IN VITRO EVALUATION OF SURFACE CLEANING METHODS IN TWO DIFFERENT IMPLANT DEFECT ANGULATIONS: A PILOT STUDY
Recently, prominence has been given to the use of power abrasive devices to improve the cleaning effectiveness on contaminated implant surfaces, and in an in-vitro study, it has been stated that air powder abrasion is the most efficient and less damaging cleaning modality in comparison to sonic scaler and curette for different defect morphologies15. However, there is a paucity of information on the use of air powder abrasive devices to reach a definite conclusion and it is warranted to perform comparative study designs evaluating the effectiveness. There is a new air-abrasive material called trehalose, a natural noncariogenic disaccharide with a good taste. It is thermostable and approved for use in food processing16. It is highly water-soluble (689g/L) with a pH of 6.4. In one clinical study, subgingival air-polishing with trehalose powder has revealed encouraging clinical outcomes17. Therefore, the aim of this study is to investigate the cleaning potential of an air abrasive device with trehalose powder on implant surfaces in comparison to Er: YAG laser application in an in-vitro model of two different defect angulations.
Steps to reproduce
Two different cleaning methods were used on the implant surfaces as follows: 1. Air powder abrasive device (MyLunos®; Dürr Dental Group, Bietigheim-Bissigen, Germany) with trehalose powder (Perio Combi®; 30 µm grain size, Dürr Dental Group, Bietigheim -Bissigen, Germany) and a special hand piece for subgingival instrumentation were used with a nozzle tip parallel to the implant surface for 20 seconds. The nozzle tip was used only once for each implant in horizontal sweeping movements and then discarded (Figure 2a). 2. Er:YAG laser (VersaWave, Delight; Hoya-Con Bio) with a wavelength of 2940 nm was used. The parameters were set at 20 Hz/120 mJ, with a water irrigation according to the manufacturer’s instructions. The pulse width was 200 ms. The quartz chisel tip was selected (1.2- 0.4 mm, rectangular shape) and applied in horizontal sweeping movements for 20 seconds (Figure 2b). After both instrumentations, implant surfaces were evaluated for residual stain using digital photographs at the following site locations: Shoulder area (SA), the neck of the threads (NT), apically facing thread surface (ATS), area between threads (ABT) (Figure 3). One blinded and calibrated examiner (OLT) assessed the photographs by evaluating and grading the aforementioned implant sites for the residual stain. For the agreement between the first and second measurements, the intraclass correlation coefficient (ICC) of reliability was found close to 1.00 showing that the measurements can be repeated with a non-significant error. Evaluation of surface cleanliness After instrumentations, implants were removed carefully from the models. Loosened ink particles were cleaned by gentle water and air spray. Digital color photos were taken in standardized conditions by a digital camera (dark chamber, ISO 125, aperture f/7.1, shutter speed 1/60 s, distance 31.4 cm with a Nikon D5300, Tokyo, Japan), positioned vertically to the implant axis. Twin flash R1C1 wireless close-up Speedlight system (Tokyo, Japan) was used with power settings of ½ from one side. Evaluations on the surface ink remnants were performed with an image processing software (Image J 1.46 r, National Institutes of Health, Bethesda, Maryland, USA). Statistics For statistical analysis IBM SPSS Statistics 22 (IBM SPSS, Turkey) was used. The normal distribution of the data was assessed by Kolmogorov-Smirnov and Shapiro Wilks tests, and the parameters followed the normal distribution. Student t-test was used for the paired evaluation of the total cleaning effects of the cleaning methods according to two different defect angulations. Significance was evaluated at p <0.05 level.