -

    Contact angle measurement;

  • -

    MG-63 area, morphology, metabolic activity

 CAP reduced contact angle and supports spreading of MG-63 cells
Canullo et al.2013 [42]
  • -

    Ti discs;

  • -

    Smooth;

  • -

    Sweden & Martina

 n/a 30 per group (60) Plasma Reactor (Colibri, Gambetti Company)
  • -

    360 s

  • -

    10 W

 Untreated n/a L 929 viability, adhesion, morphology CAP treatment could be used for abutment cleansing to favor peri-implant tissue healing
Giro et al. 2013 [49]
  • -

    Root form Ti implants;

  • -

    CaP;

  • -

    Integra-CP, Bicon LLC, Boston

 No contamination 24 implants kiNPen (INP, Greifswald, Germany)
  • -

    20 s per quadrant;

  • -

    Ar 4.0 slm

 n/a n/a
  • -

    Surface energy;

  • -

    Surface chemical assessment;

  • -

    BIC;

  • -

    BAFO

 Higher degrees of surface wettability resulted in significantly higher BIC and BAFO following CaP-CAP
Idlibi et al. 2013 [18]
  • -

    Ti discs;

  • -

    Machined;

  • -

    Friadent, Mannheim, Germany

 Oral biofilm formed in situ at the buccal site of molar and premolar teeth for 72h 20 in each group (200) Custom built (Leibniz Institute of Surface Modification, Leipzig, Germany) CAP 1:
  • -

    196.25 s

  • -

    5 W;

  • -

    He 2.0 slm;

  • -

    D: 2 mm

CAP 2:
  • -

    196.25 s;

  • -

    3W;

  • -

    He 2.0 slm;

  • -

    D: 2 mm

CAP 3:
  • -

    49.06 s;

  • -

    5W;

  • -

    He 2.0 slm;

  • -

    D: 2 mm

CAP 4:
  • -

    49.06 s;

  • -

    5W;

  • -

    He 2.0 slm and O2 sccn;

  • -

    D: 2 mm

 1. Untreated control; 2. Gas; 3. DL; 4. AA; 5a and 5b. CHX 2.
  • -

    196.25 s;

  • -

    He 2.0slm;

  • -

    D: 2mm

3.
  • -

    2.5 W;

  • -

    25 ms pulse and 50 ms pause.

4.
  • -

    Amino acid glycine powder;

  • -

    5a.

  • -

    60 s

  • -

    5b.

  • -

    200 s
  • -

    Biofilm viability;

  • -

    Biofilm quantity;

  • -

    Biofilm morphology

 CAP significantly reduced the viability and quantity of biofilm, although complete removal was not achieved. Its efficacy correlated with the treatment duration and CAP power
Danna et al. 2015 [47]
  • -

    Root form Ti implants;

  • -

    GB/AE and CaP;

  • -

    Integra-Ti, Bison LLC, Boston, MA

 No contamination 56 implants kiNPen (INP, Greifswald, Germany)
  • -

    20 s per quadrant;

  • -

    16% O2, 1% H, 78% N 5 slm

 n/a n/a
  • -

    Surface physical characterization;

  • -

    Surface morphology;

  • -

    SE;

  • -

    Surface chemical characterization;

  • -

    BIC;

  • -

    BAFO

 CAP-treated Ti and CaP implants showed decreased levels of C and increased levels of Ti and O, Ca and O. No significant differences for BAFO. Significant increase in BIC for CAP-treated Ti implants, not for CaP surfaces
Duske et al. 2015 [48]
  • -

    Ti discs;

  • -

    Sandblasted etched;

  • -

    Straumann, Freiburg, Germany

 Biofilm formed in vitro from subgingival plaque 10 discs per group kINPen08, INP Greifswald, Germany
  • -

    540 s per disc (60 s per spot);

  • -

    2–3 W;

  • -

    Ar 99%, O2 1% 5 slm;

  • -

    D: 5 mm

  1. Untreated

  2. BR

  3. BR+CAP

  4. 4. Auto

 BR 1 mm/s for 120 s
  • -

    Biofilm morphology;

  • -

    MG-63 cell morphology, area and number;

  • -

    Biofilm regrowth;

  • -

    Cell growth

 Biofilm remnants on BR and CAP impaired MG-63 cell development, whilst BR+CAP provided an increased area of MG-63 cells
Ibis F et al. 2016 [50]
  • -

    Ti discs;

  • -

    304 SS, 316 SS, Ti6Al4V, UHMWPE;

  • -

    Hipokrat Medical Devices A.S., Izmir Turkey

 Escherichia coli; Staphylococcusaureus n/a Custom made n/a n/a n/a
  • -

    Contact angle measurement;

  • -

    Biofilm viability

 Up to > 95% biofilm was inactivated by CAP and up to 50% was retarded. Increased hydrophilicity after CAP was obtained.
Lee et al. 2016 [51]
  • -

    Ti discs;

  • -

    Machined/ASD/RBM/sandblasting SLA;

  • -

    N/A

 No contamination n/a Custom made Pure He/He and O2D: 20 mm n/a n/a
  • -

    Optical emission;

  • -

    Wettability

 CAP treatment enhances wettability of the Ti surfaces especially for the He/O2 CAP
Preissner et al. 2016 [53]
  • -

    Ti implants;

  • -

    Sandblasted acid-etched micro-rough surface + 0.5 machined collar;

  • -

    Tiny implant, BTI Biotechnology Institute, Minano, Spain

 Streptococcus mitis Eight implants per group (32) TTP60 and TTP120, kINPen Med (INP Greifswald, Germany) TTP 60: 60 s; Ar 4.3 slm;

  1. Negative control (1% sodium chloride)

  2. DL GaAlAs

 1.
  • -

    60 s;

2.
  • -

    60 s at 2.0 W
  • -

    Bacterium identification;

  • -

    Bacterial adhesion

 Number of dead cells was higher with CAP compared to DL and control
TTP 120: 120 s; Ar 4.3 slm n/a
Canullo et al. 2017 [44]
  • -

    Ti discs

  • -

    Machined/plasma sprayed/zirconia-blasted;

  • -

    Sweden & Martina

 Streptococcus mitis (720) Plasma beam mini (Diener Electronic)
  • -

    120 s

  • -

    8 W

  • -

    D: 2mm

 n/a n/a
  • -

    Bacterial adhesion;

  • -

    MC3T3-E1 adhesion, morphology and viability;

  • -

    Contact angle measurements;

  • -

    Protein adsorption

 CAP enhanced MC3T3-E1 attachment and spreading as well as bacterial decontamination
Canullo et al. 2017 [43]
  • -

    Ti discs

  • -

    Machined/plasma sprayed/zirconia-blasted and acid-etched;

  • -

    Sweden & Martina

 No contamination 92 discs per group (216) Plasma R (Sweden & Martina)
  • -

    720 s

  • -

    10 W

 Untreated n/a
  • -

    Surface morphology;

  • -

    Contact angle measurements;

  • -

    MG-63 morphology, adhesion

 CAP showed a positive effect on MG-63 cells grown on CAP-treated and untreated machined, plasma sprayed, and zirconia discs.
Matthes et al. 2017 [52]
  • -

    Ti discs

  • -

    Sandblasted acid-etched;

  • -

    Biomet 3i LLC, Palm Beach Garden, FL, USA

 Biofilm formed in vitro from subgingival plaque 200 kINPen09, neoplas GmbH, INP Greifswald, Germany
  • -

    300 or 720 s;

  • -

    3.5 W;

  • -

    Ar 5 slm;

  • -

    D: 5mm

  1. AA

  2. AA + CAP

 1 and 2 Erythritol for 90 s
  • -

    MG-63 adhesion and morphology;

  • -

    Water contact angle

 AA + CAP did not enhance MG-63 spreading compared to AA alone.
Matthes et al. 2017 [52]
  • -

    Ti discs

  • -

    Sandblasted acid-etched;

  • -

    Biomet 3i LLC, Palm Beach Garden, FL, USA

 Biofilm formed in vitro from subgingival plaque 200 kINPen09, neoplas GmbH, INP Greifswald, Germany
  • -

    300 or 720 s;

  • -

    3.5 W;

  • -

    Ar 5 slm;

  • -

    D: 5mm

  1. AA

  2. AA + CAP

 1 and 2 Erythritol for 90 s
  • -

    MG-63 adhesion and morphology;

  • -

    Water contact angle

 AA+CAP did not enhance MG-63 spreading compared to AA alone.
Karaman et al. 2018 [27]
  • -

    Ti discs;

  • -

    RGD (arginine, glycine, aspartic acid) coated;

  • -

    Titania Medical Devices; Izmir, Turkey

 No contamination n/a Custom made n/a

  1. RGD

  2. RGD + CAP

 n/a
  • -

    Surface characterization;

  • -

    Contact angle measurements;

  • -

    Surface topography;

  • -

    hMSC attachment, morphology, and proliferation

 RGD + CAP significantly increased cell adhesion and proliferation
Canullo et al.2018 [45]
  • -

    Implants

  • -

    ZirTi surface

  • -

    Premium Sweden & Martina, Due Carrare, Italy

 No contamination Four implants per animal (eight beagle dogs) Ar-plasma (Diener electronic, Jettingen, Germany)
  • -

    720 s

  • -

    75W

 Untreated n/a
  • -

    Old bone

  • -

    New bone

  • -

    Total mineralized bone

  • -

    Soft tissues

 Implants treated using AR-plasma reached higher BIC when compared to untreated
Ulu et al. 2018 [55]
  • -

    Ti discs;

  • -

    SLA;

  • -

    NucleOSS, Izmir, Turkey

 S. aureus 76 Plasma One (Plasma Medical Systems, Bad Ems, Germany)
  • -

    120 sec

  • -

    5 W;

  • -

    D: 1 mm

 Laser ER:YAG 30 s at 100mJ/pulse power
  • -

    Antimicrobial activity;

  • -

    Biofilm viability;

  • -

    Surface roughness

 Cap showed superior antibiofilm activity than contact and noncontact laser treatment without temperature increase or damages to the surface of Ti discs
Yang et al. 2018 [12]
  • -

    Ti A2;

  • -

    N/A;

  • -

    Northwest Institute for Non-Ferrous Metal Research. Xi’an, China

 Porphyromonas gingivalis n/a Custom made
  • -

    CAP1: 120 s

  • -

    CAP2: 240 s

  • -

    CAP 3: 360 s

  • -

    D: 1.5cm

 Untreated n/a
  • -

    Surface chemical characterization;

  • -

    Surface roughness measurement;

  • -

    Water contact angle measurement;

  • -

    Bacterial morphology;

  • -

    MG-63 and MC3T3-E1 growth rate

 CAP improved surface hydrophilicity and roughness and completely eliminated P. ginigvalis in 360 s, promoting growth of both cell lines
Lee et al. 2019 [37]
  • -

    Ti discs;

  • -

    Sandblasted etched Ti discs;

  • -

    Osstem Implant Co., Ltd., Busan, Korea

 P. gingivalis Five discs per group, two discs per group Custom made
  • -

    He 5 slm;

  • -

    D: 30 mm

 UntreatedHe without CAPHe + CAP n/a
  • -

    Bacterial count;

  • -

    Bacterial viability;

  • -

    Bacterial morphology

 He-CAP was effective for removing P. gingivalis from SLA discs without surface alterations
Matthes et al. 2019 [28]
  • -

    Zirconia discs;

  • -

    Yttria-stabilized zirconium dioxide, polished and sintered;

  • -

    VITA Zahnfabrik H. Rauter

 No contamination n/a kINPen09, kINPen08 and kiNPen Chamber, (INP Greifswald, Germany)
  • -

    kiNPen 09 e kiNPen 08:

  • -

    300 s per side;

  • -

    Ar 5.5 slm;

  • -

    D: 5 mm

 0.2% CHX;0.1% octenidine;70% ethanol Antiseptic solutions for 900 s
  • -

    HGF-1 cell area, adhesion and morphology;

  • -

    Water contact angle

 CAP reduced water contact angle and supported cell coverage, whereas CHX and octenidine reduced cell surface coverage.
  • -

    Chamber

  • -

    300 s per side;

  • -

    Ar 5 slm

  • -

    D: 10mm

  • -

    Ti discs;

  • -

    Smooth;

  • -

    Sirona Dental Systems

Naujokat et al. 2019 [22]
  • -

    Ti implants;

  • -

    Abrasive-blasted, acid-etched, and calcium phosphate-coated;

  • -

    Camlog, Screw Line, Camlog Biotechnologies AG, Basel, Switzerland

 No contamination 16 implants kINPen Med, INP Greifswald, Germany
  • -

    240 s,

  • -

    Ar 4.3–4.4 slm;

  • -

    D: 7 mm;

 Untreated n/a
  • -

    Surface morphology;

  • -

    BIC;

  • -

    ITBD;

  • -

    PIBD

 CAP did not lead to remarkable change in surface morphology. CAP conditioning prior to insertion resulted in higher BIC and ITBD, but not faster or stronger bone adherence and mineralization
Smeets et al. 2019 [54]
  • -

    Zirconia discs;

  • -

    Yttria-stabilized zirconia containing 5% yttria;

  • -

    Moje Keramik-Implantate

 No contamination (364) Yocto III (Diener Electronic) CAP 1
  • -

    720 s;

  • -

    O2

CAP 2
  • -

    720 s;

  • -

    Ar

 1. UV 1a.
  • -

    λ 250 nm;

  • -

    2mW/cm2

1b.
  • -

    λ 360 nm;

  • -

    0.05 mW/cm2
  • -

    Surface structure, topography;

  • -

    Surface wettability;

  • -

    Surface chemistry;

  • -

    MC3T3-E1 attachment, morphology, viability, and proliferation

 CAP and UV caused a significant reduction of organic material, increased the hydrophilicity of zirconia, and improved the conditions for osteoblasts
  • -

    Ti discs;

  • -

    Machined;

  • -

    Camlog, Biotechnologies AG, Basel, Switzerland

  • -

    Polyurethane;

  • -

    RM-A;

  • -

    Hatano Research Institute

Yang et al. 2020 [21]
  • -

    Zirconia discs;

  • -

    Yttrium-stabilized;

  • -

    Wieland, Pforzheim, Germany

 S. mutans; P. gingivalis n/a CAP Med-I (Plasma Health Scientech Group, Tsinghua University, China) CAP1
  • -

    30 s;

  • -

    He 13.5 slpm

  • -

    D: 1 cm

CAP2
  • -

    60 s

  • -

    He 13.5 slpm

  • -

    D: 1 cm

CAP2
  • -

    90 s

  • -

    He 13.5 slpm

  • -

    D: 1 cm

 Untreated n/a
  • -

    Surface topography;

  • -

    Surface wettability;

  • -

    Surface chemical composition;

  • -

    Bacterial adhesion, morphology, viability;

  • -

    Biofilm quantification

 The He-CAP jet increased hydrophilicity without changing surface topography and eliminated bacterial growth with surface chemistry change.

Abbreviations: Titanium (Ti); Cold atmospheric plasma (CAP); Alumina-blasted/acid-etched (AB/AE); Surface energy (SE); Bone-to-implant contact (BIC); Bone area fraction occupancy (BAFO); Human osteoblastic cells (MG-63); Calcium phosphate (CaP); Argon (Ar); Helium (He); Oxygen (O); Diode laser (DL); Air abrasion (AA); Grit-blasted/acid-etched (GB/AE); Brushing (BR); Autoclaved biofilm (Auto); Anodic spark deposition (ASD); Resorbable blast media (RBM); Sandblasting with large grit followed by acid-etching (SLA); Human mesenchymal stem cells (hMSCs); chlorhexidine (CHX); Interthread bone density (ITBD); Peri-implant bone density (PIBD); Murine fibroblastic cells (L929).